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Using point-of-care tests (POCTs) at peripheral dispensaries could improve access to testing and timely treatment. However, the effect of providing additional services on nurse workload and client wait times are unknown. We use discrete-event simulation (DES) modelling to understand the effect of providing four point-of-care tests for ANC on nurse utilization and wait times for women seeking maternal and child health (MCH) services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected detailed time-motion data over 20\u2009days from one high volume dispensary in western Kenya during the 8-month implementation period (2014\u20132015) of the intervention. We constructed a simulation model using empirical arrival distributions, activity durations and client pathways of women seeking MCH services. We removed the intervention from the model to obtain wait times, length-of-stay and nurse utilization rates for the baseline scenario where only HIV testing was offered for ANC. Additionally, we modelled a scenario where nurse consultations were set to have minimum durations for sufficient delivery of all WHO-recommended services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 183 women visited the dispensary for MCH services and 14 of these women received point-of-care testing (POCT). The mean difference in total waiting time was 2\u2009min (95%CI: &lt;\u20091\u20134\u2009min,<jats:italic>p<\/jats:italic>\u2009=\u20090.026) for MCH women when integrated POCT was given, and 9\u2009min (95%CI: 4\u201314\u2009min,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) when integrated POCT with adequate ANC consult times was given compared to the baseline scenario. Mean\u00a0length-of-stay increased by 2\u2009min (95%CI: &lt;\u20091\u20134\u2009min,<jats:italic>p<\/jats:italic>\u2009=\u20090.015) with integrated POCT and by 16\u2009min (95%CI: 10\u201321\u2009min,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with integrated POCT and adequate consult times compared to the baseline scenario. The two nurses\u2019 overall daily utilization in the scenario with sufficient minimum consult durations were 72 and 75%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The intervention had a modest overall impact on wait times and length-of-stay\u00a0for women seeking MCH services while ensuring pregnant women received essential diagnostic testing. Nurse utilization rates fluctuated among days: nurses experienced spikes in workload on some days but were under-utilized on the majority of days. Overall, our model suggests there was sufficient time to deliver all WHO\u2019s required ANC activities and offer integrated testing for ANC first and re-visits with the current number of healthcare staff. Further investigations on improving healthcare worker, availability, performance and quality of care are needed. Delivering four point-of-care tests together for ANC at dispensary level would be a low burden strategy to improve ANC.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12889-019-7739-4","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T17:03:27Z","timestamp":1575392607000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Integrating HIV, syphilis, malaria and anaemia point-of-care testing (POCT) for antenatal care at dispensaries in western Kenya: discrete-event simulation modelling of operational impact"],"prefix":"10.1186","volume":"19","author":[{"given":"N.","family":"Young","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Taetgmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Zulaika","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Aol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Ter Kuile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Langley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,3]]},"reference":[{"key":"7739_CR1","unstructured":"World Health Organization. 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Glob Health Action. 2016;9(0):1\u201310.","journal-title":"Glob Health Action"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7739-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-019-7739-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-7739-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,28]],"date-time":"2024-07-28T02:47:55Z","timestamp":1722134875000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-019-7739-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":51,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["7739"],"URL":"https:\/\/doi.org\/10.1186\/s12889-019-7739-4","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"30 October 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Any woman arriving at the facility to be followed for the time-motion study was greeted, introduced to the study and verbally consented. Verbal consent was obtained as no personal identifiable data were collected and the research activities were minimal risk. A short statement explained the study purpose (to measure activity and wait times), study procedures (wear a number badge and carry a time sheet throughout the visit), and confidentiality (no personal information such as name or test results would be collected). Women who disagreed would be free to continue their visits without timesheets and their arrival badge numbers would be skipped.The protocol and consent procedure were reviewed and approved by the scientific and ethical steering committees of the Kenya Medical Research Institute (protocol number 2271) and the Liverpool School of Tropical Medicine Ethics Committee (14.017). For U.S. CDC, while this activity was determined to be human subjects research, CDC staff involvement did not constitute engagement in human subjects\u2019 research, thus not requiring human subjects research review by the CDC institutional review board.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1629"}}