Inter-professional mentor teams (IP-MT) and systems analysis and improvement approach (SAIA) for elimination of mother-to-child transmission of HIV (eMTCT) at University affiliated teaching and referral hospitals in Kenya.

Abstract

Elimination of mother-to child transmission (eMTCT) of HIV is a complex cascade of interventions longitudinally administered during pregnancy, delivery and after, until the baby is no longer at risk of infection. Systems Analysis and Improvement Approach (SAIA) an institutional implementation strategy that packages systems engineering tools have in clinical trial setting been shown to effectively optimize performance. This study evaluated feasibility of institutionalizing inter-professional mentoring teams (IP-MT) that utilize SAIA for strengthening delivery of eMTCT services at referral and teaching hospitals affiliated to the Faculties of Health sciences. Nurse midwives drawn from 15 referral and teaching hospitals affiliated to faculties of Health Sciences of 4 Universities in Kenya and who were trained on SAIA were tasked to mobilize fellow colleagues to build IP-MT to support eMTCT within their hospital following additional 2-day online SAIA training and follow-up mentorship as needed. In the current training 71 health workers of different cadres were trained. Retention of trained personnel was 37.5% and 92.9% for the first and second cohort respectively. Nine facilities established the IP-MT but only one hospital had participation of a consultant doctor. Eight hospitals were able to analyze their facility performance for the period preceding the training using the PMCT cascade analysis tool (P-CAT). Two-thirds of expected pregnant women booked into care. Four of the eight hospitals had consistent fidelity across all components of the eMTCT service. Two hospitals failed to provide anti-retroviral drugs to 50% of eligible women. Timely early infant diagnosis occurred in 271 (92.5%) of the 293 identified HIV exposed infants. Teaching and referral hospitals affiliated to University health professions schools offer opportunity for interprofessional collaboration and opportunity to improve the quality of eMTCT services. Collation of the P-CAT findings helped identify common program gaps and facility specific deficiency in delivery of eMTCT.