In response to PAR-10-038, we propose to test whether adapting an established HIV/AIDS program support platform to strengthen maternal and newborn health (MNH) services will increase uptake of these services and thus improve outcomes for both HIV-negative and HIV-positive women and their newborns. One of NIAID's key strategic priorities is to reduce health disparities and improve health by using translational research. Tanzania, the largest country in East Africa, has an HIV prevalence of 5.7% and some of the highest maternal and neonatal mortality rates in the world. With the support of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Tanzania has made remarkable progress in providing HIV services, averting 7,500 newborn HIV infections in 2009 alone. In contrast, expanding uptake of basic maternal and newborn health (MNH) services needed to reduce maternal and newborn mortality has been less successful. Fewer than half of Tanzania's women and newborns utilize high-quality MNH services, despite the existence of well-defined policies and guidelines. Our preliminary data suggest that low service utilization may be due to poor quality of services. Poor quality of services in turn results in poor health outcomes. To succeed in the same weak health systems, HIV programs have pioneered an innovative approach to upgrade infrastructure, provide training and quality assurance, and work with local communities. Could this three-pronged health system support strategy originally developed for HIV programs be expanded to improve the quality and uptake of MNH services? Despite its clinical and

Public Health Relevance

There are massive global disparities in maternal, newborn, and HIV/AIDS mortality, with sub-Saharan Africa most severely affected. In the past eight years the President's Emergency Plan for AIDS Relief (PEPFAR), an HIV prevention and treatment program, has successfully overcome structural health system barriers in low- income countries to provide HIV testing, care, and treatment for millions of people. This cluster-randomized implementation research study will test whether adapting and expanding PEPFAR's health system support strategy to strengthen maternal and newborn health services can improve the utilization, equity, and quality of maternal and newborn health services and HIV services in eastern Tanzania-an area with high HIV prevalence and high rates of maternal and newborn mortality.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI093182-06
Application #
8887286
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Bacon, Melanie C
Project Start
2011-08-15
Project End
2017-07-31
Budget Start
2015-08-01
Budget End
2017-07-31
Support Year
6
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Harvard University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
149617367
City
Boston
State
MA
Country
United States
Zip Code
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Larson, Elysia; Vail, Daniel; Mbaruku, Godfrey M et al. (2017) Beyond utilization: measuring effective coverage of obstetric care along the quality cascade. Int J Qual Health Care 29:104-110
Kruk, Margaret E; Hermosilla, Sabrina; Larson, Elysia et al. (2015) Who is left behind on the road to universal facility delivery? A cross-sectional multilevel analysis in rural Tanzania. Trop Med Int Health 20:1057-66
Larson, Elysia; Vail, Daniel; Mbaruku, Godfrey M et al. (2015) Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women. PLoS One 10:e0135621
Larson, Elysia; Hermosilla, Sabrina; Kimweri, Angela et al. (2014) Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC Health Serv Res 14:483
Kruk, Margaret E; Hermosilla, Sabrina; Larson, Elysia et al. (2014) Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania. Bull World Health Organ 92:246-53
Mbaruku, Godfrey M; Larson, Elysia; Kimweri, Angela et al. (2014) What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania? Hum Resour Health 12:38