Table 1.
Changes in implementation methods from NGO-led RST pilot to MoH-led national RST rollout in Zambia 2008–2012.
Fig 1.
Phased changes in syphilis testing and treatment algorithm in Zambia 2009–2012.
Legend: 4Cs: condoms, counselling, compliance, contact tracing, offer HIV test; RPR:Rapid Plasma Reagin; non-treponemal qualitative test; quantitative testing may also be available;RST: Rapid Syphilis Test, a treponemal test;TPHA*:Treponema pallidum Haemoagglutination assay, a treponemal laboratory test;BP: Benzathine Penicillin 2.4 megaunits IM. *The testing algorithm involving TPHA applied to tertiary care centres and was unavailable at sites included in this evaluation.
Fig 2.
Conceptual framework for the evaluation of RST pilot study and national programme in Zambia, adapted from Asiimwe et al (2012).
Legend: In this context, these themes were understood to mean the following: Learnability: how easy or difficult it was for HCW to learn to perform the RST, perform it accurately and learn about quality control and quality assurance; Willingness: Willingness of the HCW to perform the RST, to take part in the cascaded training i.e. being trained by or training other colleagues; willingness to take part in supervisory and quality assurance activities; Suitability: HCWs’ belief the RST test was relevant to their work and could be successfully integrated into existing services; HCWs’ belief in the appropriateness of the current supporting components of the RST programme i.e. training, supervision and quality maintenance; Satisfaction: HCWs’ satisfaction with the test itself, its impact on workflow and satisfaction with the supporting components of the programme; Efficacy: Ability of HCWs to implement same-visit testing and treatment (STAT), to incorporate the test and to integrate quality assurance and quality control activities into their workflow; Effectiveness: How the organisational and systemic environment, including implementation of policy, guidelines, supply chain and other logistics, impacted on successful delivery of the programme. In addition, how the social context (the community, patients and their partners) influenced programme delivery.
Table 2.
Health care worker and facility data for pilot and rollout evaluation phases.
Fig 3.
Changes in Syphilis Testing before and after RST introduction and perceived effect on workload for different HCW cadres in Zambia.
HCW: Healthcare Worker; RST: Rapid Syphilis Test; RPR: Rapid Plasma Reagin; MCH: Maternal and Child Health; BP: Benzathine Penicillin 2.4 mega units IM. *Rollout HCWs used their own initiative in integrating RSTs into facility workflow. RPR confirmation was often done immediately where RPR was available and performed by the same HCW performing RST.