title: Increasing retention in care of HIV-positive women in PMTCT services through continuous quality improvement-breakthrough (CQI-BTS) series in primary and secondary health care facilities in Nigeria: a cluster randomized controlled trial. The Lafiyan Jikin Mata Study.
abstract: BACKGROUND
  Rates of retention in care of HIV-positive pregnant women in care programs in Nigeria remain generally poor with rates around 40% reported for specific programs. Poor quality of services in health facilities and long waiting times are among the critical factors militating against retention of these women in care. The aim of the interventions in this study is to assess whether a continuous quality improvement intervention using a Breakthrough Series approach in local district hospitals and primary health care clinics will lead to improved retention of HIV-positive women and mothers.
  
  
  METHODS
  A cluster randomized controlled trial with 32 health facilities randomized to receive a continuous quality improvement/Breakthrough Series intervention or not. The care protocol for HIV-infected pregnant women and mothers is the same in all sites. The quality improvement intervention started 4 months before enrollment of individual HIV-infected pregnant women and initially focused on reducing waiting times for women and also ensuring that antiretroviral drugs are dispensed on the same day as clinic attendance. The primary outcome measure is retention of HIV-positive mothers in care at 6 months postpartum.
  
  
  CONCLUSIONS
  Results of this trial will inform whether quality improvement interventions are an effective means of improving retention in prevention of mother-to-child transmission of HIV programs and will also guide where health system interventions should focus to improve the quality of care for HIV-positive women. This will benefit policymakers and program managers as they seek to improve retention rates in HIV care programs.
authors.affiliation: *Center for Integrated Health Programs (CIHP), Abuja, Nigeria; †World Health Organization Nigeria (WHO), WHO Country Office, Abuja, Nigeria; ‡INSERM U897, Center de Recherche en Epidémiologie et Biostatistique, Institut de Santé Publique Epidémiologie Développement (ISPED), Université de Bordeaux, Bordeaux, France; and §National AIDS and STIs Control Programme (NASCP), Department of Public Health, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Oyeledun
authors.forename: Frank
authors.initials: F
authors.lastname: Oronsaye
authors.forename: Taiwo
authors.initials: T
authors.lastname: Oyelade
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
authors.forename: Deborah
authors.initials: D
authors.lastname: Odoh
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Anyaike
authors.forename: Francis
authors.initials: F
authors.lastname: Ogirima
authors.forename: Bernice
authors.initials: B
authors.lastname: Ameh
authors.forename: Abiola
authors.initials: A
authors.lastname: Ajibola
authors.forename: Bamidele
authors.initials: B
authors.lastname: Osibo
authors.forename: Collins
authors.initials: C
authors.lastname: Imarhiagbe
authors.forename: Inedu
authors.initials: I
authors.lastname: Abutu
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D009549:Nigeria; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement; D063728:Secondary Care Centers / Q000592:standards*
chemical_list: D019380:Anti-HIV Agents