Improving HIV Prevention and Treatment Integration in Family Planning Clinics Using the Systems Analysis and Improvement Approach SAIA in Kenya

What this Trial Is About

East and Southern Africa, home to a significant portion of the global population living with HIV, faces a high HIV burden, especially among adolescent girls and young women AGYW. This research evaluates the Systems Analysis and Improvement Approach SAIA, an implementation strategy aimed at improving HIV counseling, testing, linkage to care, and pre-exposure prophylaxis PrEP services in family planning FP clinics. The study focuses on assessing SAIAs effectiveness when delivered at scale by Kenyan public health workers compared to usual procedures without specific interventions. The study involves a cluster-randomized trial where SAIA is implemented in selected FP clinics by Mombasa County public health staff. SAIA uses a five-step cycle repeated every 4-6 weeks, including understanding the care cascade, identifying bottlenecks through process mapping, implementing workflow changes, monitoring performance, and repeating improvement cycles. The intervention aims to improve HIV prevention and treatment integration within FP services, with particular attention to new FP clients and new and returning AGYW clients. Participants involvement includes receiving HIV counseling, testing, linkage to care, and PrEP screening as part of routine FP services, with data collected over 24 months. Researchers will analyze quantitative and qualitative data using the RE-AIM framework to evaluate reach, effectiveness, adoption, implementation, and maintenance of SAIA. Additionally, the study will estimate the costs and budget impact of scaling SAIA at the county level. The total study duration includes continuous monitoring and assessment of outcomes from months 1 to 24.

Systems Analysis and Improvement Approach to Improve Integration of HIV Prevention and Treatment Services