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Bangwe Health Center — preventing HIV infection through data and targeted response

The challenge

As a clinical officer and Sexually Transmitted Infections (STI) coordinator in Blantyre, Malawi, Suzike Likumbo had become adept at handling crises.

 

By 2022 she and her team had spent years battling an HIV epidemic which, at its peak in 2019, saw nearly 18% of the district’s residents living with the virus. Before 2020, coordinators like Likumbo had not had access to the data they needed to identify outbreaks like the one in Bangwe, and the statistics they could see were often outdated.

 

“It was complicated to get data to see what was actually happening in the district”, she remembers. Responding to outbreaks had also been a challenge. “We were doing interventions, but there was a lack of coordination, and everyone – community-based organizations, private clinics, civil society organizations – was doing their own thing in terms of prevention delivery,” says Likumbo. “The system wasn’t coordinated or coherent. It was quite hectic and challenging.” 

“It was complicated to get data to see what was actually happening in the district. We were doing interventions, but there was a lack of coordination, and everyone – community-based organizations, private clinics, civil society organizations – was doing their own thing in terms of prevention delivery. The system wasn’t coordinated or coherent. It was quite hectic and challenging.” 

Implementing the Blantyre Prevention Strategy

In 2020, Blantyre District began implementing the Blantyre Prevention Strategy (BPS), an approach to coordinating and strengthening existing healthcare systems to enable them to better prevent new HIV infections. With its strong focus on data use, improved coordination and community engagement, BPS has given Likumbo and her team greater insights into the spread of STIs in her district.

 

In 2022, for example, she and her team spotted a sudden rise in infections at Bangwe Health Center. The spike was dramatic enough to cause alarm: the facility had registered 660 new STI cases in a quarter, nearly triple that of the previous quarter. “As a district, we got worried,” she says. Following the BPS approach resulted in a dramatically more effective response to the STI outbreak in Bangwe than what would have been possible prior to 2020.

Data-based decision making to target interventions

“BPS has brought about real data-based decisions,” she reports. “In the case of Bangwe, it all started by looking at data in PALMS.” BPS worked with local and national data users to develop a data pipeline that brings together multiple previously fragmented data sources into the Prevention Adaptive Learning and Management System (PALMS).

 

PALMS is a user-friendly dashboard that collates and triangulates the data for ease of access and improved decision-making. It can be accessed on a computer, tablet or smartphone. “PALMS helps us identify red flags and underperforming indicators, and everything else follows from that. Now we can meet as a district and see where we have a lot of STIs, then try to find out why. We are able to target our interventions.”

“BPS has brought about real data-based decisions. In the case of Bangwe, it all started by looking at data in PALMS. [It] helps us identify red flags and underperforming indicators, and everything else follows from that. Now we can meet as a district and see where we have a lot of STIs, then try to find out why. We are able to target our interventions.”

A coordinated approach, guided by community insights

By bringing different HIV service providers together, explains Likumbo, BPS enabled to the District Health Management Team to coordinate their response to the rises in new infections more effectively. Together with local private clinics, implementing partners and community organizations, Likumbo’s team conducted road shows that combined HIV testing, STI screenings and management, condom distribution, and education on STI prevention.

 

Prior to BPS, Likumbo remembers, “we would go into the communities, but not consistently, and we wouldn’t get clear feedback from them.” But now, thanks to BPS’ emphasis on community engagement, they are better able to address the root causes of outbreaks. “We asked a patient in Bangwe, ‘why have you stopped taking PrEP?’ and they said, ‘I’ve stopped taking PrEP because it’s being offered at the ARV clinic, and when people see me there they think I’m getting ARVs.’ It really gets to the root of people’s concerns”, she explains.

A continuous feedback loop to improve quality and delivery of HIV prevention

Community-level insights like these create the kind of feedback loop that is key to delivering a more informed HIV response. For example, community insights that PrEP provision at ARV clinics created a barrier to access, informed change ideas raised through the BPS-supported Quality Improvement Collaborative, known as PrePUP!

 

The Bangwe QI teams then developed and tested different methods of distribution, which ultimately helped to increase PrEP uptake in Bangwe.The BPS approach includes regular meetings between civil society groups, community organizations and local health facilities, allowing them to share information and provide feedback on interventions. These relationships enabled the district team to identify the sources of new infections in Bangwe, and with remarkable precision.

 

“We learned that specific new hotspots had been opened – certain bars, houses where sex workers were operating,” says Likumbo. “If we had been going into the communities on our own, we would never have got this information.”In the case of Bangwe Health Center, the results of this new strategy were highly encouraging. Not only was Likumbo’s team able to use newly-available data to identify the steep rise in cases; they were also able to join with local private clinics, implementing partners and community organizations to mount a coordinated and highly targeted response.

“BPS is a game-changer. It has really positively changed the way I do my work, the way I coordinate with others, the way I see data, the way I work with the community and with the health facilities. I feel empowered.”

Outcomes

Thanks to these interventions, the rate of new STI infections in Bangwe quickly began to drop; in early 2023 the health facility reported only 222 new infections, down by two thirds compared to six months before. PrEP one-month continuation rates also rose by over seven percent during the same period, from 23.1% to 30.4%. Likumbo credits this success to the BPS approach.

 

“Without it, we would not have been able to respond as promptly, and it wouldn’t have been as easy to come up with interventions,” she says. “Interventions used to take a top-down approach, and they weren’t as targeted. We are now working together.”

 

She hopes that other districts can benefit from the new approach she and her team have adopted in Blantyre. “We have tested this in Blantyre, we have seen that this is working”, she says. “Moving forward, this should inform the policies in Malawi. It should be replicated in other districts in the country, and even beyond.”

 

“BPS is a game-changer. It has really positively changed the way I do my work, the way I coordinate with others, the way I see data, the way I work with the community and with the health facilities”, adds Likumbo. “I feel empowered. It has really helped me a lot.”

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