Table 4.

Quotes form respondents

	Quote	Respondent
1	“…first the problem that is there is that the guideline are few, you can find that they come but they are not enough if you compare with the number of facilities that should have the guideline…”	District Officer
2	“Another thing I would say I did not understand properly is about the testing of the children, the DBS [Dry Blood Spot, for early infant diagnosis of HIV] procedure (shaking her head) is still difficult for me… At training, only two people got to practically do it as we watched. So since I was taught during the training I have not been able to do it so I am not sure if I get the DBS kits I would even be able to do it.”	Private hospital PMTCT
3	“R: You may think he (patient) is in (WHO) stage 1 when he is in stage 3 … just that it is easy to miss the stages so it is a problem. So WHO staging is not as good as CD4 whose criteria are clear, from here to here the patient is eligible… Also, for WHO staging, you need more time to go through each stage and its diseases as you refer to the guideline ….”	Private hospital CTC
4	“I: … What makes you provide services according to guideline? R: confidence I: confidence, your confidence? R: Yes I: Can you explain to me that? R: Because whatever I do to the patient I am sure about it and that I can do it I: Ahaa. So what do you think brought on that confidence? R: Understanding and the training that I have.”	Public health centre HTC
5	“I think I can just say it is laxity (she laughs) are you recording also laxity? But let me just say the truth before God. That following up to test after three months in truth we have many things and may be in truth let God forgive us because we have not been keen on that … we have not prioritized it even when reagents are available …”	Public district PMTCT
6	“In this dispensary, [this respondent found this practice going on when she joined the facility] they told me in one seminar they were told they could invite partners of expectant mother by letters. So we do that and they come.”	Public dispensary PMTCT
7	“…. at times providers used normal saline instead of the buffer. I had to tell them no, that cannot give you the correct results that we need. You are required to use that buffer which is specific for that test ….”	Regional officer
8	“…. so when we reach there, we give coaching and mentoring to all providers who give these services; for example, at a dispensary providers are not many so they can all be called and we give them coaching and mentoring about say PMTCT”.	District officer
9	“But also, at times, there are challenges of movement of providers who have been trained. ………so you find the service cannot be performed because the trained staff has been transferred to another facility.”	District Officer
10	“…I will counsel but I will not go to details because I look there are five other mothers waiting for me, I am hungry, time is finished and the mother is also tired so I don’t go to details. When I see she has agreed to take the medication and she knows she will take it every day I end it there (she laughs).”	Public district PMTCT
11	“Aaah ….in truth there is a problem, for example about CTC … So when CTC client comes to pick medication, he comes into this same room. So to protect their privacy we make the outpatients wait outside there until that HIV client leaves the room … but the other patients suspect because HIV clients take a long time.”	Public dispensary’s facility manager
12	“Sometimes the test for confirmation is the one missing and that too is a challenge … because you cannot test a patient when you don’t have the confirmation test. What if the first test turns positive?”	Public health centre HTC
13	“Yes, they have the tests and they help us, for example these tests like DetermineTM, they run out and from the DMO they delay bringing more. But we are grateful that YYYY (FBO facility) usually help us. Even with drugs also … these ARVs and cotrimoxazole …”	Public dispensary’s facility manager
14	“Lost to follow ups are many among the pastoralists. I think it’s because of … it’s because of education, they have not got enough education these pastoralists … maybe we could arrange to trace them but they move around. It is hard”	Public health centre HFM
15	“… especially people with awareness when you start counseling they tell you please stop the stories and give me my results. Don’t go round, give me the results, I start treatment if am sick. So you find you are cut short.”	Private hospital CTC
16	“R: You find some patients agree (to join patient groups) but many refuse … you know these stigma things, they say that they fear being announced and prefer just coming to clinic to pick their medication.”	Public dispensary HTC
17	“…. many mothers when you tell them that if you take these medications you will give birth to a child who is safe (uninfected), many mothers put effort to take the medication so that they save their babies.”	Public district PMTCT