Systematic review of quality improvement interventions for prevention of mother-to-child transmission programmes in sub-Saharan African

Background: Mother to child transmission of HIV infection remains a major public health concern in sub-Saharan Africa despite the notable scale up of HIV care and treatment services. In order to improve these services, quality... [ view full abstract ]

Background: Mother to child transmission of HIV infection remains a major public health concern in sub-Saharan Africa despite the notable scale up of HIV care and treatment services. In order to improve these services, quality improvement intervention of various prevention of mother-to-child transmission (PMTCT) cascade indicators was implemented in different African countries.

Methods: A systematic literature search for studies describing the approaches, progresses and challenges of PMTCT quality improvement interventions in sub-Saharan Africa interventions up to December 2015. We searched the following databases: PubMed, Web of Science, Google Scholar and Scopus. Bibliographies of included studies and conference proceedings were also searched. The risk of bias of included studies was assessed. A narrative synthesis method was used to analyse the outcomes.

Results: In total 3030 articles were screened, of which 13 met the inclusion criteria. The included studies were conducted in 8 African countries. The interventional approaches include formation of improvement teams which regularly examine performance gaps, identify root causes, develop and implement various change ideas to address the identified gaps. Another approach was the creation of learning networks for capacity building especially for managers, nurses and community health workers. Others include mentorship, on-site training, supportive supervision and service delivery standards action planning. Rapid scale up of fundamental components of PMTCT programme with the use of data-driven participatory processes especially to understand facility-level bottlenecks. Collaboration of non-governmental organisations and coordination by governmental partners. Healthcare workers successively implemented QI projects with dramatic improvement of key PMTCT indicators. Adapting processes such as data reporting, educational level, sustainability and policy-makers commitment are some of the challenges.

Conclusion: Quality improvement interventions can be implemented to improve outcomes in limited resource settings. However, a successive intervention still need a detailed design, stakeholders buy-in, building up local capacity for sustainability and dependable data system.