ART decentralization timeline.

<p>The timeline displays HIV care in Neno District from August 1, 2006, when public care first became available, through December 31, 2012. (DH = district hospital, CH = community hospital, HC = health center, RHC = rural health center).</p

Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: A retrospective cohort study

<div><p>HIV/AIDS remains the second most common cause of death in low and middle-income countries (LMICs), and only 34% of eligible patients in Africa received antiretroviral therapy (ART) in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program from August 1, 2006, when ART first became available, through December 31, 2013. We used GPS data to calculate patient-level distance to care, and examined number of annual ART visits and one-year lost to follow-up (LTFU) in HIV care. The number of ART patients in Neno increased from 48 to 3,949 over the decentralization period. Mean travel distance decreased from 7.3 km when ART was only available at the district hospital to 4.7 km when ART was decentralized to 12 primary health facilities. For patients who transferred from centralized care to nearer health facilities, mean travel distance decreased from 9.5 km to 4.7 km. Following a transfer, the proportion of patients achieving the clinic’s recommended ≥4 annual visits increased from 89% to 99%. In Cox proportional hazards regression, patients living ≥8 km from a health facility had a greater hazard of being LTFU compared to patients <8 km from a facility (adjusted HR: 1.7; 95% CI: 1.5–1.9). ART decentralization in Neno District was associated with increased ART enrollment, decreased travel distance, and increased retention in care. Increasing access to ART by reducing travel distance is one strategy to achieve the ART coverage and viral suppression objectives of the 90-90-90 UNAIDS targets in rural impoverished areas.</p></div

Association between travel distance to care and hazard of loss to follow up (LTFU), and exploratory analysis of association between patient covariates and LTFU.

<p>Association between travel distance to care and hazard of loss to follow up (LTFU), and exploratory analysis of association between patient covariates and LTFU.</p

Map of decentralization of ART services from 2008 to 2012.

<p>Crosses show location of health facilities. Dots show number of ART patients by home village, color-coded by health facility patient attended. Larger dots indicate a larger number of patients.</p

Demographic, clinical, and distance-to-care for patient cohorts during each phase of full decentralization.

<p>Demographic, clinical, and distance-to-care for patient cohorts during each phase of full decentralization.</p

Comparison of demographic, clinical and distance data for transfers and non-transfers.

<p>Comparison of demographic, clinical and distance data for transfers and non-transfers.</p

Implementation outcomes of the integrated district evidence to action (IDEAs) program to reduce neonatal mortality in central Mozambique: an application of the RE-AIM evaluation framework

Abstract Background Scarce evidence exists on audit and feedback implementation processes in low-resource health systems. The Integrated District Evidence to Action (IDEAs) is a multi-component audit and feedback strategy designed to improve the implementation of maternal and child guidelines in Mozambique. We report IDEAs implementation outcomes. Methods IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces between 2016 and 2020 and evaluated using a quasi-experimental design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Reach is the proportion of pregnant women attending IDEAs facilities. Adoption is the proportion of facilities initiating audit and feedback meetings. Implementation is the fidelity to the strategy components, including readiness assessments, meetings (frequency, participation, action plan development), and targeted financial support and supervision. Maintenance is the sustainment at 12, 24, and 54 months. Results Across both provinces, 56% of facilities were exposed to IDEAs (target 57%). Sixty-nine and 73% of pregnant women attended those facilities’ first and fourth antenatal consultations (target 70%). All facilities adopted the intervention. 99% of the expected meetings occurred with an average interval of 5.9 out of 6 months. Participation of maternal and child managers was high, with 3076 attending meetings, of which 64% were from the facility, 29% from the district, and 7% from the province level. 97% of expected action plans were created, and 41 specific problems were identified. “Weak diagnosis or management of obstetric complications” was identified as the main problem, and “actions to reinforce norms and protocols” was the dominant subcategory of micro-interventions selected. Fidelity to semiannual readiness assessments was low (52% of expected facilities), and in completing micro-interventions (17% were completed). Ninety-six and 95% of facilities sustained the intervention at 12 and 24 months, respectively, and 71% had completed nine cycles at 54 months. Conclusion Maternal and child managers can lead audit and feedback processes in primary health care in Mozambique with high reach, adoption, and maintenance. The IDEAs strategy should be adapted to promote higher fidelity around implementing action plans and conducting readiness assessments. Adding effectiveness to these findings will help to inform strategy scale-up

Increased number of HIV tests at health facilities Q3 2013 –Q2 2017.

Fig 4 shows the trend in the number of HIV tests performed outside of the hospital across four rural districts in Lesotho over time, plotted against the targets for HIV testing established by the Universal Health Coverage goals. The figure shows the change over time beginning in the third quarter of 2013 (before the National Health Reform) through the fourth quarter of 2016 (more than two years into the National Health Reform).</p

This document is the 2019 annual report on technical support authored by Partners in Health regarding the pharmacy and medical supply chain management detailing augmentation of cold chain capacity for five health centers to appropriately store several life-saving medicines, as well as the interim outcomes for antenatal care visits, facility-based deliveries, and inter-facility transfer of complex cases.

(PDF)</p

This supplement includes the standardized survey questions for key stakeholders as well as the data collection tool from which our outcome variables of interest were derived.

(PDF)</p