# Scaling up the systems analysis and improvement approach for prevention of mother-to-child HIV transmission in Mozambique (SAIA-SCALE)

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2021 · $600,272

## Abstract

Despite significant increases in global health investment and the availability of low-cost, efficacious
interventions designed to prevent mother to child HIV transmission (PMTCT) 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. The
introduction of the Option B+ strategy – where HIV-infected pregnant women rapidly initiate lifelong
antiretroviral therapy (ART) independent of disease status – has the potential to dramatically reduce HIV
transmission during pregnancy, birth and the breastfeeding period, and as a result, it has been scaled up
throughout high HIV burden countries in sub-Saharan Africa. Despite these significant investments to scale-up
Option B+, results have been poor, with high rates of loss to follow-up and low viral suppression, leading to
continued HIV transmission to children and HIV-associated morbidity among mothers. A previous research
project (the Systems Analysis and Improvement Approach – or SAIA – cluster randomized trial) demonstrated
that a package of systems engineering tools including cascade analysis, process mapping, and continuous
quality improvement, was effective at improving flow through the PMTCT cascade across three sub-Saharan
African countries. The overall goal of this application is to develop a model to deliver the SAIA intervention
(SAIA-SCALE) that is led by district maternal and child health (MCH) supervisors (rather than research
nurses), to serve as a foundation for national scale-up. We propose to implement the SAIA intervention in all
districts in one province in Mozambique using MCH supervisors as disseminating agents, who will implement
SAIA in subordinate health facilities. Using a three-year phased-in design, 12 districts will be randomly
allocated into three implementation waves, and a mixed-methods evaluation will be used to assess the impact
of the intervention. Our specific aims are to: Aim 1: Develop an effective district-based dissemination and
implementation strategy for the SAIA intervention (SAIA-SCALE), using the RE-AIM model to evaluate the
program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance; and Aim 2: Using activity based
micro-costing and mathematical models of HIV transmission, estimate the budget and program impact from the
payer perspective to scale-up the SAIA intervention compared to the standard of care. The results of this
implementation research are expected to generate knowledge of global health significance, and by providing a
real-world implementation model for the SAIA intervention and programmatically relevant information, is
designed to lead to rapid policy translation for future scale-up in countries with high burden of HIV and weak
PMTCT delivery systems.

## Key facts

- **NIH application ID:** 10102279
- **Project number:** 5R01MH113435-05
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Kenneth Sherr
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $600,272
- **Award type:** 5
- **Project period:** 2017-03-15 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10102279

## Citation

> US National Institutes of Health, RePORTER application 10102279, Scaling up the systems analysis and improvement approach for prevention of mother-to-child HIV transmission in Mozambique (SAIA-SCALE) (5R01MH113435-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10102279. Licensed CC0.

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