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. 2020 Nov 13;20(1):1042.
doi: 10.1186/s12913-020-05900-4.

Using the critical path method to rollout and optimise new PMTCT guidelines to eliminate mother-to-child transmission of HIV in Zimbabwe: a descriptive analysis

Reuben Musarandega  1 , Joanna Robinson  2 , Priti Dave Sen  2 , Anna Hakobyan  2 , Angela Mushavi  3 , Agnes Mahomva  3 , Godfrey Woelk  4
Affiliations

Using the critical path method to rollout and optimise new PMTCT guidelines to eliminate mother-to-child transmission of HIV in Zimbabwe: a descriptive analysis

Reuben Musarandega et al. BMC Health Serv Res. .

Abstract

Background: Achievement of the elimination target for mother-to-child transmission (MTCT) of HIV in selected countries has increased hope to end the HIV epidemic in children across the world. However, MTCT rates remain well above the 5% elimination target in most sub-Saharan Africa countries. These countries require innovative strategies to scale-up their interventions to end paediatric HIV. We describe how the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) consortium and the Children's Investment Fund Foundation (CIFF) used the critical path method to facilitate rapid expansion and optimization of 2010 and 2013 WHO PMTCT guidelines to reduce Zimbabwe's MTCT rate from 22% in 2010 to 6.4% in 2015.

Methods: We analysed activities implemented and PMTCT programme data for the period before and during the EGPAF-CIFF project. The critical path method involved a cycle of collecting and analysing quarterly PMTCT indicator data and planning and implementing targeted activities to improve the PMTCT indicators. We performed a graphical trend analysis of data that measured availability of PMTCT services. Using Pearson's Chi2 test, we compared results of PMTCT uptake indicators at the start and end of the EGPAF-CIFF project and used regression discontinuity analysis to assess effectiveness of activities implemented to improve the PMTCT service uptake indicators.

Results: Zimbabwe rolled out WHO 2010 and 2013 PMTCT guidelines in less than 1 year during the EGPAF-CIFF project, yet it took more than 4 years to roll-out previous guidelines. All PMTCT indicators increased significantly (p < 0.001) comparing the five-year periods before and during the EGPAF-CIFF project. Critical path activities implemented increased five of the seven PMTCT uptake indicators.

Conclusion: Zimbabwe rapidly rolled-out and optimised new WHO PMTCT guidelines and drastically reduced its MTCT rate using the critical path method. We recommend wider use of the critical path method in public health programmes.

Keywords: Critical path method; Elimination; PMTCT; Paediatric HIV; Quality improvement; Vertical transmission.

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Conflict of interest statement

The findings and conclusions in this study are those of the authors and not necessarily the views of EGPAF, CIFF or the Zimbabwe Ministry of Health and Child Care or other EGPAF-CIFF consortium members. RM and AM1 were working for EGPAF-Zimbabwe, AM2 working for MoHCC, JR and GW working for EGPAF-Global, PDS and AH working for CIFF during designing and implementation of the project.

Figures

Fig. 1
Fig. 1
Zimbabwe MTCT rates, 2000–2015 [Source: MoHCC, HIV estimates report, 2016]. formula image Final MTCT. formula image MTCT at 6 weeks. formula image Target < 5%
Fig. 2
Fig. 2
Number of sites offering or with interruptions in PMTCT services related to critical path indicators, 2000–2015
Fig. 3
Fig. 3
Trends in quarterly critical path indicator results, 2010–2015. formula image ANC bookings. formula image HIV testing. formula image AZT prophylaxis. formula image CD4 testing. formula image Mothers ART. formula image Infant NVP. formula image EID
See this image and copyright information in PMC

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