What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother-to-child transmission of HIV delivery in Mozambique.

摘要: Introduction : Efforts to implement and take scale highly efficacious, low-cost interventions prevent mother-to-child HIV transmission (pMTCT) have been a cornerstone of reproductive health services in sub-Saharan Africa for over decade. Yet efforts increase access utilization these remain far from optimal. This study developed applied an approach systematically classify pMTCT performance identify modifiable system factors associated with which may be replicated other systems. Methods Facility-level measures were collected at 30 sites 12-month period reviewed consistency. Five combinations three indicators (1. testing; 2. CD4 3. antiretroviral prophylaxis combined therapy initiation) compared including composite all three, combination 1. 3., each individually. Approaches visually assessed describe facility performance, focusing on rank order consistency across high, medium low categories. Modifiable non-modifiable ascertained site ranking process was estimate association through unadjusted Chi-square tests logistic regression. After describing high versus performing clinics, the effect inclusion 10 middle performers assessed. Results The indicator most consistently reference (HIV testing, therapy) single measure therapy. Lower clinics ranked measurement strategies; demonstrated more variability. Association between clinic characteristics varied markedly strategies. Using indicator, larger catchment area, higher number institutional deliveries, onsite point-of-care capacity, numbers nurses doctors while location, NGO support, women’s support group, community linkages patient-tracking systems stock-outs not performance. Conclusions Classifying provided consistent results measures, though granularity improved by aggregating either or performers. Human resources, size positively effective service delivery. Keywords: implementation science; measures; PMTCT; Mozambique; classification; strengthening. To supplementary material this article please see Supplementary Files column right (under Article Tools). (Published: 24 March 2014) Citation: Gimbel S et al. Journal International AIDS Society 2014, 17 :18828 http://www.jiasociety.org/index.php/jias/article/view/18828 | http://dx.doi.org/10.7448/IAS.17.1.18828