SAIA-Hypertension: Integrating care cascades 

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

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 is working 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.  This 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.


Leading up to the trial launch, HAI worked in partnership with the Ministry of Health to identify and meet health system resource challenges, including distribution of blood pressure cuffs and essential materials, and to establish a reporting framework.

As of May 2020, the SAIA-HTN project is undeway, having launched the implementation phase of the study.

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[2019-2024] Systems Analysis and Improvement to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN).

This project receives funding support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL142412, via a subagreement from the University of Washington.

[2012-2015] Systems Analysis and Improvement to Optimize pMTCT: A Cluster Randomized Trial.

This project received funding support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number R01HD075057, via a subagreement from the University of Washington.


For additional SAIA project funding information, visit the SAIA main page.


Explore how SAIA is transforming service delivery 




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