Maureen Fatsani Tshabalala, EGPAF/SA Presented by: Ncumisa Vika Date: 5 th December 2011 MOAE0201

1. Identifying gaps and implementing changes to improve the quality of mother-to-child transmission (PMTCT) program interventions using randomised chart extraction and review at Swartruggens Hospital in North West Province, South Africa Maureen Fatsani Tshabalala, EGPAF/SA Presented by: Ncumisa Vika Date: 5th December 2011 MOAE0201

2. Issues • To measure facility performance at Swartruggens Hospital and its four feeder clinics, a baseline randomised chart extraction and review was performed by EGPAF’s South Africa program in July 2009 • 35 charts of HIV-positive pregnant women in the PMTCT program were assessed using an Excel- based tool • 0% had a baseline WHO clinical staging assessment • 20% had received a baseline CD4 count result • 89% had received ARV prophylaxis • 46% of eligible women received long life ART • 69% of HIV-exposed infants received ARV prophylaxis post delivery • This information informed implementation of quality improvement (QI) strategies

3. QI Strategies to Address the Gaps at the Hospital and its Feeder Clinics • The QI strategies were initiated in July 2009 by EGPAF in partnership with DOH • Process mapping to identify gaps in the system (process of enrolment, counselling, treatment initiation, M&E, etc.) was performed • Goals and targets of improvement were set by hospital & clinic staff with guidance from EGPAF • EGPAF and DOH trained hospital and feeder clinic staff on QI methods • The hospital and the clinics each formed QI teams • Improvement cycles were initiated by the teams • A checklist for nurses’ self assessments was developed by the hospital to guide and make sure that all steps in managing HIV+ pregnant women are being followed • Monthly data review sessions between hospital and clinics were held to assess data management • EGPAF provided technical assistance on addressing the identified gaps • EGPAF mentored and coached on the improvement cycles

4. Results • A follow-up assessment was performed in July 2010 to evaluate the QI strategies used and the results indicated the following: • 63% of the women had a baseline WHO clinical staging assessment (up from 0%) • 95% of women were receiving their baseline CD4 results (up from 20%) • 100% of clients received ARV prophylaxis (up from 89%) • 84% of eligible women received ART as treatment (up from 46%) • 100% of HIV-exposed infants received ARV prophylaxis post-delivery (up from 69%) • Clinic staff noted improvements in the referral processes between hospital and feeder clinics • Randomised chart extraction and review enabled the identification of HIV care delivery gaps and highlighted areas of improvement

5. Results in Graphic format