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

描述(由申请人提供)：系统分析和改进以优化预防母婴传播：一项整群随机试验。尽管全球卫生投资大幅增加，并提供了低成本、有效的干预措施，以减少艾滋病毒负担高的低收入和中等收入国家的艾滋病毒母婴传播，但将这些科学进展转化为有效的交付战略的工作进展缓慢、不均衡和不完整。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办法加强实施防止母婴传播干预措施，有可能减少母婴传播级联过程中的降幅，从而显著改善婴儿和产妇的结局。这项提议的目标是为系统评估和改进撒哈拉以南非洲的防止母婴传播服务制定一个模式。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，我们将对科特迪瓦、肯尼亚和莫桑比克的防止母婴传播服务的系统分析工具和相关的业绩改进办法的可行性和影响进行调整和评估。目前正在为莫桑比克的防止母婴传播服务开发和试行这一系统分析工具和相关的业绩改进办法。这项实施研究的结果预计将产生对全球健康具有重要意义的知识，并通过广泛的防治艾滋病紧急救援网络传播研究结果和干预工具，从而迅速影响在最需要的国家加强预防母婴传播服务的交付。

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.