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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Systems analysis and improvement to optimize pMTCT (SAIA): A cluster randomized trial
Implementation Science, Volume 9, No. 1, Article 55, Year 2014
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Description
Background: Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) in low- and middle-income countries with high HIV burden, the translation of scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. A five-step, facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of pMTCT service provision by improving understanding of inefficiencies (step one: cascade analysis), guiding identification and prioritization of low-cost workflow modifications (step two: value stream mapping), and iteratively testing and redesigning these modifications (steps three through five). This protocol describes the SAIA intervention and methods to evaluate the intervention's impact on reducing drop-offs along the pMTCT cascade.Methods: This study employs a two-arm, longitudinal cluster randomized trial design. The unit of randomization is the health facility. A total of 90 facilities were identified in Côte d'Ivoire, Kenya and Mozambique (30 per country). A subset was randomly selected and assigned to intervention and comparison arms, stratified by country and service volume, resulting in 18 intervention and 18 comparison facilities across all three countries, with six intervention and six comparison facilities per country. The SAIA intervention will be implemented for six months in the 18 intervention facilities. Primary trial outcomes are designed to assess improvements in the pMTCT service cascade, and include the percentage of pregnant women being tested for HIV at the first antenatal care visit, the percentage of HIV-infected pregnant women receiving adequate prophylaxis or combination antiretroviral therapy in pregnancy, and the percentage of newborns exposed to HIV in pregnancy receiving an HIV diagnosis eight weeks postpartum. The Consolidated Framework for Implementation Research (CFIR) will guide collection and analysis of qualitative data on implementation process.Discussion: This study is a pragmatic trial that has the potential benefit of improving maternal and infant outcomes by reducing drop-offs along the pMTCT cascade. The SAIA intervention is designed to provide simple tools to guide decision-making for pMTCT program staff at the facility level, and to identify low cost, contextually appropriate pMTCT improvement strategies.Trial registration: ClinicalTrials.gov NCT02023658. © 2014 Sherr et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Sherr, Kenneth H.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Gimbel, Sarah O.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Rustagi, Alison S.
United States, Seattle
University of Washington
Nduati, Ruth W.
Kenya, Nairobi
Network of Aids Researchers in East and Southern Africa
Kenya, Nairobi
University of Nairobi
Cuembelo, Fátima
Mozambique, Maputo
Universidade Eduardo Mondlane
Farquhar, Carey
United States, Seattle
University of Washington
Wasserheit, Judith N.
United States, Seattle
University of Washington
United States, Seattle
University of Washington School of Medicine
Gloyd, Stephen S.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Koné, Ahoua
Unknown Affiliation
Robinson, Julia
Unknown Affiliation
Granato, Adam
Unknown Affiliation
Kouyaté, Seydou
Unknown Affiliation
Mbatia, Grace
Unknown Affiliation
Wariua, Grace
Unknown Affiliation
Maina, Martin
Unknown Affiliation
Njuguna, Peter Mwaura
Unknown Affiliation
Coutinho, Joana
Unknown Affiliation
Cruz, Emelita
Unknown Affiliation
Jamnadas, Mehol
Unknown Affiliation
Zucule, Justina
Unknown Affiliation
Michel, Cathy
Unknown Affiliation
Wagenaar, Bradley H.
Unknown Affiliation
Pfeiffer, James T.
Unknown Affiliation
Statistics
Citations: 52
Authors: 23
Affiliations: 6
Identifiers
Doi:
10.1186/1748-5908-9-55
e-ISSN:
17485908
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Qualitative
Study Locations
Ivory Coast
Kenya
Mozambique
Participants Gender
Female