Hamida Sadick, a nurse midwife at Chilomoni Hospital in Blantyre, Malawi, is the winner of this year’s Annette J. Bartley Memorial Scholarship, earning a free trip to the IHI National Forum. The scholarship, which is awarded to one nursing professional every year, includes a free registration to the Forum and covers travel and lodging.
Ms. Sadick’s role includes carrying out HIV testing and counseling and ensuring that mothers with HIV begin and adhere to anti-retroviral treatment (ART) for HIV prior to giving birth. She assists in safe delivery, counsels on family planning methods, conducts antenatal and post-natal checkups, and screens for cervical cancer. She also ensures that exposed infants receive appropriate treatment as soon as possible after birth to prevent transmission and enrolls the infants in an HIV care clinic that follow them until they are 24 months old.
A panel of judges — including Annette’s closest nursing colleagues and friends from IHI’s staff and faculty — chose this year’s Bartley Scholarship winning essay from dozens of excellent candidates.
Annette J. Bartley, RN, BA, MS, MPH (March 21, 1962 – November 24, 2016) was a nurse and health care improvement coach for more than 30 years, which included several leadership roles in frontline clinical care and management. A beloved member of the Institute for Healthcare Improvement (IHI) community, Annette died in November 2016, leaving behind a legacy of kindness, compassion, and optimism.
Here is Ms. Sadick’s scholarship-winning essay:
Eliminating Mother to Child Transmission of HIV through a Quality Improvement Approach at Chilomoni Hospital, Blantyre, Malawi
Background
It’s a long journey to end pediatric HIV/AIDS, but as the saying goes, a journey of one thousand miles starts with a single step. For a long time, babies under 24 months delivered from HIV-positive mothers have been victims to HIV/AIDS. Many reasons including a knowledge gap, stigma in the communities, and substandard health care contributed to high rates of HIV among exposed babies.
The Malawi national guidelines on HIV exposed infants recommend enrollment of exposed infants in an Early Infant Diagnosis (EID) program. This is a program that aims at eliminating mother-to-child transmission of HIV through comprehensive prevention of mother-to-child transmission (PMTCT) package initiated during antenatal care until the baby is 24 months old.
In 2018 at Chilomoni Hospital in Blantyre, Malawi, records revealed that only 34 percent of exposed babies registered in EID program in 2016 were discharged uninfected at 24 months. Lost to follow up constituted 56 percent, while death and transfer out share the remaining 10 percent. To eliminate mother-to-child transmission of HIV, an EID quality improvement initiative was implemented at Chilomoni Hospital with support from the district management office. The aim of the initiative was to increase the percentage of the infant discharged uninfected from form the EID program from 34 percent in July 2018 to 90 percent by March 2019.
Design
A quality improvement team of 15 was formed in the anti-retroviral therapy (ART) department, which was composed of the facility in charge, nursing in charge, health surveillance assistants, clinical officers, laboratory personnel, data clerks, and an expert client. The team met biweekly in the first three months, then monthly. The project used the Model for Improvement with Plan-Do-Study-Act cycles. The facility QI mentor and district QI manager provided monthly coaching to the team and guidance. Monthly data reviews were done and data story board was created to display the progress.
The project implemented three high-impact change ideas which were: intensification of health education, tracing of missed appointment through phone calls, and home visits. The health education was intensified at ART initiation and every subsequent visit. After every clinic the data clerks would generate missed appointments list which was used to conduct phone calls or home visits.
PDSA cycle for the EID project
Results
There has been tremendous improvement, with a median of 91 percent of exposed babies discharged uninfected at 24 months since November 2019. The project has also improved client’s knowledge of PMTCT and reduced the default rate among HIV PMTCT clients. The facility has learnt the power of QI approach, team work, and the client-centered care model in closing performance gap.
Infants discharged uninfected far back before the intervention
Infants discharged uninfected after the intervention
