title: Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.
abstract: Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.
authors.affiliation: a Hope Through Health , New York , NY , USA.|b Department of Pediatrics , Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx , NY , USA.|c Department of Family and Social Medicine , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiori
authors.affiliation: a Hope Through Health , New York , NY , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schechter
authors.affiliation: d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Monica
authors.initials: M
authors.lastname: Dey
authors.affiliation: b Department of Pediatrics , Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx , NY , USA.|c Department of Family and Social Medicine , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Braganza
authors.affiliation: e Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.|f Department of Global Health & Social Medicine , Harvard Medical School , Boston , MA , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rhatigan
authors.affiliation: d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Spero
authors.initials: S
authors.lastname: Houndenou
authors.affiliation: d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Christophe
authors.initials: C
authors.lastname: Gbeleou
authors.affiliation: d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Palerbo
authors.affiliation: d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Elfamozo
authors.initials: E
authors.lastname: Tchangani
authors.affiliation: a Hope Through Health , New York , NY , USA.|d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lopez
authors.affiliation: a Hope Through Health , New York , NY , USA.|d Hope Through Health/Association Espoir pour Demain , Kara , Togo.
authors.forename: Emily
authors.initials: E
authors.lastname: Bensen
authors.affiliation: e Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.|f Department of Global Health & Social Medicine , Harvard Medical School , Boston , MA , USA.|g Ariadne Labs , Boston , MA , USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D000163:Acquired Immunodeficiency Syndrome; D002648:Child; D003695:Delivery of Health Care; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000458:organization & administration*; D058996:Quality Improvement; D011787:Quality of Health Care; D014037:Togo
keywords: Pediatric HIV; Togo; care delivery value chain; global healthcare delivery; implementation science