<mxfile host="app.diagrams.net" agent="tch-process-diagram" version="24.0.0"><diagram id="fig-01-syphilis-screening-and-rpr-titration" name="Figure 1 — Syphilis rapid treponemal screening, RPR qualitative card, and serial titration flow"><mxGraphModel dx="1000" dy="700" grid="1" gridSize="10" guides="1" tooltips="1" connect="1" arrows="1" fold="1" page="1" pageScale="1" pageWidth="1000" pageHeight="1434" math="0" shadow="0"><root><mxCell id="0"/><mxCell id="1" parent="0"/><mxCell id="title" value="Figure 1 — Syphilis rapid treponemal screening, RPR qualitative card, and serial titration flow" style="text;html=1;fontSize=20;fontStyle=1;align=left;verticalAlign=top;whiteSpace=wrap;fontFamily=Segoe UI;fontColor=#0F172A;" vertex="1" parent="1"><mxGeometry x="36" y="20" width="940" height="36" as="geometry"/></mxCell><mxCell id="lane_mt" value="Medical Technologists" style="swimlane;horizontal=1;startSize=36;html=1;whiteSpace=wrap;fontStyle=1;fontSize=12;fontFamily=Segoe UI;fillColor=#2E7D32;fontColor=#FFFFFF;strokeColor=#CBDECC;swimlaneFillColor=#EDF8EF;rounded=1;arcSize=4;collapsible=0;" vertex="1" parent="1"><mxGeometry x="48" y="82" width="597" height="1228" as="geometry"/></mxCell><mxCell id="lane_ref" value="Samar Provincial Hospital (SPH) / NRL" style="swimlane;horizontal=1;startSize=36;html=1;whiteSpace=wrap;fontStyle=1;fontSize=12;fontFamily=Segoe UI;fillColor=#555555;fontColor=#FFFFFF;strokeColor=#D4D4D4;swimlaneFillColor=#F4F4F4;rounded=1;arcSize=4;collapsible=0;" vertex="1" parent="1"><mxGeometry x="669" y="82" width="298" height="1228" as="geometry"/></mxCell><mxCell id="n1" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.1&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Initiate syphilis screening per diagnostic testing algorithm" style="rounded=1;arcSize=50;fillColor=#DDF2E1;fontColor=#0F172A;fontStyle=1;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="58" width="274" height="56" as="geometry"/></mxCell><mxCell id="n2" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.3&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Dispense 10 µL serum and buffer onto Treponemal Rapid Cassette; read at 15 to 20 minutes" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="155" width="274" height="74" as="geometry"/></mxCell><mxCell id="d0" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.3&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Control line C present and visible?" style="shape=hexagon;perimeter=hexagonPerimeter2;fixedSize=1;size=18;fillColor=#E0F3E2;fontColor=#0F172A;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="7" y="271" width="284" height="44" as="geometry"/></mxCell><mxCell id="n4x" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.3&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Invalid: repeat with a new cassette" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="310" y="357" width="274" height="42" as="geometry"/></mxCell><mxCell id="d1" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.3&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Test line T visible (reactive)?" style="shape=hexagon;perimeter=hexagonPerimeter2;fixedSize=1;size=18;fillColor=#E0F3E2;fontColor=#0F172A;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="7" y="356" width="284" height="44" as="geometry"/></mxCell><mxCell id="n3" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.6.1&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Report Treponemal Cassette as Non-Reactive" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="442" width="274" height="58" as="geometry"/></mxCell><mxCell id="n3b" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.6.1&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Report treponemal cassette as Reactive" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="310" y="450" width="274" height="42" as="geometry"/></mxCell><mxCell id="n4" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.4.2&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Dispense 50 µL serum and 1 drop carbon antigen onto 18 mm circle of RPR card" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="310" y="542" width="274" height="58" as="geometry"/></mxCell><mxCell id="n5" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.4.2&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Rotate for exactly 8 minutes at 100 rpm under humidified cover" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="310" y="641" width="274" height="58" as="geometry"/></mxCell><mxCell id="d2" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.4.3&lt;/font&gt;&lt;/b&gt;&lt;br&gt;RPR card qualitative result reactive or weakly reactive?" style="shape=hexagon;perimeter=hexagonPerimeter2;fixedSize=1;size=18;fillColor=#E0F3E2;fontColor=#0F172A;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="305" y="741" width="284" height="60" as="geometry"/></mxCell><mxCell id="n6" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.4.5&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Perform two-fold serial dilutions to determine endpoint titer" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="843" width="274" height="58" as="geometry"/></mxCell><mxCell id="n7" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.6.1&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Report RPR as Reactive with documented endpoint titer" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="942" width="274" height="58" as="geometry"/></mxCell><mxCell id="n8" value="&lt;b&gt;&lt;font color=&quot;#2E7D32&quot;&gt;5.6.1&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Report RPR as Nonreactive" style="rounded=1;arcSize=14;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="310" y="851" width="274" height="42" as="geometry"/></mxCell><mxCell