Table 2 Perceptions of workforce roles and responsibilities facilitating Option B

Expansion of patient care roles for midwives & nurses

Many HCWs wanted the midwives to have a more longitudinal experience with their patients in order to improve care and midwife engagement. A consistent example given was the ability of midwives and nurses to prescribe prophylaxis under Option B policy. Some HCWs felt midwives and nurses should be able to prescribe ARV treatment as well.

“The midwives are not involved in treating [PMTCT] patients… they never really respond to the concerns of HIV-positive patients because of this… [It would help] to inform the midwives about the outcomes of the pregnancies they are following.”—Midwife

Importance of community-based workers and integration into the clinic

Community counselors were felt to be extremely important in addressing barriers that prevent patients from accessing care through outreach and home visits. However, many felt their efforts could be improved by integrating their services into the standard clinical visit, rather than providing them as separate services.

“Integrating community counselors into different levels of service at the clinic… and into the antenatal care visits [would improve services].”—Community counselor

The importance of a welcoming environment and provider-patient relationship

HCWs consistently described a strong provider-patient relationship and the creation of a welcoming environment at the clinic by healthcare workers as a facilitator of PMTCT success.

“Developing trust with the women through maintaining confidentiality and giving them an appropriate welcome, among other things [is a major facilitator of Option B]… The behavior of some HCWs, [however], does not encourage the women to return for their follow-up appointments.”—Community counselor