Systems Analysis and Improvement to Optimize pMTCT: A Cluster Randomized Trial

描述（由申请人提供）：优化pMTCT的系统分析和改进：一项集群随机试验。尽管全球卫生投资大幅增加，而且在艾滋病毒负担沉重的中低收入国家有了旨在减少母婴艾滋病毒传播的低成本、有效的干预措施，但将这些科学进展转化为有效的提供战略的速度缓慢、不平衡和不完整。因此，儿童艾滋病毒感染在很大程度上仍未得到控制。通过适合具体情况的系统分析和改进方法加强预防母婴传播干预措施的实施，可以潜在地减少预防母婴传播梯级的下降，从而显著改善婴儿和孕产妇的结局。这项建议的目标是建立一个模型，系统地评估和改进撒哈拉以南非洲的预防母婴传播服务。在具体目标1中，我们将确定与科特迪瓦、肯尼亚和莫桑比克的高绩效和低绩效预防母婴传播服务相关的卫生系统因素和服务提供方法。在具体目标2中，我们将调整评估系统分析工具和相关绩效增强方法在科特迪瓦，肯尼亚和莫桑比克的预防母婴传播服务的可行性和影响。目前正在为莫桑比克的预防母婴传播服务开发和试点这一系统分析工具和相关的提高绩效方法。预计这项实施研究的结果将产生具有全球卫生意义的知识，并且通过广泛的总统防治艾滋病紧急救援计划网络传播研究结果和干预工具，可以迅速影响在最需要的国家加强预防母婴传播服务的提供。

DESCRIPTION (provided by applicant): Systems Analysis and Improvement to Optimize pMTCT: A Cluster Randomized Trial. 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 Cote 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 Cote 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. PUBLIC HEALTH RELEVANCE: This research is highly relevant to public health in developing countries, where implementation of health advancements has not reached populations with sufficient speed and scale. Through assessing whether the application of systems engineering approaches leads to improvements in pMTCT effectiveness in Cote d'Ivoire, Kenya and Mozambique, we will build evidence on how to achieve rapid, sustainable and scalable improvements in services that can dramatically improve population health measures in resource limited countries.