Cost and Effectiveness of Systems Analysis & Improvement Approach for pMTCT

In 2014, a cluster randomized controlled trial (RCT) in Mozambique, Côte d’Ivoire and Kenya collected data to evaluate a standardized Systems Analysis Improvement Approach (SAIA) that applies industrial and systems engineering techniques to pMTCT service delivery. The SAIA intervention will facilitate understanding and improvement of the complex, interconnected components that comprise pMTCT, thereby supporting the translation of evidence on efficacious interventions that prevent vertical HIV transmission into effective programs at scale. An additional supplemental study, building off of the SAIA trial, was funded by the National Institutes of Health in mid-2014. Through this supplemental study, Health Alliance International will incorporate biological and other patient-level outcomes into the SAIA trial in Mozambique, and model cost effectiveness of the SAIA intervention. The specific aims to this study are to: 1) Evaluate SAIA effectiveness on HIV-free infant survival, and identify maternal and program-level determinants of HIV-free infant survival relevant for Option B+; 2) Evaluate SAIA effectiveness on maternal ART adherence, retention in care, and viral suppression, and identify patient and program-level determinants of maternal outcomes relevant for Option B+; and 3) Evaluate SAIA cost effectiveness as well as provide relevant cost data on Option B+.