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：一项群集随机试验。尽管全球卫生投资大幅增加，而且在艾滋病毒负担沉重的低收入和中等收入国家提供了旨在减少母婴艾滋病毒传播的低成本、有效干预措施，但将这些科学进步转化为有效的交付战略的工作一直缓慢、不平衡和不完整。因此，儿童艾滋病毒感染在很大程度上仍然不受控制。通过适当的系统分析和改进方法，加强实施预防母婴传播干预措施，有可能减少预防母婴传播连锁反应的沿着下降，从而大大改善婴儿和孕产妇的结局。该提案的目标是建立一个模式，用于系统评估和改善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行这一系统分析工具和相关的业绩增强办法。这项实施研究的结果预计将产生对全球卫生重要性的认识，并通过广泛的总统艾滋病紧急救援计划网络传播研究结果和干预工具，可以迅速影响最需要的国家的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.