TABLE 3.

Cameroon and Zambia Change Ideas Shared With Stakeholders After 15 Months of Implementation of a Quality Improvement Collaboration to Improve Early Infant Diagnosis of HIV and Antiretroviral Therapy Initiation

Health care worker capacity building	Provide on-the-job mentorship to optimize PMTCT services
	Demonstrate proper DBS sample collection for HF staff in MCH, labor, and postnatal wards, as needed
	Orient new lay counselors on standard documentation and register completion
	Pair lay counselors based on experience levels to enable peer-to-peer learning
Data quality and documentation	Review registers monthly and provide refresher trainings to fill gaps, as needed
	Reinforce proper documentation practices among all MCH lay counselors
	Enlarge and display national register standard operating procedures
	Assign nurses to supervise lay counselor documentation practices
	Confirm and update caregiver contact information with every visit
	Conduct quarterly reviews for data quality in relevant registers
Client and family education and engagement	Provide targeted, one-on-one health education talks to HIV-infected mothers
	Deliver HF invitations to increase male partner involvement/participation in MCH services
	Recruit and engage mentor mothers to provide health education from the peer perspective
	Provide one-on-one health information and counseling to HIV-infected mothers regarding male involvement in care and the importance of disclosure
	Male partner engagement during ANC visits for all education provided
	Introduce a “care buddy” to increase retention in care where clients attend treatment preparation sessions with a friend, family member, or support person to help with treatment adherence
Workflow process improvements	Develop and use DBS tracking forms between ANC and laboratory departments
	Develop and display a flowchart to illustrate MOH standard of care
	Prioritize immediate action on positive HIV test results received from laboratory
	Develop interfacility communication system to enable confirmed patient transfers
	Assign HIV test (DBS) stock management focal persons
	Active HEI case finding through retrospective ANC chart review and follow up
	Engage the facility-based “linkage officer” to facilitate communication of DBS HIV test results with MCH staff
	Screen postnatal discharge cards upon arrival at postnatal care for HIV testing
	Develop and use a tracking list to follow up on missing DBS results
	Designate specific days to prioritize the provision of EID and ANC services
Community engagement	Engage community-based volunteer peer mothers in active tracking and follow-up
	Introduce geographic HIV-infected pregnant women social networks
	Convene sensitization meetings to engage religious leaders in the community
	Engage safe mother action groups in tracking and follow-up activities

Abbreviations: ANC, antenatal care; ART, antiretroviral therapy; DBS, dried blood sample; EID, early infant diagnosis; HEI, HIV-exposed infant; HF, health facility; MCH, maternal child health; MOH, Ministry of Health; PMTCT, prevention of mother-to-child transmission of HIV.