Conference Abstract | Volume 8, Abstract NACNDC/19JASH00049 (Poster) | Published: 28 Nov 2025
Ceasar Nyeko1,&, John Khisa1, Ronald Tamale1, Joseph Ekong1
1Uganda Episcopal Conference (UEC)-Uganda Catholic Medical Bureau (UCMB), Kampala-Uganda.
&Corresponding author: Ceasar Nyeko, Uganda Episcopal Conference (UEC)-Uganda Catholic Medical Bureau (UCMB), Kampala-Uganda, Email: ceasarnyeko02@gmail.com
Received: 21 Sep 2025, Accepted: 20 Oct 2025, Published: 28 Nov 2025
Domain: Infectious Disease Epidemiology
Keywords: Task shifting, Point-of-care testing, Duty roster optimisation, on-site mentorship
©Ceasar Nyeko et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Ceasar Nyeko et al. Using multiple CQI approaches to strengthen rapid gains in maternal HIV re-testing through task-shifting and point-of-care testing: A multi-site CQI project in Masaka, Uganda, Jan–Jun 2025. Journal of Interventional Epidemiology and Public Health. 2025;8(ConfProc6):00049. https://doi.org/10.37432/JIEPH-CONFPRO6-00049
Uganda’s 2022 consolidated guidelines recommend repeat HIV testing in the third trimester and at delivery/postpartum to detect incident infection and prevent vertical transmission. However, retesting uptake remains suboptimal in routine services. Despite the roll out of the new guidelines through training, CMEs, mentorship & dissemination of the printed SOPs, health facilities continue to perform below the expected standard of care, jeopardizing reduction of mothers to get child transmission of HIV. Women who acquire HIV during pregnancy or breast feeding after an initial HIV negative test result have a high risk at least a 40% chance of transmitting the infection to the baby. Re-testing helps to identify HIV positive women infected later during pregnancy or breastfeeding and initiate them on treatment to prevent transmission to the babies. The Quality Improvement (QI) team at UCMB noted a significant underutilization of maternal retesting among eligible women (of the 710 eligible women for maternal retesting in Oct-Dec 2024 quarter, only 149(21%) were retested.
We conducted a multi-facility quality-improvement (QI) initiative in 11 Uganda Catholic Medical Bureau (UCMB) facilities in Masaka Region (3 hospitals, 8 lower-level units). Baseline coverage of maternal retesting among eligible women was measured in Oct–Dec 2024 using routine registers. Beginning Jan 2025, sites implemented a standardized QI bundle: (1) roster optimization to ensure ≥2 midwives on ANC/MAT/PNC clinic days; (2) task shifting to counsellors/VHTs for eligibility screening and pre-test counselling; (3) relocation of retesting to point-of-care stations to reduce delays; and (4) on-site mentorship for all midwives (not only PMTCT focal persons). Sites ran monthly PDSA cycles with run charts reviewed in departmental meetings. The primary outcome was maternal retesting coverage (% of eligible women retested per month). Secondary measures included missed-opportunity rate and turnaround time from eligibility to test.
At baseline, 21% (149/710) of eligible women were retested. After implementation, monthly retesting coverage increased steadily, reaching 91% by June 2025 across the 11 facilities. Improvements were observed in both hospitals and lower-level units. Facilities reported reduced missed opportunities after moving testing to POC and extending mentorship to all midwives. No stock-outs or prolonged waiting times were reported during the period.
A pragmatic QI bundle staffing optimization, task shifting, point-of-care retesting, and unit-wide mentorship was associated with substantial and rapid gains in maternal HIV retesting coverage in faith-based facilities. Scaling this approach, aligned with national retesting schedules, could accelerate early detection of incident maternal infection and reduce vertical transmission risk in high-burden settings.
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