title: Prioritizing the PMTCT implementation research agenda in 3 African countries: INtegrating and Scaling up PMTCT through Implementation REsearch (INSPIRE).
abstract: Countries with high HIV prevalence face the challenge of achieving high coverage of antiretroviral drug regimens interventions including for the prevention of mother-to-child transmission of HIV (PMTCT). In 2011, the World Health Organization and the Department of Foreign Affairs, Trade and Development, Canada, launched a joint implementation research (IR) initiative to increase access to effective PMTCT interventions. Here, we describe the process used for prioritizing PMTCT IR questions in Malawi, Nigeria, and Zimbabwe. Policy makers, district health workers, academics, implementing partners, and persons living with HIV were invited to 2-day workshops in each country. Between 42 and 70 representatives attended each workshop. Using the Child Health Nutrition Research Initiative process, stakeholder groups systematically identified programmatic barriers and formulated IR questions that addressed these challenges. IR questions were scored by individual participants according to 6 criteria: (1) answerable by research, (2) likely to reduce pediatric HIV infections, (3) addresses main barriers to scaling-up, (4) innovation and originality, (5) improves equity among underserved populations, and (6) likely value to policy makers. Highest scoring IR questions included health system approaches for integrating and decentralization services, ways of improving retention-in-care, bridging gaps between health facilities and communities, and increasing male partner involvement. The prioritized questions reflect the diversity of health care settings, competing health challenges and local and national context. The differing perspectives of policy makers, researchers, and implementers illustrate the value of inclusive research partnerships. The participatory Child Health Nutrition Research Initiative approach effectively set national PMTCT IR priorities, promoted country ownership, and strategically allocated research resources.
authors.affiliation: *World Health Organization, Geneva, Switzerland; †World Health Organization, Lilongwe, Malawi; ‡Ministry of Health, Lilongwe, Malawi; §Federal Ministry of Health, Abuja, Nigeria; ‖World Health Organization, Abuja, Nigeria; ¶World Health Organization, Harare, Zimbabwe; #Ministry of Health and Child Welfare, Harare, Zimbabwe; **World Health Organization, AFRO, Brazzaville, Congo; ††World Health Organization, Intercountry Support Team, Harare, Zimbabwe; ‡‡World Health Organization, Intercountry Support Team, Ouagadougou, Burkina Faso; and §§Department of Foreign Affairs, Trade and Development, Ottawa, Canada.
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
authors.forename: Harriet
authors.initials: H
authors.lastname: Chanza
authors.forename: Frank
authors.initials: F
authors.lastname: Chimbwandira
authors.forename: Michael
authors.initials: M
authors.lastname: Eliya
authors.forename: Ishmael
authors.initials: I
authors.lastname: Nyasulu
authors.forename: Ellen
authors.initials: E
authors.lastname: Thom
authors.forename: Felicitas
authors.initials: F
authors.lastname: Zawaira
authors.forename: Deborah
authors.initials: D
authors.lastname: Odoh
authors.forename: David
authors.initials: D
authors.lastname: Okello
authors.forename: Taiwo
authors.initials: T
authors.lastname: Oyelade
authors.forename: Sarah
authors.initials: S
authors.lastname: Banda
authors.forename: Christine
authors.initials: C
authors.lastname: Chakanyuka Musanhu
authors.forename: Custodia
authors.initials: C
authors.lastname: Mandlhate
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.forename: Toure
authors.initials: T
authors.lastname: Isseu
authors.forename: Morkor
authors.initials: M
authors.lastname: Newman
authors.forename: Saliyou
authors.initials: S
authors.lastname: Sanni
authors.forename: April
authors.initials: A
authors.lastname: Baller
authors.forename: Joyce
authors.initials: J
authors.lastname: Seto
authors.forename: Nathan
authors.initials: N
authors.lastname: Shaffer
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006292:Health Priorities; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D009549:Nigeria / Q000453:epidemiology; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents