SAIA-PMTCT: Optimizing the prevention of mother-to-child HIV transmission 

HAI faculty at the UW led the research that established the effectiveness, adaptability, and scalability of the Systems Analysis and Improvement Approach (SAIA) to improve service delivery for the prevention of mother-to-child transmission of HIV (PMTCT).

Mother-to-child HIV transmission rates can be reduced to <1% using known prevention and treatment regimens.  Unfortunately, effective implementation of and adherence to these regimens have been uneven in practice in sub-Saharan Africa, often due to the complexity of the PMTCT cascade, which requires multiple sequential, conditional visits over 2+ years for HIV-positive women and their infants.

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. Designed by HAI faculty at the University of Washington, SAIA was initially piloted in Mozambique, and later evaluated through a cluster randomized trial in Mozambique, Côte d’Ivoire and Kenya to test the effectiveness of the approach on PMTCT service delivery. Over 9 months, 18 facilities tested 158 workflow modification resulting in substantial increases in ARV initiation (3-fold increase in intervention facilities compared with control) and HIV screening among HIV-exposed infants (17-fold increase in intervention facilities compared with controls). 

HAI and UW are collaborating on a follow-on study in Mozambique to evaluate the scalability and effectiveness of the SAIA strategy when implemented by public sector health providers opposed to research nurses. 


Since April 2018, the SAIA-SCALE project has been supporting district managers in all 12 districts of Manica province to introduce and support the SAIA approach to strengthen prevention of mother-to-child HIV transmission services in three health facilities in each district.  Notably, the first 30 months of implementation demonstrated enduring enthusiasm for the approach and, that with modest financial support and practical tools, district managers can enhance their routine work with creative, testable, facility-level micro-interventions.



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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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