id="n9" value="&lt;b&gt;&lt;font color=&quot;#555555&quot;&gt;5.6.2&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Refer reactive serum to Samar Provincial Hospital for confirmatory TP-PA" style="shape=document;boundedLbl=1;size=0.12;fillColor=#FFFFFF;fontColor=#1E293B;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#555555;" vertex="1" parent="lane_ref"><mxGeometry x="12" y="1042" width="274" height="66" as="geometry"/></mxCell><mxCell id="e1" value="&lt;b&gt;&lt;font color=&quot;#FFFFFF&quot;&gt;5.6&lt;/font&gt;&lt;/b&gt;&lt;br&gt;Result reporting and confirmatory referral complete" style="rounded=1;arcSize=50;fillColor=#2E7D32;fontColor=#FFFFFF;fontStyle=1;strokeWidth=3;html=1;whiteSpace=wrap;fontSize=12;fontFamily=Segoe UI;shadow=1;strokeWidth=1.5;strokeColor=#2E7D32;" vertex="1" parent="lane_mt"><mxGeometry x="12" y="1150" width="274" height="56" as="geometry"/></mxCell><mxCell id="e1" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n1" target="n2"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e2" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n2" target="d0"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e3" value="Yes" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d0" target="d1"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e4" value="No" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=1.000;exitY=0.500;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d0" target="n4x"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="496.0" y="375.3"/></Array></mxGeometry></mxCell><mxCell id="e5" value="Repeat" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=1.000;exitY=0.500;exitDx=0;exitDy=0;entryX=1.000;entryY=0.500;entryDx=0;entryDy=0;dashed=1;" edge="1" parent="1" source="n4x" target="n2"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="657.3" y="461.0"/><mxPoint x="657.3" y="274.7"/></Array></mxGeometry></mxCell><mxCell id="e6" value="No" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d1" target="n3"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e7" value="Yes" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.000;exitY=0.500;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d1" target="n3b"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="36.0" y="461.0"/><mxPoint x="36.0" y="503.8"/><mxPoint x="496.0" y="503.8"/></Array></mxGeometry></mxCell><mxCell id="e8" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n3b" target="n4"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e9" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n3" target="e1"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="197.3" y="603.5"/><mxPoint x="36.0" y="603.5"/><mxPoint x="36.0" y="1211.5"/><mxPoint x="197.3" y="1211.5"/></Array></mxGeometry></mxCell><mxCell id="e10" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n4" target="n5"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e11" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n5" target="d2"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e12" value="Yes" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.000;exitY=0.500;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d2" target="n6"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="197.3" y="853.6"/></Array></mxGeometry></mxCell><mxCell id="e13" value="Discordant — refer" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="d2" target="n8"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e14" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n6" target="n7"><mxGeometry relative="1" as="geometry"></mxGeometry></mxCell><mxCell id="e15" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n7" target="n9"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="197.3" y="1103.8"/><mxPoint x="818.7" y="1103.8"/></Array></mxGeometry></mxCell><mxCell id="e16" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n8" target="n9"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="496.0" y="1103.8"/><mxPoint x="818.7" y="1103.8"/></Array></mxGeometry></mxCell><mxCell id="e17" value="" style="edgeStyle=orthogonalEdgeStyle;rounded=1;html=1;endArrow=block;endFill=1;endSize=5;strokeWidth=1.7;strokeColor=#475569;fontSize=10;fontStyle=1;labelBackgroundColor=#FFFFFF;fontFamily=Segoe UI;exitX=0.500;exitY=1.000;exitDx=0;exitDy=0;entryX=0.500;entryY=0.000;entryDx=0;entryDy=0;" edge="1" parent="1" source="n9" target="e1"><mxGeometry relative="1" as="geometry"><Array as="points"><mxPoint x="818.7" y="1211.5"/><mxPoint x="197.3" y="1211.5"/></Array></mxGeometry></mxCell><mxCell id="legend" value="" style="rounded=1;arcSize=6;fillColor=#F8FAFC;strokeColor=#E2E8F0;html=1;" vertex="1" parent="1"><mxGeometry x="24" y="1328" width="952" height="62" as="geometry"/></mxCell><mxCell id="lg_medical_technologists" value="Medical Technologists" style="rounded=1;arcSize=30;html=1;whiteSpace=wrap;fontSize=11;fontFamily=Segoe UI;fillColor=#D5EFD9;strokeColor=#2E7D32;strokeWidth=1.5;" vertex="1" parent="1"><mxGeometry x="40" y="1336" width="152" height="20" as="geometry"/></mxCell><mxCell id="lg_courier_referral" value="Courier / Referral Laboratory" style="rounded=1;arcSize=30;html=1;whiteSpace=wrap;fontSize=11;fontFamily=Segoe UI;fillColor=#E4E4E4;strokeColor=#555555;strokeWidth=1.5;" vertex="1" parent="1"><mxGeometry x="200" y="1336" width="178" height="20" as="geometry"/></mxCell><mxCell id="meta" value="Master: draw.io (this file). Parent: SOP-S-003 5.1, 5.3, 5.4.2, 5.4.3, 5.4.5, 5.6, 5.6.1, 5.6.2. Draft - pending review." style="text;html=1;fontSize=9;fontColor=#94A3B8;align=left;" vertex="1" parent="1"><mxGeometry x="24" y="1410" width="952" height="16" as="geometry"/></mxCell></root></mxGraphModel></diagram></mxfile>