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Table 1 Illustrative facility-level workflow modifications

From: Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial

Intended effect Workflow modification
Increase the proportion of women in ANC who receive HIV testing and counseling Initiate a grouped HIV counseling protocol for pregnant women in the ANC service waiting area rather than providing individual counseling for all women within ANC services.
Increase the proportion of HIV-infected pregnant women with access to CD4 testing Initiate CD4 blood draw for HIV-infected women by ANC nurses at the time of HIV diagnosis rather than referral to separate HIV clinics for enrolment and subsequent blood draw.
Increase the proportion of eligible HIV-infected pregnant women who initiate cART during pregnancy Initiate cART for eligible pregnant women after the first counseling visit post determination of eligibility rather than requiring completion of three counseling visits before initiating cART (while maintaining subsequent counseling visits post-cART initiation).
Increase the proportion of HIV-exposed infants receiving HIV screening with PCR at six weeks of age Attach ANC cards with HIV exposure data to the well child monitoring card at birth for institutional deliveries in order to systematically identify exposed infants at the six week well-child care visit.
  1. ANC: antenatal care; cART: Combination anti-retroviral therapy; CD4: Cluster of differentiation 4; HIV: Human immunodeficiency virus; PCR: Polymerase chain reaction.