Research Article: Improving Prevention of Mother-to-Child Transmission of HIV Care and Related Services in Eastern Rwanda

Date Published: July 20, 2010

Publisher: Public Library of Science

Author(s): Younsook Lim, Jim Yong Kim, Michael Rich, Sara Stulac, Jean Bosco Niyonzima, Mary C. Smith Fawzi, Rose Gahire, Martha Mukaminega, Marya Getchell, Curtis W. Peterson, Paul E. Farmer, Agnès Binagwaho

Abstract: Younsook Lim and colleagues describe the Rwanda Learning Collaborative on Child Health, which aimed to improve and extend the impact of prevention of mother-to-child transmission of HIV/AIDS.

Partial Text: A recent World Health Organization (WHO) report found a complex array of positive and negative impacts of global health initiatives (GHIs) on existing health systems [1]. The report’s examination of published studies and both quantitative and qualitative data collected in 15 countries demonstrated the need for programs proactively designed to have positive effects on “nontargeted” health services. Here, we describe an effort that was designed to improve the quality and extend the impact of prevention of mother-to-child transmission of HIV/AIDS (PMTCT) care in a manner that benefited multiple areas of clinical care.

The Rwanda Learning Collaborative on Child Health (RLC) was conceived as a service delivery component of the Joint Learning Initiative on Children and HIV/AIDS (JLICA). The project sought to increase access to and the quality of PMTCT services in the Eastern Province of Rwanda using a learning collaborative model. This method focuses on peer-to-peer learning through periodic “learning sessions,” meetings at which participants convene to discuss improvement of selected indicators. The approach allows for multiple improvement ideas to be simultaneously tested and evaluated [6].

All 17 health centers carried out improvement activities in target areas for the duration of the project. Thirty-four unique ideas covering all areas of improvement were tested. Increasing health center attendance through provision of material incentives, expanding access to services through outreach sites, and strengthening links between patients and health care providers through CHWs were among the many ideas health centers explored. Although most health centers reported notable improvements during the project, these numbers are not amenable to standard tests of statistical significance because of the underlying assumptions inherent in the statistical methods used in quality improvement.

The experience of the RLC suggests that the learning collaborative model can have a positive impact not only on the quality of targeted areas of care, but also on the capacity of health centers to more effectively deliver nontargeted services. This systems-based approach was useful in encouraging problem solving in a local context, assisting in the determination of where resources were needed, and encouraging demand from those who utilize services.