Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research
Open accessAbstract
Background: Despite large investments to prevent mother-to-child-transmission (PMTCT), pediatric HIV elimination goals are not on track in many countries. The Systems Analysis and Improvement Approach (SAIA) study was a cluster randomized trial to test whether a package of systems engineering tools could strengthen PMTCT programs. We sought to (1) define core and adaptable components of the SAIA intervention, and (2) explain the heterogeneity in SAIA's success between facilities. Methods: The Consolidated Framework for Implementation Research (CFIR) guided all data collection efforts. CFIR constructs were assessed in focus group discussions and interviews with study and facility staff in 6 health facilities (1 high-performing and 1 low-performing site per country, identified by study staff) in December 2014 at the end of the intervention period. SAIA staff identified the intervention's core and adaptable components at an end-of-study meeting in August 2015. Two independent analysts used CFIR constructs to code transcripts before reaching consensus. Results: Flow mapping and continuous quality improvement were the core to the SAIA in all settings, whereas the PMTCT cascade analysis tool was the core in high HIV prevalence settings. Five CFIR constructs distinguished strongly between high and low performers: 2 in inner setting (networks and communication, available resources) and 3 in process (external change agents, executing, reflecting and evaluating). Discussion: The CFIR is a valuable tool to categorize elements of an intervention as core versus adaptable, and to understand heterogeneity in study implementation. Future intervention studies should apply evidence-based implementation science frameworks, like the CFIR, to provide salient data to expand implementation to other settings.
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Self-citation
- Authors
- Gimbel, S., Rustagi, A. S., Robinson, J., Kouyate, S., Coutinho, J., Nduati, R., Pfeiffer, J., Gloyd, S., Sherr, K., with input from the SAIA study team, Granato, S. A., Kone, A., Cruz, E., Manuel, J. L., Zucule, J., Napua, M., Mbatia, G., Wariua, G., & Maina, M.
- Affiliations
- University of Washington (US)
- Health Alliance International (US)
- Health Alliance International, Bouake, Cote d'Ivoire;
- University of Nairobi (KE)
- Health Alliance International, Seattle, WA;
- Beira Operations Research Center(CIOB), Beira, Mozambique; and
- Sofala Provincial Department of Health, Beira, Mozambique.
- Network of AIDS Researchers of Eastern and Southern Africa (NARESA), Nairobi, Kenya;
- Corresponding author
- Gimbel, Sarah
- ORCID
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2016-08-01
- Volume
- 72
- Issue
- 2
- Pages
- S108-S116
- ISSN
- 1525-4135 (ISSN-L)
- PMC
- PMC5113237
- OpenAlex
- W2469559349
- Cited by
- 50
- References
- 26
- Citations by year
- 2026: 3 · 2024: 7 · 2023: 9 · 2022: 13 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 2 · 2017: 1
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Doris Duke Charitable Foundation (P30AI027757)
- University of Washington
- U.S. President’s Emergency Plan for AIDS Relief
- National Institutes of Health
- Center for AIDS Research, University of Washington (P30 AI027757)
- National Institute of Allergy and Infectious Diseases (P30AI027757)
- Fogarty International Center (K02TW009207)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD075057)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- prevention of mother-to-child transmission of HIV, Consolidated Framework for Implementation Research, implementation research, systems engineering, flow mapping, continuous quality improvement, health facility performance, intervention heterogeneity
- MeSH terms
- Female, Humans, Infant, Newborn, Cote d'Ivoire, Pregnancy, Pregnancy Complications, Infectious, Systems Analysis, HIV Infections, Infectious Disease Transmission, Vertical
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