SAIA-PMTCT

Despite widespread availability of antiretroviral therapy, elimination of mother-to-child HIV transmission persists due to inefficiencies in HIV diagnosis, treatment initiation, retention in care and poor ART adherence among HIV-infected pregnant and postpartum women.

PMTCT in sub-Saharan Africa

The advent of the Option B+ strategy – where all pregnant and postpartum women initiate lifelong antiretroviral therapy (ART) – has streamlined the prevention of mother-to-child HIV prevention (PMTCT) cascade.  However, due to persistent leaks across this cascade, resulting in undiagnosed and untreated, or poorly controlled, HIV infection, leading to high mother-to-child HIV transmission, and high maternal morbidity and mortality. The original SAIA strategy was developed to address inefficiencies in the PMTCT cascade, which was evaluated through a 9-month cluster randomized-controlled trial in Côte d’Ivoire, Kenya and Mozambique, demonstrating substantial improvements in maternal ARV initiation and early infant screening.

In the follow-on scale-up effectiveness trial (SAIA-SCALE), we are assessing not if the SAIA strategy improves the PMTCT cascade, but how to take to scale SAIA across large, public sector health systems. Specifically, we are testing a novel dissemination model, where district maternal and child health supervisors (rather than research teams) lead SAIA strategy cycles in subordinate health facilities. Using a three-wave stepped wedge cluster RCT design, we are scaling SAIA for PMTCT to cover three health facilities in each of Manica’s 12 districts, and to serve as a foundation for further scale-up, are using a mixed-methods evaluation based on the RE-AIM framework to assess SAIA-SCALE’s impact. Furthermore, we are estimating the potential budget and program impact to scale-up SAIA nationally.

Recent Publications and Posters

Study Location

The original SAIA-PMTCT was implemented in health facilities across Côte d’Ivoire, Kenya, and Mozambique. The on-going SAIA-SCALE project is being implemented in 36 health facilities across all 12 districts in Manica province in central Mozambique.

SAIA-PMTCT Team

Other Investigators:

Sarah Gimbel - sgimbel@uw.edu

Grace John-Stewart - gjohn@uw.edu

Ruanne Barnabas - rbarnaba@uw.edu

James Pfeiffer - jamespf@uw.edu

Sarah Holte - sholte@fhcrc.org

Donors

Partners

Interested in collaborating? Contact us!