Systems analysis and improvement approach to optimize the cardiometabolic care cascade (SAIA-CMD) in central mozambique - undiagnosed and untreated hypertension (HTN) and type II diabetes (T2D) are…

The Department of Health and Human Services National Institutes of Health Fogarty International Center awarded the University of Washington $417,681 on August 20, 2026, under the International Research and Research Training program (CFDA 93.989) to develop and evaluate a Systems Analysis and Improvement Approach to optimize cardiometabolic care delivery for hypertension and type 2 diabetes in central Mozambique.

The recipient will apply the SAIA implementation strategy to improve diagnosis and management services for comorbid hypertension and type 2 diabetes by implementing the WHO Package of Essential NCD Interventions. The work includes exploration of patient needs, health system stakeholder requirements, and national policies; refinement of the SAIA-CMD strategy; evaluation of whether the strategy improves clinical outcomes among adults with comorbid conditions; and identification of implementation success drivers and sustainability. The study is framed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework.

Place of performance is Seattle, Washington. The award period runs through May 31, 2031. This is a project grant, the assistance type supporting biomedical and behavioral research conducted internationally to reduce disparities in global health and foster partnerships between U.S. and foreign researchers.

Systems analysis and improvement approach to optimize the cardiometabolic care cascade (SAIA-CMD) in central mozambique - undiagnosed and untreated hypertension (HTN) and type II diabetes (T2D) are the principal drivers of cardiometabolic disease (CMD) globally, disproportionately affecting health outcomes in low- and middle-income countries (LMICS) such as in mozambique. This dual burden of HTN and T2D is rapidly increasing as countries undergo the epidemiologic transition from infectious diseases to non-communicable diseases as principal causes of morbidity and mortality. However, diagnosis and treatment for HTN and T2D remain suboptimal. Over the past 15 years, several implementation research studies have applied the systems analysis and improvement approach (SAIA) to optimize care cascades for preventing mother-to-child HIV transmission, addressing HTN among people with HIV, and to pilot SAIA for T2D. SAIA is highly acceptable to frontline care providers in health care settings and has been shown to improve service delivery of evidence-based interventions and improve clinical outcomes. The overall goal of this proposal is to develop a practical and scalable model for improving HTN and T2D diagnosis and management services. The study builds on the SAIA implementation studies by developing the SAIA-CMD implementation strategy - application of SAIA to improve the delivery of the evidence-based who package of essential NCD interventions (pen). We will evaluate whether the SAIA-CMD strategy improves HTN and T2D among comorbid adults; identify its drivers of implementation success and describe whether implementation is sustained and any adaptations made to the SAIA-CMD strategy. Framed by the exploration, preparation, implementation and sustainment (EPIS) framework, we will explore the needs of patients with comorbid HTN and T2D, health system stakeholders, and national policies (aim 1A). Based on this work, our team will refine SAIA-CMD for application to the targeted evidence-based intervention (who pen) and we will prepare for the SAIA-CMD trial by identifying implementation determinants, adapting intervention tools, and developing a detailed implementation plan (aim 1B). This will facilitate our study's transition to the SAIA-CMD hybrid type III cluster randomized trial implementation phase (aim 2) to evaluate its effectiveness on integrated HTN and T2D cascade optimization and identify drivers of implementation success. Finally, in the sustainment phase, we will describe sustained implementation, determinants of sustained implementation, and strategy adaptations for SAIA-CMD (aim 3). Our research will uncover opportunities for health system efficiencies that take advantage of decades of USG investment in mozambique, while also identifying modalities for delivering cardiometabolic care that are transferable to the united states. Moreover, the evidence-based practices being delivered in our study, the who pen, are analogous to the american heart association's recommendations for HTN and T2D. Thus, our study's implementation strategies to deliver these evidence-based practices will be relevant and informative to the US context.