TY - JOUR
T1 - Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo
T2 - Design of an open-label, parallel, group randomized trial
AU - Yotebieng, Marcel
AU - Behets, Frieda
AU - Kawende, Bienvenu
AU - Ravelomanana, Noro Lantoniaina Rosa
AU - Tabala, Martine
AU - Okitolonda, Emile W.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/4/26
Y1 - 2017/4/26
N2 - Background: Despite the rapid adoption of the World Health Organization's 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum. Methods: The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics. Discussion: If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation. Trial registration: The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669.
AB - Background: Despite the rapid adoption of the World Health Organization's 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum. Methods: The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics. Discussion: If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation. Trial registration: The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669.
KW - Cluster-randomized trial
KW - Continuous quality improvement
KW - DR Congo
KW - Prevention of mother-to-child transmission
KW - Universal test-and-treat
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U2 - 10.1186/s12913-017-2253-9
DO - 10.1186/s12913-017-2253-9
M3 - Article
C2 - 28446232
AN - SCOPUS:85018852353
SN - 1472-6963
VL - 17
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 306
ER -