Background: Efficacious interventions to prevent mother-to-child
HIV transmission (PMTCT) have not translated well into effective
programs. Previous studies of systems engineering applications to
PMTCT lacked comparison groups or randomization.
Methods: Thirty-six health facilities in Côte d’Ivoire, Kenya, and
Mozambique were randomized to usual care or a systems engineering
intervention, stratified by country and volume. The
intervention guided facility staff to iteratively identify and then
rectify barriers to PMTCT implementation. Registry data quanti-
fied coverage of HIV testing during first antenatal care visit,
antiretrovirals (ARVs) for HIV-positive pregnant women, and
screening HIV-exposed infants (HEI) for HIV by 6–8 weeks. We
compared the change between baseline (January 2013–January
2014) and postintervention (January 2015–March 2015) periods
using t-tests. All analyses were intent-to-treat.
Results: ARV coverage increased 3-fold [+13.3% points (95% CI:
0.5 to 26.0) in intervention vs. +4.1 (212.6 to 20.7) in control
facilities] and HEI screening increased 17-fold [+11.6 (22.6 to 25.7)
in intervention vs. +0.7 (212.9 to 14.4) in control facilities]. In
prespecified subgroup analyses, ARV coverage increased signifi-
cantly in Kenya [+20.9 (23.1 to 44.9) in intervention vs. 221.2
(252.7 to 10.4) in controls; P = 0.02]. HEI screening increased
significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs.
+3.7 (213.1 to 20.6) in controls; P = 0.04]. HIV testing did not
differ significantly between arms.
Conclusions: In this first randomized trial of systems engineering
to improve PMTCT, we saw substantially larger improvements in
ARV coverage and HEI screening in intervention facilities compared
with controls, which were significant in prespecified subgroups.
Systems engineering could strengthen PMTCT service delivery and
protect infants from HIV