Besada, DonelaGoga, AmeenaDaviaud, EmmanuelleRohde, SarahChinkonde, Jacqueline RoseVilleneuve, SusieClarysse, GuyRaphaely, NikaOkokwu, SteveTumwesigye, NathanDaries, NathalieDoherty, Tanya2018-10-012018-10-012018Besada, D. et al. (2018). Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal. BMJ Open, 2018:8 e020754.2044-6055http://dx.doi.org/10.1136/ bmjopen-2017-020754http://hdl.handle.net/10566/4081OBJECTIVES To explore the roles of community cadres in improving access to and retention in care for PMTCT (prevent mother-to-child transmission of HIV) services in the context of PMTCT Option B+ treatment scale-up in high burden low-income and lower-middle income countries. DESIGN/METHODS Qualitative rapid appraisal study design using semistructured in-depth interviews and focus group discussions (FGDs) between 8 June and 31 July 2015. SETTING AND PARTICIPANTS Interviews were conducted in the offices of Ministry of Health Staff, Implementing partners, district offices and health facility sites across four low-income and lower-middle income countries: Cote D’Ivoire, Democratic Republic of Congo (DRC), Malawi and Uganda. A range of individual interviews and FGDs with key stakeholders including Ministry of Health employees, Implementation partners, district management teams, facility-based health workers and community cadres. A total number of 18, 28, 31 and 83 individual interviews were conducted in Malawi, Cote d’Ivoire, DRC and Uganda, respectively. A total number of 15, 9, 10 and 16 mixed gender FGDs were undertaken in Malawi, Cote d’Ivoire, DRC and Uganda, respectively. RESULTS Community cadres either operated solely in the community, worked from health centres or in combination and their mandates were PMTCT-specific or included general HIV support and other health issues. Community cadres included volunteers, those supported by implementing partners or employed directly by the Ministry of Health. Their complimentary roles along the continuum of HIV care and treatment include demand creation, household mapping of pregnant and lactating women, linkage to care, infant follow-up and adherence and retention support. CONCLUSIONS Community cadres provide an integral link between communities and health facilities, supporting overstretched health workers in HIV client support and follow-up. However, their role in health systems is neither standardised nor systematic and there is an urgent need to invest in the standardisation of and support to community cadres to maximise potential health impacts.enThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Community cadresImproving accessPMTCT (prevent mother-to-child transmission of HIV)CommunitiesHealth facilitatorsArticle