Continuous quality improvement, linkage to peer supporters in prevention of mother-to-child human immunodeficiency virus transmission programs in Rwanda.

Abstract

Background: Peer supporters are instrumental for the successful navigation of prevention of mother-to-child human immunodeficiency virus (HIV) transmission services, including maternal viral load suppression and early infant HIV diagnosis. These outcomes are critical for the elimination of mother-to-child HIV transmission. We assessed the impact of continuous quality improvement (CQI) services on assignment to peer supporters and undetection of the viruses among pregnant women living with HIV (WLHIV) and mother-to-child transmission of HIV (MTCT) rates among HIV exposed babies in Rwanda.

Aim: To assess the impact of CQI services on assignment to peer supporters and undetection of the viruses among pregnant WLHIV and MTCT rates among HIV exposed babies in Rwanda.

Methods: Between 2021 and 2022, CQI services were implemented in 18 of the 38 healthcare facilities included in this analysis. Healthcare workers in 18 facilities used CQI approaches to key predictors of, and contributors related to, the implementation of the prevention of MTCT (PMTCT) program to improve maternal and infant outcomes. This was a secondary data analysis that explored the association between CQI and assignment to peer supporters, undetection of the virus, and MTCT rates. To assess the impact of CQI on these outcomes, a multivariable logistic regression model was used to compute adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI).

Results: A total of 1145 mother-baby pairs were included, of whom 558 (48.7%) were from facilities that implemented CQI. At the end of evaluation, 1043 (91.0%) either completed 24-months of follow-up or remained in care in the same facilities. Of 102 not available at the evaluation, 84 were transferred out, and 18 were dead or lost to follow-up. Overall, 405 (35.4%) women were assigned to peer supporters, 1004 (87.7%) had undetectable viruses, and 8 (0.7%) infants were infected with HIV. Compared to women from non-CQI facilities, those from CQI implementing facilities had 32% higher odds of being assigned to peer supporters (aOR = 1.32; 95%CI: 1.02-1.71). Similarly, disclosing HIV status (aOR = 1.53; 95%CI: 1.10-2.14) and a higher number of health care workers per 1000 active patients (> 4 vs ≤ 4) (aOR = 1.34; 95%CI: 1.05-1.75) were associated with higher odds of being linked to peer supporters. Having a formal education was associated with reduced odds of being linked to peer supporters compared to those with no education. Compared to women from non-CQI facilities, those from CQI implementing facilities had 51% higher odds of having undetectable viruses (aOR = 1.51; 95%CI: 1.05-2.18). CQI was associated with fewer transferred out compared to non-CQI facilities (6.0% vs 8.8%; P = 0.07).

Conclusion: Nearly 3 in 10 pregnant WLHIV in Rwanda were linked to peer support to support the successful navigation of PMTCT services, and CQI increased this linkage and aided the achievement of undetectable viruses. Implementing CQI and promoting HIV status disclosure is critical to facilitate peer support linkage and improve maternal and infant outcomes.