Despite significant increases in global health investment and the availability of low-cost, efficacious interventions designed to reduce mother to child HIV transmission in low and middle-income countries with high HIV burden, the translation of these scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled.
Enhancing the implementation of PMTCT interventions through appropriate systems analysis and improvement approaches can potentially reduce drop-offs along the PMTCT cascade, leading to dramatic improvements in infant and maternal outcomes. HAI received funding from the National Institutes of Health (NIH) in 2013 to conduct a three-year project to develop a model for systematic assessment and improvement of PMTCT services in Côte d’Ivoire, Kenya and Mozambique that will have generalizable application to optimize PMTCT services across PEPFAR-supported countries in sub-Saharan Africa.
Specific aims of this study are to:
- Identify health system factors and service delivery approaches associated with high and low performing PMTCT services;
- Develop and refine a systems analysis tool and associated performance enhancement approach for application to PMTCT services, and;
- Evaluate the feasibility and impact of a systems analysis tool and associated performance enhancement approach for PMTCT services.
To respond to aim three, a cluster randomized trial was implemented in early 2014, comparing changes in PMTCT performance indicators in 18 intervention and 18 control facilities. This study is sufficiently robust to provide country-level estimates of PMTCT improvement associated with the study intervention. Additional process data has also been collected to identify mediating factors for successful implementation of the study intervention and best practice workflow modifications that optimize PMTCT performance. The results of this implementation research are expected to generate knowledge of global health significance, and by disseminating the study results and intervention tools through the broad PEPFAR network, can rapidly impact PMTCT service delivery enhancements across the highest need countries.
This study is supported by a grant from the National Institutes of Health.