Description and Impact of Continuous Quality Improvement of PMTCT Services in Sub-Saharan Africa

Abstract

The prevention of mother to child transmission of HIV (PMTCT) is a major global health problem and continuous quality improvement (CQI) has demonstrated a way to address this problem. A lot of work on CQI has demonstrated the efficacy of sequential, small interventions as a single intervention. This paper analyzes CQI for PMTCT at the level of each individual intervention by describing the interventions and their impact. In a secondary analysis of a database of longitudinal PMTCT cascade indicators from 17 facilities across Côte d’Ivoire, Mozambique, and Kenya, we find that there are many interventions that do not directly target these cascade indicators but nonetheless have a broad impact. There are a large number of interventions that focus on service reorganization and strengthening norms. When assessing the impact of individual interventions, we find that targeting an outcome on the PTMCT cascade does not necessarily correspond to an impact in that outcome and sometimes intervention is associated with worse outcomes. This study has important limitations due to bias from time varying covariates and endogeneity, and the suggested associations should be interpreted with caution.