Systems Analysis and Improvement to Optimize pMTCT

January 24, 2017 updated by: Kenneth Sherr, University of Washington

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 Côte 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 Côte 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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

36

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Côte D'Ivoire
      • Bouake, Côte D'Ivoire
        • Ministry of Health
  • Kenya
      • Nairobi, Kenya
        • Ministry of Health
  • Mozambique
    • Sofala
      • Beira, Sofala, Mozambique
        • Ministry of Health

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • health facility with pMTCT services in central Mozambique, northern Cote d'Ivoire or western Kenya
  • health facility with at least 20 HIV-infected women identified in antenatal care per year

Exclusion Criteria:

  • health facility over 20 kilometers from a main transport corridor
  • health facility with an ongoing prospective study or systems analysis and improvement approach in place

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Systems analysis and improvement
pMTCT systems analysis and improvement
Other: pMTCT systems analysis and improvement
Five-step systems analysis and iterative improvement cycles carried out over a six-month period in intervention facilities.
No Intervention: Control
No systems analysis and improvement intervention for prevention of mother to child HIV transmission services in place.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Uptake of HIV counseling and testing at first antenatal care visit
Time Frame: Patients will be assessed at first antenatal care visit (average of 25 weeks gestational age)
# women counseled and tested for HIV in their first ANC visit/# first ANC visits
Patients will be assessed at first antenatal care visit (average of 25 weeks gestational age)
Uptake of CD4 testing at antenatal care
Time Frame: Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age)
# CD4 counts of HIV-infected pregnant women/# HIV-infected women newly identified in ANC
Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age)
Use of appropriate ARVs in pregnancy for prophylaxis or initiation of ART during pregnancy
Time Frame: Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age)
# HIV-infected pregnant women starting AZT prophylaxis or ART /# women testing HIV-positive in ANC 3 months previously
Patients will be assessed during the antenatal care period (average of 25-40 weeks gestational age)
Infant HIV determination
Time Frame: 6 weeks post-partum
# infants <6 weeks of age receiving a PCR test/# women testing HIV-positive in ANC 5 months previously
6 weeks post-partum

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Washington

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Eduardo Mondlane University
Health Alliance International
Network of AIDS Researchers of Eastern and Southern Africa
Centro de Investigacao Operacional da Beira

Investigators

  • Principal Investigator: Kenneth Sherr, PhD, University of Washington

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2014

Primary Completion (Actual)

March 1, 2015

Study Completion (Actual)

March 1, 2015

Study Registration Dates

First Submitted

December 9, 2013

First Submitted That Met QC Criteria

December 23, 2013

First Posted (Estimate)

December 30, 2013

Study Record Updates

Last Update Posted (Estimate)

January 26, 2017

Last Update Submitted That Met QC Criteria

January 24, 2017

Last Verified

January 1, 2017

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 44167-EG
  • R01HD075057 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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