Background: The Partnership for HIV-Free Survival (PHFS), a USAID initiative implemented in Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda between 2012 and 2016, was designed to use basic quality improvement (QI) practices to reduce mother-to-child transmission of HIV. Along with improved prevention of mother-to-child transmission (PMTCT) service delivery, participating facilities saw improvements in retention in care for HIV-infected mothers and their infants and HIV-free child survival at two years. Knowledge exchange platforms (i.e. structured opportunities for peer-to-peer learning across facilities at district, provincial, and national forums) were a key component of the PHFS design.
Methods: In 2017-2018, MEASURE Evaluation, funded by USAID, conducted a legacy evaluation of PHFS. The team conducted an extensive review of QI records at PHFS facilities and qualitative semi-structured interviews with national, provincial, community and facility-level partners across all six countries.
Results: Stakeholders described knowledge exchange platforms as a cornerstone element of PHFS in all six countries. While the specific structure of knowledge exchange events varied across countries, they provided supportive space for health facility staff and community health workers to present and model their patient-focused local innovations and improved outcomes on common PMTCT QI indicators. These events propelled PHFS work forward, motivating participants to continue implementing successful change ideas and providing an opportunity to learn from other facilities'' successes, adopt innovative change ideas, and tailor innovations to their local facility and community. For example, in Kenya, an innovative patient scheduling strategy with designated PMTCT clinic days for mother-baby pairs, presented by one health facility at a county-level knowledge exchange event, spread to nearly all 28 PHFS sites in the following months.
Conclusions: In the context of QI, knowledge exchange platforms that bring together PMTCT stakeholders for inter-facility sharing of successful QI work and local innovations has potential to be an impactful strategy. Sharing innovations that are simple, low-cost, and locally developed, facilitates adoption to other facilities. Knowledge exchange platforms should be scaled up alongside QI efforts, for PMTCT and other health areas, to promote collaboration of stakeholders, motivation of frontline staff, adoption of change ideas, and improvement of local health services.