In Mozambique, the SAIA team is evaluating the evidence-based Systems Analysis and Improvement Approach (SAIA) to optimize hypertension screening and treatment services for people living with HIV.

Undiagnosed and untreated hypertension is the largest driver of cardiovascular disease globally, including in high HIV burden countries such as Mozambique. With the expansion of HIV treatment, the population of people living with HIV is aging and, as a result, is increasingly in need of comprehensive hypertension screening and management.

The Systems Analysis and Improvement Approach (SAIA) is an evidence-based multi-step implementation strategy that systematically identifies barriers and facility-level solutions to health care delivery and patient flow using a systems engineering approach. As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, HAI is committed to evaluating the effectiveness of SAIA—shown to be effective in improving efficiency and coverage of HIV services—when applied to non-communicable disease services.

In the SAIA-Hypertension project, HAI worked with the District Health Directorates of Manica & Sofala provinces and the Department of Cardiology at the University of Eduardo Mondlane to adapt the SAIA toolkit for use in hypertension care among people living with HIV in Mozambique.  A cluster randomized trial aims to assess whether the SAIA strategy effectively improves screening, linkage to care, treatment initiation, blood pressure monitoring, and adherence to anti-hypertensive medication among PLHIV, and also provide actionable guidance on implementation best practices and cost effectiveness to guide nationwide scale-up.

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