Effectiveness of the systems analysis and improvement approach to optmize the hypertension care cascade for people living with HIV in central Mozambique: results from a hybrid type III cluster randomized trial

Background: The burden of hypertension among people living with HIV (PLHIV) in sub- Saharan Africa is growing, contributing to the need for integrated services. Systems engineering strategies can effectively improve service delivery in resource-constrained settings. We conducted a trial to assess the Systems Analysis and Improvement Approach (SAIA) to optimize hypertension care quality and continuity for PLHIV in Sofala and Manica provinces in Mozambique. Methods: A hybrid type III cluster randomized controlled trial compared outcomes between eight intervention and eight control clinics. We used generalized estimating equations assuming an exchangeable correlation structure and a log-binomial regression to estimate the risk ratio of controlled blood pressure between study arms, adjusting for study phase and whether clients were newly recruited or retained from a previous phase.