Evidence map›Paper›PMID 36195890›Full record

Trial reportImplementation science : IS2022

Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial.

Jessica E Long, McKenna C Eastment, George Wanje, Barbra A Richardson, Emily Mwaringa, Mwanakarama Athman Mohamed, Kenneth Sherr, Ruanne V Barnabas, Kishorchandra Mandaliya, Walter Jaoko and 1 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02994355 (HIV Testing at Family Planning Clinics in Mombasa County, Kenya), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
2.5field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02994355 nacompletednot on this map

HIV Testing at Family Planning Clinics in Mombasa County, Kenya: A Cluster-Randomized Trial Comparing the Systems Analysis and Improvement Approach (SAIA) to Usual Procedures

TypeinterventionalSponsorUniversity of WashingtonRan2018 to 2022Enrolled24ConditionsHIVArmsSystems Analysis and Improvement Approach
3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Review
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 2 countries.

Jessica E LongDepartment of Epidemiology, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA. jesslong@uw.edu.ORCID 0000-0002-6447-8586
McKenna C EastmentPresent Address: Department of Medicine, University of Washington, Seattle, WA, USA.
George WanjeDepartment of Global Health, University of Washington, Seattle, WA, USA.
Barbra A RichardsonDepartment of Global Health, University of Washington, Seattle, WA, USA.
Emily MwaringaMombasa County Department of Health, Mombasa, Kenya.
Mwanakarama Athman MohamedMombasa County Department of Health, Mombasa, Kenya.
Kenneth SherrDepartment of Epidemiology, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
Ruanne V BarnabasDepartment of Epidemiology, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
Kishorchandra MandaliyaDepartment of Global Health, University of Washington, Seattle, WA, USA.
Walter JaokoMedical Microbiology, University of Nairobi, Nairobi, Kenya.
R Scott McClellandDepartment of Epidemiology, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
University of Washington · USUniversity of Nairobi · KE

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI Kenneth Sherr · 1988 to 2026
$104.9M
VENEREAL DISEASET32AI007140 · NIAID · UNIVERSITY OF WASHINGTON · PI Julia Cook Dombrowski · 1985 to 2026
$19.4M
RCT of an Implementation Science Tool to Integrate HIV testing into Family Planning Services K24HD088229 · NICHD · UNIVERSITY OF WASHINGTON · PI MCCLELLAND, RAYMOND SCOTT · 2016 to 2020
$863k
Randomized controlled trial of an implementation science tool to increase cervical cancer screening in Mombasa, KenyaK08CA228761 · NCI · UNIVERSITY OF WASHINGTON · PI EASTMENT, MCKENNA CLAIRE · 2018 to 2022
$756k
NCI NIH HHS K08 CA228761NIAID NIH HHS P30 AI027757NIAID NIH HHS T32 AI007140NICHD NIH HHS K24 HD088229
6 · The paper itself

Abstract

backgroundIn Kenya, HIV incidence is highest among reproductive-age women. A key HIV mitigation strategy is the integration of HIV testing and counseling (HTC) into family planning services, but successful integration remains problematic. We conducted a cluster-randomized trial using the Systems Analysis and Improvement Approach (SAIA) to identify and address bottlenecks in HTC integration in family planning clinics in Mombasa County, Kenya. This trial (1) assessed the efficacy of this approach and (2) examined if SAIA could be sustainably incorporated into the Department of Health Services (DOHS) programmatic activities. In Stage 1, SAIA was effective at increasing HTC uptake. Here, we present Stage 2, which assessed if SAIA delivery would be sustained when implemented by the Mombasa County DOHS and if high HTC performance would continue to be observed.

methodsTwenty-four family planning clinics in Mombasa County were randomized to either the SAIA implementation strategy or standard care. In Stage 1, the study staff conducted all study activities. In Stage 2, we transitioned SAIA implementation to DOHS staff and compared HTC in the intervention versus control clinics 1-year post-transition. Study staff provided training and minimal support to DOHS implementers and collected quarterly HTC outcome data. Interviews were conducted with family planning clinic staff to assess barriers and facilitators to sustaining HTC delivery.

resultsOnly 39% (56/144) of planned SAIA visits were completed, largely due to the COVID-19 pandemic and a prolonged healthcare worker strike. In the final study quarter, 81.6% (160/196) of new clients at intervention facilities received HIV counseling, compared to 22.4% (55/245) in control facilities (prevalence rate ratio [PRR]=3.64, 95% confidence interval [CI]=2.68-4.94). HIV testing was conducted with 60.5% (118/195) of new family planning clients in intervention clinics, compared to 18.8% (45/240) in control clinics (PRR=3.23, 95% CI=2.29-4.55). Interviews with family planning clinic staff suggested institutionalization contributed to sustained HTC delivery, facilitated by low implementation strategy complexity and continued oversight.

conclusionsIntervention clinics demonstrated sustained improvement in HTC after SAIA was transitioned to DOHS leadership despite wide-scale healthcare disruptions and incomplete delivery of the implementation strategy. These findings suggest that system interventions may be sustained when integrated into DOHS programmatic activities.

trial registrationClinicalTrials.gov (NCT02994355) registered on 16 December 2016.

Indexed as

COVID-19HIV InfectionsAmbulatory Care FacilitiesFamily Planning ServicesFemaleHIV TestingHumansKenyaPandemicsSystems AnalysisFamily planning clinicsHIV counseling and testingImplementation scienceSustainabilitySystem analysis and improvement approach (SAIA)

Identifiers

PMID36195890
PMCPMC9530422
OpenAlexW4301397783

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.