Original Research

HIV retesting in pregnant women in South Africa: Outcomes of a quality improvement project targeting health systems’ weaknesses

Lauren M. Golden, Lee Fairlie, Freda Might, Stina Mojela, Dorothy Motsamai, Suzan Motshepe, Enoch Manyame, Craig Parker, Helen Rees, Gloria Maimela, Matthew F. Chersich
Southern African Journal of HIV Medicine | Vol 19, No 1 | a784 | DOI: https://doi.org/10.4102/sajhivmed.v19i1.784 | © 2018 Lauren M. Golden, Lee Fairlie, Freda Might, Stina Mojela, Dorothy Motsamai, Suzan Motshepe, Enoch Manyame, Craig Parker, Helen Rees, Gloria Maimela, Matthew Chersich | This work is licensed under CC Attribution 4.0
Submitted: 05 July 2017 | Published: 12 July 2018

About the author(s)

Lauren M. Golden, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Lee Fairlie, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Freda Might, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Stina Mojela, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Aurum Institute, South Africa
Dorothy Motsamai, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Suzan Motshepe, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Enoch Manyame, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Craig Parker, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Helen Rees, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Gloria Maimela, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Matthew F. Chersich, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa


Share this article

Bookmark and Share

Abstract

Introduction: South Africa is moving towards achieving elimination of mother-to-child transmission (eMTCT) but gaps remain in eMTCT programmes. Documenting successful outcomes of health systems interventions to address these gaps could encourage similar initiatives in the future.

Methods: We describe the effectiveness of a Quality Improvement Project (QIP) to improve HIV retesting rates during pregnancy among women who had previously tested negative by redesigning the clinic process. Eight poorly-performing clinics were selected and compared with eight better-performing control clinics in a subdistrict in North West Province. Over nine months, root cause analysis and testing of change ideas using Plan-Do-Study-Act cycles were used to identify and refine interventions. Analysis of patient flow showed that women were referred for retesting following their nurse-driven antenatal visits, and many left without retesting as this would have further prolonged their visit. Processes were redesigned and standardised, where a counsellor was charged with retesting patients before antenatal consults. Staff were mentored on data collection and interpretation process. Quality improvement nurse advisors monitored indicators bi-weekly and adjusted interventions accordingly.

Results: Retesting in intervention clinics rose from 36% in the three months pre-intervention to full coverage at month nine. At the end of the study, retesting in intervention clinics was 20% higher than in controls. Retesting also increased in the subdistrict overall.

Conclusion: Service coverage and overall impact of HIV programmes can be raised through care-process analysis that optimises patient flow, supported by targeted QI interventions. These QI methodologies may be effective elsewhere for identifying new HIV infections in pregnant/breastfeeding women, and possibly in other services.


Keywords

HIV; PMTCT; health systems; quality improvement

Metrics

Total abstract views: 229
Total article views: 87


Crossref Citations

No related citations found.