The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.
The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.
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DOI：
10.1186/1756-0500-7-743
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发表时间：
2014-10-21
影响因子：
1.8
通讯作者：
Sherr, Kenneth
中科院分区：
文献类型：
--
作者：
Gimbel, Sarah;Voss, Joachim;Sherr, Kenneth
背景技术背景：预防母婴传播级联分析工具的目的是向设施一级的一线卫生管理人员提供快速、独立和定量跟踪母婴传播级联患者流量的手段，并随时确定诊所一级改进干预措施的优先领域。在六个月的时间里，五位经验丰富的母婴健康管理人员和研究人员反复调整和测试了这一用于pMTCT服务的系统分析工具。他们优先考虑纳入预防母婴传播方案的各个组成部分，向27名保健管理人员分发了多个版本，并在5个设施进行了试点。流程图技术用于绘制这五个设施中的PMTCT级联步骤，记录产前护理就诊、艾滋病毒检测和咨询、预防性抗逆转录病毒药物的提供、安全分娩、安全婴儿喂养、婴儿随访（包括艾滋病毒检测）和计划生育，以获得特定于地点的服务提供知识。结果：基于Excel的最终工具中包含七个pMTCT级联步骤。流行率计算作为小标题列入相关步骤。不需要数据输入的单元格被锁定，措辞被简化，逐步下降和最大化函数被包括在级联的关键步骤沿着。虽然下降函数允许卫生工作者快速评估每一步有多少患者损失，但最大化函数详细说明了如果只有一步提高到100%容量而其他步骤保持不变，则所服务的额外人员。我们的经验表明，对设施级联分析工具的调整-一级的预防母婴传播服务是可行的，作为讨论在哪里实施改进战略的起点是适当的。由此产生的工具促进了一线卫生工作者和管理人员的参与，他们填写，解释，应用该工具，然后跟进质量改进活动。一线健康管理者需要对pMTCT级联分析工具的采用、解释和可持续性进行研究。试验注册：ClinicalTrials.gov NCT 02023658，2013年12月9日。
BACKGROUND: The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery.RESULTS: Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant.CONCLUSIONS: Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed.TRIAL REGISTRATION: ClinicalTrials.gov NCT02023658, December 9, 2013.