Gimbel Sarah, Voss Joachim, Mercer Mary Anne, Zierler Brenda, Gloyd Stephen, Coutinho Maria de Joana, Floriano Florencia, Cuembelo Maria de Fatima, Einberg Jennifer, Sherr Kenneth
Department of Family Child Nursing, University of Washington, Box 357262, Seattle, USA.
BMC Res Notes. 2014 Oct 21;7:743. doi: 10.1186/1756-0500-7-743.
The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery.
Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant.
Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed.
ClinicalTrials.gov NCT02023658, December 9, 2013.
预防母婴传播（pMTCT）级联分析工具的目标是为机构层面的一线卫生管理人员提供手段，以便他们能够快速、独立且定量地追踪患者在pMTCT级联中的流程，并轻松确定诊所层面改进干预措施的优先领域。在六个月的时间里，五名经验丰富的母婴健康管理人员和研究人员反复调整并测试了这个用于pMTCT服务的系统分析工具。他们确定了pMTCT级联中要纳入的组成部分，向27名卫生管理人员分发了多个版本，并在五个机构进行了试点。采用流程映射技术绘制这五个机构中PMTCT级联步骤，记录产前检查、艾滋病毒检测与咨询、预防性抗逆转录病毒药物的提供、安全分娩、安全婴儿喂养、婴儿随访（包括艾滋病毒检测）以及计划生育情况，以便获取特定地点的服务提供情况。
基于Excel的最终工具纳入了七个pMTCT级联步骤。患病率计算作为相关步骤下的子标题纳入。不需要输入数据的单元格被锁定，措辞被简化，并且在级联的关键步骤中纳入了逐步递减和最大化功能。递减功能使卫生工作者能够快速评估每个步骤有多少患者流失，而最大化功能则详细说明了如果只有一个步骤提高到100%的能力而其他步骤保持不变时额外服务的人数。
我们的经验表明，针对机构层面的pMTCT服务调整级联分析工具是可行且合适的，可作为讨论在何处实施改进策略的起点。最终的工具便于一线卫生工作者和管理人员参与其中，他们填写、解释、应用该工具，然后跟进质量改进活动。需要对一线卫生管理人员采用、解释和维持此pMTCT级联分析工具的情况进行研究。
ClinicalTrials.gov NCT02023658，2013年12月9日。
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