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ACCESS TO AND USE OF REAL-TIME DATA IMPROVES SERVICE TARGETING AND DELIVERY

High-quality, accessible, and stigma-free HIV services are essential to district-level HIV prevention programs. Prior to BPS, Quality Improvement (QI) approaches were not being routinely applied HIV prevention programs. The QI program element of the BPS applies QI approach to district-led HIV prevention in coordination with central authorities and in line with national quality strategies.

 

BPS adapted the Breakthrough Series Collaborativemodel to establish a QI collaborative focused on pre-exposure prophylaxis (PrEP). In addition to targeted training for district health staff, the “PrEPUP!” collaborative, originally comprised of 23 public, private, and non-governmental facilities, was the initial mechanism for capacity building in Blantyre. A similar approach has been adapted in Lilongwe to support the PathToScale injectable PrEP implementation science initiative. Since 2024, Blantyre’s QI approach has shifted as the collaborative transitioned to a new phase including district-led affinity groups and clusters.

 

More background on the BPS QI approach can be found in “Using quality improvement to close HIV prevention gaps and strengthen district health systems: Blantyre, Malawi’s approach and early implementation” published by the Frontiers in Reproductive Health journal in June 2025.

WHAT IS QI COLLABORATIVE? 

Bruce Agins

Director of HealthQual based at the University of California

Use of quality improvement (QI) for HIV prevention was nascent at the beginning of BPS. BPS’s innovative application of QI methodologies through a QI collaborative has been a critical platform for data use, information sharing, and bringing community insights to service providers. ​​​

Edward Moses

QI Consultant for UCSF HealthQual

The PrEPUp! Collaborative – the first QI collaborative focused on pre-exposure prophylaxis (PrEP) – involves 23 PrEP providers in Blantyre and is building capacity at facilities and at the district/city health offices to implement QI approaches for HIV prevention. Shared learning through PrEPUp! has improved uptake of PrEP services in the participating facilities compared to others in Blantyre and Lilongwe. 

Elements of Blantyre’s quality improvement approach post-collaborative are:

 

  1. Use of a common data platform (PALMS) is a core element of Blantyre’s integrated community insights and QI approach. PALMS facilities identification of signals that require input from clients to problem solve or further investigate and turn into change ideas for improved service delivery.

  2. Capacitated human resources at district, facility, and community levels. The capabilities built through BPS, including the district QI unit, QI support teams (QISTs), and among network committee members, support the governance, technical leadership, multisectoral partnership, and community engagement approaches that are critical to quality, accessible, and patient-centered service delivery.

  3. Use of clusters. The expansion of Blantyre’s cluster approach has led to more efficient coaching and to share peer-to-peer learning between facilities.

  4. QI as platform for data review and decision making at facility level. Through the systems mapping process, any non-urgent active surveillance signals validated as risks, passive surveillance signals, and other non-urgent inputs will be channeled to the facility QIST to review and determine the appropriate next steps in terms of investigation, root cause analyses, and programmatic interventions or change ideas.

Lessons learned:

 

  • QI capabilities can be institutionalized in district health systems. Blantyre’s QI mentors are not only skilled in QI techniques and coaching but have also developed the capacity to train others, creating a sustainable system for continuous quality improvement. With local mentors now capable of leading the QI process, Blantyre has successfully embedded QI into the daily operations of multiple health facilities, leading to improved healthcare service delivery, more efficient operations, and better patient outcomes.

  • Facilities can utilize their BPS-supported capabilities to personalize the community lab model and make linkages between their HCD work and other QI actions. They are utilizing skills learned through the community lab model to adapt existing prototypes to meet their context and ensure feasibility. Some facilities iterated the testing process based on the preliminary feedback they were getting from the data.

  • Clustering facilities together creates more efficient coaching and mentorship and enables shared learning and problem solving. Use of a cluster approach facilitated community lab activities, QI, data use, and skill building.

  • Cluster learning sessions have become a platform for sustaining the QI platform started through the PrEPUP! QI collaborative and for engaging facilities, both public and private, that were not part of the collaborative. In addition, they have enabled the district to expand training and coaching on QI and other health areas beyond HIV. Blantyre’s ability to extend QI support to health facilities outside the original project scope, led entirely by district mentors, highlights the success of its BPS QI capacity-building efforts.

  • Holding “harvest workshops” is an effective means of capturing lessons learned, best practices, successful strategies and tools to scale HIV prevention learnings from BPS into new districts and facilities.

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