Use of the antenatal antiretroviral (ARV) tracking form in maternity case records to improve ARV management
Background. The correct antiretroviral (ARV) management of HIV-positive pregnant women can be complex, with many variables to consider. uMgungundlovu District Management in KwaZulu-Natal (KZN) Province, South Africa, suspected that the taking and retrieval of blood tests relating to ARV management in pregnancy could be improved. An antenatal ARV tracking form was therefore designed: a dedicated page on which to write all the ARV-related blood results and remind clinicians to take the correct bloods at the appropriate time. The form was photocopied and distributed to all antenatal clinics throughout uMgungundlovu District.
Objectives. To audit uptake of use of the tracking form by antenatal clinicians, and to audit quality of care – did using the tracking form prompt the correct bloods to be taken and retrieved at the right time, and with correct antiretroviral management and outcome?
Methods. Data were collected by retrospective chart review of maternity case records of women who delivered at Northdale District Hospital, uMgungundlovu District, KZN. We determined compliance with use of the tracking form in the maternity case records of all HIV-positive women delivering at the hospital, and assessed quality of care by scoring 100 records of women with a tracking form in comparison with 100 records of women without one.
Results. District-wide uptake of use of the tracking form in maternity case records was 95%. Quality of care showed a statistically significant improvement in women with a tracking form present in their maternity case record: nearly 80% of those with a form were correctly managed at the booking visit, v. <20% of those without one (79% v. 19%; p<0.001). The differences in quality of care persisted at 3 and 6 months after booking. In terms of outcome, HIV viral load was suppressed at the time of delivery in 86% of women with a tracking form v. 65% of those without, and 5% of women with a tracking form had an unknown viral load v. 21% of those without.
Conclusions. Uptake of use of the tracking form increased markedly after implementation. Use of the form significantly improved the taking and retrieval of blood tests and the management of ARVs. The form has since been printed as part of the new maternity case records in KZN.
T P Kerry, District Clinical Specialist Team, uMgungundlovu District, KwaZulu-Natal, South Africa
P G T Cudahy, Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, Conn., USA; and Department of Internal Medicine, Edendale Hospital, Pietermaritzburg, South Africa
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Date published: 2020-11-27
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