An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies
Abstract Background Reducing perinatal HIV transmission and optimizing maternal and child health (MCH) outcomes in high HIV prevalence settings is an urgent, but complex, priority. Extant interventions over-emphasize individual-level provider and patient behaviors, and neglect critical health system...
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2024-12-01
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| author | Laura K. Beres Mammatli Chabela Matseliso Masitha Zachary Catanzarite Vincent J. Tukei Lynne Mofenson Appolinaire Tiam Lauren Greenberg Majoalane Mokone Ramatlapeng Thabelo Masepeli Nchephe Tsietso Mots’oane Laura Guay Amy R. Knowlton |
| author_facet | Laura K. Beres Mammatli Chabela Matseliso Masitha Zachary Catanzarite Vincent J. Tukei Lynne Mofenson Appolinaire Tiam Lauren Greenberg Majoalane Mokone Ramatlapeng Thabelo Masepeli Nchephe Tsietso Mots’oane Laura Guay Amy R. Knowlton |
| author_sort | Laura K. Beres |
| collection | DOAJ |
| description | Abstract Background Reducing perinatal HIV transmission and optimizing maternal and child health (MCH) outcomes in high HIV prevalence settings is an urgent, but complex, priority. Extant interventions over-emphasize individual-level provider and patient behaviors, and neglect critical health systems-level changes. The ‘Integrated Management Team to Improve Maternal-Child Outcomes (IMPROVE)’ study implemented a three-part, patient-centered, health-systems-level intervention to improve MCH and HIV outcomes in Lesotho. Ensuring intervention fit within the health systems context is important, but often overlooked. This manuscript describes implementation research conducted to tailor and adapt intervention implementation to optimize appropriateness, acceptability, and feasibility. It identifies resulting implementation variation across study sites and lessons learned. Methods The research team reviewed intervention implementation documentation and conducted structured reflections to: 1) assess implementation strategy adaptations, 2) identify facility-specific strategies employed to improve the MCH patient experience, and 3) synthesize lessons. Results Facility-based, integrated, multi-disciplinary management teams (MDT) were feasible and acceptable to establish through engagement with facility leadership and facilitation of a participatory training curriculum that established shared values between cadres supporting MCH, and identified facility-specific service delivery gaps and potential solutions. Ongoing MDT meetings provided coordination between facility and community-based MCH service providers to implement early ANC follow-up. Facility-specific improvement strategies included fee, staffing, and patient documentation-based changes. Piloting Positive Health, Dignity, and Prevention-focused counseling approaches resulted in tailored job aids pre-implementation. Leadership involvement was critical for improved coordination while staff turnover and competing donor priorities challenged MDT efforts. Conclusions IMPROVE created facility-specific adaptation opportunities through participatory intervention implementation practices. The MDTs, benefitting from leadership support, built relationships between HCW cadres, led facility-specific quality improvements, and, importantly, offered HCWs sought-after positive feedback by recognizing HCW efforts. The coordination, monitoring and cross-cadre communication functions of the MDTs supported implementation of other interventions, and may serve as a valuable platform for improving patient-centered care practices in similar settings and for other health services. Trial registration number: NCT04598958, 05 October 2020, retrospectively registered. Trial registration ClinicalTrials.gov, NCT04598958. Registered 05 October 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04598958 |
| format | Article |
| id | doaj-art-c6e01548c5134fffa0bf22d6474f0aad |
| institution | DOAJ |
| issn | 1472-6963 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj-art-c6e01548c5134fffa0bf22d6474f0aad2025-08-20T02:39:41ZengBMCBMC Health Services Research1472-69632024-12-0124111310.1186/s12913-024-12049-xAn integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategiesLaura K. Beres0Mammatli Chabela1Matseliso Masitha2Zachary Catanzarite3Vincent J. Tukei4Lynne Mofenson5Appolinaire Tiam6Lauren Greenberg7Majoalane Mokone8Ramatlapeng Thabelo9Masepeli Nchephe10Tsietso Mots’oane11Laura Guay12Amy R. Knowlton13Johns Hopkins University, Bloomberg School of Public Health, Department of International HealthElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationJohns Hopkins University, Bloomberg School of