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Table 1 Description of the 5-step SAIA cycle conducted with intervention clinics

From: Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial

SAIA step

Description

Frequency and location

FP clinic role

Facilitation

Cascade analysis tool

Excel-based system for quantifying and displaying the number of individuals who complete each step of a process to identify where improvement may be needed

Monthly SAIA meetings at clinics in the intervention arm

Clinic managers review the results of the cascade analysis monthly with study staff facilitators (Stage 1) or DOHS facilitators (Stage 2)

Facilitators populate the cascade analysis tool, and review results with FP clinic staff. Facilitators were study staff in Stage 1, DOHS staff in Stage 2.

Sequential process flow mapping

Drawn map of clinic processes and client movement through clinics to identify modifiable bottlenecks in their workflow for HTC

At initial training and at monthly SAIA meetings at clinics in the intervention arm

FP clinic staff draw the map of their specific clinic flow

Facilitators trained FP clinic staff and oversaw process mapping.

Micro-intervention setting

Identification of workflow modifications (termed “micro-interventions”) that clinic staff implement during the following month chosen to address clinic-specific barriers to implementing HTC

Monthly SAIA meetings at clinics in the intervention arm

FP clinic managers develop a micro-intervention that addresses a problem specific to their clinic, then implement that change over the following month.

Facilitators assist in developing ideas for feasible micro-interventions.

Micro-intervention assessment

Micro-intervention chosen in the previous monthly SAIA meeting is assessed to determine if it was (a) successfully implemented, (b) effective in improving HTC, and (c) if the micro-intervention should be adapted, adopted, or abandoned.

Monthly SAIA meetings at clinics in the intervention arm

FP clinic managers report on how successfully the micro-intervention was implemented, and decide if it should be adapted, adopted, or abandoned.

Facilitators provide HTC updates based on the Cascade Analysis Tool and assist FP clinic managers in decision making on next steps.

Iterative refinement

All previous steps are repeated at monthly SAIA meetings, where previous micro-interventions are reviewed, and new ones are chosen.

Monthly SAIA meetings at clinics in the intervention arm

FP clinic managers meet with facilitators and are prepared to review previous micro-interventions and set new ones.

Facilitators arrange SAIA meetings and attend monthly.