TY - JOUR
T1 - Implementation and Operational Research
T2 - Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial
AU - SAIA Study Team
AU - Rustagi, Alison Silvis
AU - Gimbel, Sarah
AU - Nduati, Ruth
AU - Cuembelo, Maria De Fatima
AU - Wasserheit, Judith N.
AU - Farquhar, Carey
AU - Gloyd, Stephen
AU - Sherr, Kenneth
AU - Henley, Catherine
AU - Koné, Ahoua
AU - Robinson, Julia
AU - Granato, S. Adam
AU - Kouyaté, Seydou
AU - Mbatia, Grace
AU - Wariua, Grace
AU - Maina, Martin
AU - Njuguna, Peter Mwaura
AU - Coutinho, Joana
AU - Cruz, Emelita
AU - Moore, Quincy
AU - Zucule, Justina
AU - Wagenaar, Bradley
AU - Pfeiffer, James
N1 - Funding Information:
This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Disease, the National Cancer Institute, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, and the National Institute on Aging of the US National Institutes of Health under award numbers R01HD075057 (awarded to K.S.) and P30AI027757 (awarded to the University of Washington Center for AIDS Research), as well as the Doris Duke Charitable Foundation's African Health Initiative (awarded to K.S. and M.D.F.C.), and the Fogarty International Center grant number K02TW009207 (awarded to K.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the article.
Publisher Copyright:
© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization. Methods: Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6-8 weeks. We compared the change between baseline (January 2013-January 2014) and postintervention (January 2015-March 2015) periods using t-tests. All analyses were intent-to-treat. Results: ARV coverage increased 3-fold [+13.3% points (95% CI: 0.5 to 26.0) in intervention vs. +4.1 (-12.6 to 20.7) in control facilities] and HEI screening increased 17-fold [+11.6 (-2.6 to 25.7) in intervention vs. +0.7 (-12.9 to 14.4) in control facilities]. In prespecified subgroup analyses, ARV coverage increased significantly in Kenya [+20.9 (-3.1 to 44.9) in intervention vs. -21.2 (-52.7 to 10.4) in controls; P 0.02]. HEI screening increased significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs. +3.7 (-13.1 to 20.6) in controls; P 0.04]. HIV testing did not differ significantly between arms. Conclusions: In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared with controls, which were significant in prespecified subgroups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.
AB - Background: Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization. Methods: Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6-8 weeks. We compared the change between baseline (January 2013-January 2014) and postintervention (January 2015-March 2015) periods using t-tests. All analyses were intent-to-treat. Results: ARV coverage increased 3-fold [+13.3% points (95% CI: 0.5 to 26.0) in intervention vs. +4.1 (-12.6 to 20.7) in control facilities] and HEI screening increased 17-fold [+11.6 (-2.6 to 25.7) in intervention vs. +0.7 (-12.9 to 14.4) in control facilities]. In prespecified subgroup analyses, ARV coverage increased significantly in Kenya [+20.9 (-3.1 to 44.9) in intervention vs. -21.2 (-52.7 to 10.4) in controls; P 0.02]. HEI screening increased significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs. +3.7 (-13.1 to 20.6) in controls; P 0.04]. HIV testing did not differ significantly between arms. Conclusions: In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared with controls, which were significant in prespecified subgroups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.
KW - HIV/AIDS
KW - PMTCT
KW - health systems
KW - health systems performance
KW - maternal health services
KW - systems engineering
UR - http://www.scopus.com/inward/record.url?scp=84963606384&partnerID=8YFLogxK
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U2 - 10.1097/QAI.0000000000001023
DO - 10.1097/QAI.0000000000001023
M3 - Article
C2 - 27082507
AN - SCOPUS:84963606384
SN - 1525-4135
VL - 72
SP - e68-e76
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 3
ER -