Study Setting
The participating ANC clinics were located within public health facilities operated by the Uganda Ministry of Health, and each received technical assistance in HIV reproductive health care from Mildmay Uganda. Each of the participating health facilities include an HIV clinic, a maternal and child health center (which houses the ANC clinic as well as post-partum Mother-Baby Care clinic for mothers living with HIV), in-patient pediatric ward, and other services. When a client of the HIV clinic becomes pregnant, she is transferred to the ANC clinic to receive PMTCT and pregnancy care, including ART; if she first learns of her HIV diagnosis when entering ANC, then she remains there. She receives care within the maternal and child health center until her newborn is 18 months old, or her pregnancy is prematurely terminated, after which she returns to the HIV clinic for continued care. Each ANC clinic is staffed by one doctor-in-charge (who plays more of a supervisory role), two to three midwife nurses (who prescribe treatment), and one or two peer mothers (former clients living with HIV who successfully managed their pregnancy and who provide volunteer assistance). The hospital ANC clinics service 400–600 women living with HIV annually. Women typically enter ANC care in the second trimester and are seen monthly during antenatal and early postpartum phases. Delivery takes place in the in-patient maternity ward.