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. 2012 Apr;21(4):315–324. doi: 10.1136/bmjqs-2011-000381

Figure 4.

Figure 4

Control chart on monthly highly active antiretroviral treatment (HAART) initiations for August 2004–November 2009 demonstrating the impact of additional clinics providing testing. Quality improvement (QI) intervention both contributed to the increased average initiation and improved performance across the system. The scale up of HIV testing led to a moderate limited increase in initiation, and was a prerequisite for the large increase seen in 2008 and 2009, accelerated by the expansion of QI efforts; 1=start of phase I: pilot to improve flow at sole antiretroviral (ARV) site; 2=community health centre (CHC) joins pilot; 3=seven primary healthcare clinics (PHCs) start HIV testing; 4=start of phase II: prototype regional health systems strengthening intervention, first learning session (seven PHC HIV testing sites, two HAART initiation sites); third site starts HAART initiation; 5=scale up of HIV testing sites begins (three additional sites); 6=start up of phase III: scale up of regional collaborative, Learning Session; scale up of HIV testing sites ends, all 14 PHCs testing and part of intervention; down referral starts; 7=multiple, constant changes to processes leading to sustained new level of performance. LCL, lower confidence limit; UCL, upper confidence limit.