Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial.

Area of Science:

• Global Health
• Implementation Science
• Public Health Interventions

Background:

• Despite increased global health investment, preventing mother-to-child HIV transmission (pMTCT) in high-burden countries remains challenging due to slow adoption of scientific advances.
• Pediatric HIV infection rates persist due to inefficiencies in delivering pMTCT services.
• A Systems Analysis and Improvement Approach (SAIA) was developed to address these delivery gaps.

Purpose of the Study:

• To describe the SAIA intervention protocol designed to enhance pMTCT service delivery.
• To evaluate the impact of the SAIA intervention on reducing drop-offs within the pMTCT cascade.
• To improve maternal and infant outcomes by optimizing pMTCT service provision.

Main Methods:

• A two-arm, longitudinal cluster randomized trial involving 90 health facilities across Côte d'Ivoire, Kenya, and Mozambique.
• The SAIA intervention was implemented over six months in 18 intervention facilities.
• Primary outcomes assessed include HIV testing rates, adequate prophylaxis for HIV-infected pregnant women, and timely HIV diagnosis for newborns.

Main Results:

• The study is designed as a pragmatic trial to assess the effectiveness of the SAIA intervention.
• Qualitative data on implementation processes will be collected and analyzed using the Consolidated Framework for Implementation Research (CFIR).
• The SAIA intervention provides tools for facility-level decision-making to identify cost-effective pMTCT improvements.

Conclusions:

• The SAIA intervention has the potential to significantly improve maternal and infant outcomes by streamlining the pMTCT cascade.
• This approach offers practical, low-cost strategies for enhancing pMTCT services in resource-limited settings.
• The study aims to provide a scalable model for improving pediatric HIV prevention globally.