• Marcel YotebiengEmail author,
  • Frieda Behets,
  • Bienvenu Kawende,

BMC Health Services ResearchBMC series – open, inclusive and trusted201717:306

DOI: 10.1186/s12913-017-2253-9

Received: 21 March 2017

Accepted: 20 April 2017

Published: 26 April 2017



Despite the rapid adoption of the World Health Organization’s 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum.


The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics.


If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation.

Trial registration

The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669.


Universal test-and-treat Prevention of mother-to-child transmission Continuous quality improvement Cluster-randomized trial DR Congo