P039W

ZAMBIANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

Standards-Based Management and Recognition (SBM-R): A Tool for Improving the Quality of PMTCT Services A Case Report for the Zambian Defense Forces (ZDF) Health Facilities
by: Maureen Chilila, Hilda Shasulwe, Joseph Banda, Kwame Asiedu, Joseph Nikisi, Webby Kanjipite and Lt. Col. Joyce Mulilo

Description of the Problem

Zambia has a total population of 13.3 million (2010). The national HIV prevalence rate is 14.3%:
In pregnant women: 16% The majority of HIV infection in infants occur through mother-to-child transmission. The military has not been spared from the pandemic. They have a high prevalence rate compared to the general population. The Zambia Defense Forces (ZDF) runs a parallel health system to the public health sector. ZDF has a network of 54 health facilities representing 16% of all health services in Zambia. ZDF has not received the same level of funding as the public sector, leading to: Limited and unequal availability of HIV prevention, care and support services, Constrained human, material and systems resources to deliver services for prevention of mother-to-child transmission of HIV (PMTCT), and Little on-site support for the transfer of training and implementation of quality services. As with the rest of the Zambian public health system, the management of health services to support and ensure quality of care required strengthening.

Project Goal
To reduce the
spread of HIV and AIDS and mitigate the impact of the epidemic by building the capacity of the ZDF to both prevent infections and provide treatment and care

Results
Comprehensive PMTCT services such as antenatal
care, labor and delivery, postnatal, family planning and child health care have been initiated in all model sites, with the performance of providers markedly improved, as demonstrated by the achievement of standards in the various areas. All the sites have received supportive supervision visits and mentorship. The initiative resulted in a steady increase in service uptake over the years. 11,207 mothers have been counseled and tested. Seven in every 10 positive pregnant women were provided with ARVs during the PMTCT program.

Approach
and Recognition (SBM-R) approach as a way to improve the quality of services and various support systems SBM-Ra quality improvement process that uses a set of detailed standards for the various reproductive health components Training of providers and mentorship for improved skills for providers Provision of data management tools to capture the information on PMTCT program implementation and service utilization Procurement and distribution of equipment and supplies for service provision

Introduction of the Standards-Based Management

Of these, 13% (1,436) tested HIV-positive. 277 (3%) pregnant women already knew their HIV
status at entry.

853 exposed babies have been tested for HIV using

the PCR and have been appropriately managed. The positivity rate of exposed babies has decreased from 14% to 5%.

Conclusion
The program data so far have shown that it is
possible for quality PMTCT services to be scaled up to the ZDF health facilities and to increase the number of infected women benefiting from the PMTCT program in Zambia.

Mentorship in antenatal care at ZNS Mtetezi camp clinic

Data management using electronic medical records (SmartCare)

This work has been supported by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through DOD under the terms of Grant No. N00244-09-1-0050.