Public Health, Department of Health, Behavior and SocietyElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationMinistry of HealthMinistry of HealthMinistry of HealthElizabeth Glaser Pediatric AIDS FoundationJohns Hopkins University, Bloomberg School of Public Health, Department of Health, Behavior and SocietyAbstract Background Reducing perinatal HIV transmission and optimizing maternal and child health (MCH) outcomes in high HIV prevalence settings is an urgent, but complex, priority. Extant interventions over-emphasize individual-level provider and patient behaviors, and neglect critical health systems-level changes. The ‘Integrated Management Team to Improve Maternal-Child Outcomes (IMPROVE)’ study implemented a three-part, patient-centered, health-systems-level intervention to improve MCH and HIV outcomes in Lesotho. Ensuring intervention fit within the health systems context is important, but often overlooked. This manuscript describes implementation research conducted to tailor and adapt intervention implementation to optimize appropriateness, acceptability, and feasibility. It identifies resulting implementation variation across study sites and lessons learned. Methods The research team reviewed intervention implementation documentation and conducted structured reflections to: 1) assess implementation strategy adaptations, 2) identify facility-specific strategies employed to improve the MCH patient experience, and 3) synthesize lessons. Results Facility-based, integrated, multi-disciplinary management teams (MDT) were feasible and acceptable to establish through engagement with facility leadership and facilitation of a participatory training curriculum that established shared values between cadres supporting MCH, and identified facility-specific service delivery gaps and potential solutions. Ongoing MDT meetings provided coordination between facility and community-based MCH service providers to implement early ANC follow-up. Facility-specific improvement strategies included fee, staffing, and patient documentation-based changes. Piloting Positive Health, Dignity, and Prevention-focused counseling approaches resulted in tailored job aids pre-implementation. Leadership involvement was critical for improved coordination while staff turnover and competing donor priorities challenged MDT efforts. Conclusions IMPROVE created facility-specific adaptation opportunities through participatory intervention implementation practices. The MDTs, benefitting from leadership support, built relationships between HCW cadres, led facility-specific quality improvements, and, importantly, offered HCWs sought-after positive feedback by recognizing HCW efforts. The coordination, monitoring and cross-cadre communication functions of the MDTs supported implementation of other interventions, and may serve as a valuable platform for improving patient-centered care practices in similar settings and for other health services. Trial registration number: NCT04598958, 05 October 2020, retrospectively registered. Trial registration ClinicalTrials.gov, NCT04598958. Registered 05 October 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04598958https://doi.org/10.1186/s12913-024-12049-xHIV/AIDSMultidisciplinary care teamCare coordinationMaternal and child healthMother-to-child HIV transmissionAntiretroviral therapy (ART) adherence |
| spellingShingle | Laura K. Beres Mammatli Chabela Matseliso Masitha Zachary Catanzarite Vincent J. Tukei Lynne Mofenson Appolinaire Tiam Lauren Greenberg Majoalane Mokone Ramatlapeng Thabelo Masepeli Nchephe Tsietso Mots’oane Laura Guay Amy R. Knowlton An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies BMC Health Services Research HIV/AIDS Multidisciplinary care team Care coordination Maternal and child health Mother-to-child HIV transmission Antiretroviral therapy (ART) adherence |
| title | An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies |
| title_full | An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies |
| title_fullStr | An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies |
| title_full_unstemmed | An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies |
| title_short | An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies |
| title_sort | integrated multidisciplinary management team intervention to improve patient centeredness hiv and maternal child outcomes in lesotho formative research on participatory implementation strategies |
| topic | HIV/AIDS Multidisciplinary care team Care coordination Maternal and child health Mother-to-child HIV transmission Antiretroviral therapy (ART) adherence |
| url | https://doi.org/10.1186/s12913-024-12049-x |
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