Cascade Analysis: An Adaptable Implementation Strategy Across HIV and Non-HIV Delivery Platforms

Area of Science:

• Health Systems Research
• Public Health Interventions
• Implementation Science

Background:

• Health system cascades are crucial for understanding sequential steps in care.
• Routine data can guide system improvements but is often inaccessible to frontline healthcare workers (HCWs).
• Empowering HCWs is key to innovating health system improvements.

Purpose of the Study:

• To introduce the Cascade Analysis Tool (CAT), a simulation model for health system prioritization.
• To highlight the adaptability and diverse applications of CAT across various disease areas and settings.

Main Methods:

• CAT is an Excel-based simulation model with an optimization function.
• It identifies critical steps within a health cascade for maximum system improvement.
• Adaptations involved technical (denominator estimation, binary steps) and logistical (data abstraction, HCW burden) considerations.

Main Results:

• CAT has been adapted for diverse applications including HIV, hypertension, mental health, and opioid overdose reversal.
• Adaptations have been made for mobile applications and across various geographical regions (Mozambique, Kenya, US).
• Key adaptations focused on technical aspects and practical data management for HCWs.

Conclusions:

• The Cascade Analysis Tool (CAT) is an effective, feasible, and acceptable strategy for prioritizing health system improvements.
• CAT enhances HCW autonomy, provides prompt feedback, and enables equitable resource allocation.
• Ongoing evaluations of CAT adaptations are underway to further refine its implementation.