Table 4. Considerations for Maternal ART Models of Care.

ASPECT OF MODEL OF CARE	IMPLICATIONS FOR MATERNAL ART	CROSS-CUTTING ISSUES
What kind of HIV testing is done, where is it done, and by whom?	Opt out is better for uptake. Lay counselors are more approachable but nurses provide more continuity. There is better continuity if HIV services are part of ANC consultations.	RESOURCE CONSTRAINTS	OPPORTUNITY COSTS	POLICY OR POLITICAL BARRIERS TO SYSTEMS CHANGE
Where is ART assessment and initiation done?	Referral and assessment is better in integrated services, but it is not clear if initiation is better.
Who is allowed to initiate ART?	The more cadres that can initiate ART, the more flexible and responsive initiation can be.
How are lab services integrated with ART assessment and initiation services?	Point of Care CD4 testing can speed initiation.
What mechanisms (record-keeping, appointment systems, peer escorts, etc.) are used to ensure linkage across different services?	More active linkages between services and follow up/tracing (follow up by CHWs) result in fewer drop-outs.
How are women transferred into and out of adult ART services before and after pregnancy?	For women already on ART, management of ART while pregnant needs to be coordinated with PMTCT program. For these women, and for women not on ART before pregnancy, how they are transferred back to general adult ART services can impact retention and adherence.
How are the general adult ART services organized?	More decentralized ART services, in general, make linkages between ART and ANC services easier.
What is the intended pacing of movement through the maternal ART cascade?	Drug readiness, training, PMTCT protocols, and other assumptions built into models of care can greatly increase or decrease the pace of movement through the maternal ART cascade, and thus, opportunities for drop-out.
Are CHWs, peer mentors or support groups part of the model of care?	These cadres/interventions can provide better psychosocial support for women throughout the cascade, as well as contribute to coordination of and linking across services.