Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement

Figures & data

Table 1. Quality improvement objectives and associated target values, organized by CDVC area.

No.	CDVC Area	QI Objective and target value
1	Prevention and Screening	>90% of HIV+ pregnant women enrolled in pMTCT program initiate ART within first trimester
2	Prevention and Screening	<5% of HIV+ expecting mothers lost to follow-up
3	Prevention and Screening	>85% of infants screened for HIV by PCR method within first six weeks of life
4	Prevention and Screening	>80% of medicines on “essential medication” list available at all times
5	Diagnosing and Staging	>90% of mother/infant pairs identified as late for medical consultations receive monthly home visit
6	Diagnosing and Staging	>85% of HIV+ children screened for: (1) Tuberculosis and (2) Hepatitis B
7	Pre-antiretroviral Medical and Psychosocial Care	>95% infants (of mothers initially enrolled in pMTCT program) tested for HIV at 18 months
8	Pre-antiretroviral Medical and Psychosocial Care	Improved clinical integration developed between wrap-around support services and clinical program
9	Pre-antiretroviral Medical and Psychosocial Care	>75% of pediatric patients receive “disclosure counseling” by age 13
10	Intervening and ARV Initiation	>95% of patients receive initial CD4 test within 3 months of HIV diagnosis
11	Intervening and ARV Initiation	>95% of pediatric patients initiate ART within 3 months of date of eligibility for treatment
12	Intervening and ARV Initiation	>75% of “new caretakers” receive counseling sessions
13	Continuous Management	>85% of cohort of “high risk” patients adherent to ART
14	Management of Complications	>95% of “high risk” pediatric patients receive recommended periodicity for: (1) home visits and (2) medical consultations
15	Management of Complications	Quarterly morbidity and mortality sessions conducted

Note: PCR, polymerase chain reaction.

Figure 1. Care delivery value chain for pediatric HIV services in Kara, Togo in 2014–2015.

Table 2. Accomplished QI objectives with target, baseline and year-end values.

No.	QI Prioritized objectives	Baseline	12 month
Target achieved
1	>90% of HIV+ pregnant women enrolled in pMTCT program initiate ART within first trimester	20%	100%
2	<5% of HIV+ expecting mothers lost to follow-up	^a	<1% (one pair loss-to-follow-up)
3	>85% of infants screened for HIV by PCR method within first six weeks of life	39%	95%
4	>80% of medicines on “essential medication” list available at all times	^a	97%
5	>90% of mother/infant pairs identified as late for medical consultations receive monthly home visit	^a	>98% (only one pair identified)
7	>95% infants (of mothers initially enrolled in pMTCT program) tested for HIV at 18 months	66.70%	100%
8	Improved clinical integration developed between wrap-around support services and clinical program	No plan	Plan created and implemented
10	>95% of patients receive initial CD4 test within 3 months of HIV diagnosis	66.70%	100%
12	>75% of “new caretakers” receive counseling sessions	<5%	95%
13	>85% of cohort of “high risk” patients adherent to ART	<5%	94%
14	>95% of “high risk” pediatric patients receive recommended periodicity for: (1) home visits and (2) medical consultations	(1) 85% (2) 97%	(1) 97% (2) 100%
Target not met
11	>95% of pediatric patients initiate ART within 3 months of date of eligibility for treatment	60%	75%
15	Quarterly morbidity and mortality sessions conducted	2	1 over 12-month period
Insufficient data collection
6	>85% of HIV+ children screened for: (1) Tuberculosis and (2) Hepatitis B	NA	NA
9	>75% of pediatric patients receive “disclosure counseling” by age 13	NA	NA

^{Note: PCR, polymerase chain reaction.}

^aBaseline data did not exist for this area, in process of QI efforts, developed strategy for capturing data.

Figure 2. Schematic model for CDVC/quality improvement integration.