HIV
Conditions
Keywords
HIV, pMTCT
Brief summary
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 contextually appropriate systems analysis and improvement approaches can potentially reduce drop-offs along the pMTCT cascade, leading to dramatic improvements in infant and maternal outcomes. The goal of this proposal is to develop a model for systematic assessment and improvement of pMTCT services in sub-Saharan Africa. In specific aim 1, we will identify health system factors and service delivery approaches associated with high and low performing pMTCT services in Côte d'Ivoire, Kenya and Mozambique. In specific aim 2 we will adapt evaluate the feasibility and impact of a systems analysis tool and associated performance enhancement approach for pMTCT services in Côte d'Ivoire, Kenya and Mozambique. This systems analysis tool and associated performance enhancement approach is currently being developed and piloted for pMTCT services in Mozambique. 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.
Interventions
OTHERpMTCT systems analysis and improvement
Five-step systems analysis and iterative improvement cycles carried out over a six-month period in intervention facilities.
Sponsors
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Network of AIDS Researchers of Eastern and Southern Africa
Centro de Investigacao Operacional da Beira
Health Alliance International
Eduardo Mondlane University
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* health facility with pMTCT services in central Mozambique, northern Cote d'Ivoire or western Kenya * health facility with at least 20 HIV-infected women identified in antenatal care per year
Exclusion criteria
* health facility over 20 kilometers from a main transport corridor * health facility with an ongoing prospective study or systems analysis and improvement approach in place
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Uptake of HIV counseling and testing at first antenatal care visit | Patients will be assessed at first antenatal care visit (average of 25 weeks gestational age) | \# women counseled and tested for HIV in their first ANC visit/# first ANC visits |
| Uptake of CD4 testing at antenatal care | Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age) | \# CD4 counts of HIV-infected pregnant women/# HIV-infected women newly identified in ANC |
| Use of appropriate ARVs in pregnancy for prophylaxis or initiation of ART during pregnancy | Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age) | \# HIV-infected pregnant women starting AZT prophylaxis or ART /# women testing HIV-positive in ANC 3 months previously |
| Infant HIV determination | 6 weeks post-partum | \# infants \<6 weeks of age receiving a PCR test/# women testing HIV-positive in ANC 5 months previously |
Countries
Côte d’Ivoire, Kenya, Mozambique
Outcome results
None listed