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. 

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Funding

[2017-2022] Scaling up the Systems Analysis and Improvement Approach for pMTCT in Mozambique.

This project receives funding support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH113435, 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.

[2016-2019] Usability and Feasibility of a Phone-based Decision Support Tool for Option B+.

This project received funding support from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R21AI124399, via a subagreement from the University of Washington.

[2014-2017] Assessing a tablet-based clinical training approach for nurses providing Option B+ services.

This project received funding support from the National Institute of Allergy and Infectious Disease of the National Institutes of Health under award number P30AI027757, via a subagreement from the University of Washington.

[2014-2015] Cost and Effectivenss of Systems Analysis & Improvement for pMTCT in Mozambique.

This project received funding support from the National Institute of Child Health and Human Development of the National Institutes of Health as a supplement to 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

WHAT IS SAIA?

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