Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 19:7:1558630.
doi: 10.3389/frph.2025.1558630. eCollection 2025.

Using quality improvement to close HIV prevention gaps and strengthen district health systems: Blantyre, Malawi's approach and early implementation

Sara M Allinder  1 , Edward Moses  2 , Moses Enock  2 , Gift Kawalazira  3 , Rose Nyirenda  4 , Andrew Gonani  5 , Yohane Kamgwira  6 , Bruce Agins  7 , Richard Birchard  7 , Joseph Murungu  8 , Deborah Hoege  1 , Charles B Holmes  1 , Martias Joshua  9
Affiliations

Using quality improvement to close HIV prevention gaps and strengthen district health systems: Blantyre, Malawi's approach and early implementation

Sara M Allinder et al. Front Reprod Health. .

Abstract

Application of quality improvement (QI) methodology to HIV prevention is relatively nascent but has the potential to transform national and local programs. In Blantyre, Malawi, a unique government-led partnership known as the Blantyre Prevention Strategy (BPS) is applying QI as a core element of a cohesive sub-national HIV prevention system. BPS launched a QI collaborative (QIC) in early 2021-the first of its kind dedicated to HIV prevention within a health system context-focused on scale-up of pre-exposure prophylaxis (PrEP) to prevent HIV. Known as PrEPUp!, the QIC included 23 participating facilities-representing the public and private sectors, drop-in centers for key populations, and a tertiary education clinic-and has become the major platform for facility teams to exchange knowledge and share progress. Based on the implementation of QI activities, interventions identified for testing resulted in health center system modifications that promotes increased uptake of PrEP. In addition, knowledge generated through the QIC informs other stakeholders, including implementing partners funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and improves coordination and mentoring executed by the Blantyre District Health Office (DHO). In a departure from traditional QI, BPS has engaged community labs that generate insights from clients and other influential stakeholders about demand and service access barriers and has connected those labs with facilities through learning sessions. This approach has been widely lauded locally in Malawi and is being adapted in Lilongwe District to underpin implementation science for injectable PrEP.

Keywords: HIV; HIV prevention; Malawi; district-based model; health system; prevention; quality improvement (QI); sub-national.

PubMed Disclaimer

Conflict of interest statement

EM and ME were employed through MaiKhanda Trust for the first 2 years of BPS implementation. They left MaiKhanda and continued working on BPS as technical expert consultants to UCSF-HealthQual and, since 2024, as employees of Compelling Works in Malawi. They have no commercial interests. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
BPS quality improvement collaborative methodology (the planning group included UCSF-HEALTHQUAL, MaiKhanda trust, population services international, and the DHO, i.e., HQ/MK/PSI/DHO).
Figure 2
Figure 2
Zingwangwa health centre PrEP process map wall chart, photo taken September 27, 2021.
See this image and copyright information in PMC

References

    1. Ministry of Health. Malawi Population-Based HIV Impact Assessment (MPHIA) 2015–2016: Final Report. Malawi Ministry of Health. (2018). Available at: https://phia.icap.columbia.edu/malawi-final-report/ (Accessed November 05, 2024).
    1. Kawalazira G, Kamgwira Y, Allinder SM, Mablekisi C, Nyirenda R, Hoege D, et al. A health systems approach to more effective subnational HIV prevention: development of Malawi’s Blantyre prevention strategy. BMJ Glob Health. (2025) 10(2):e016880. 10.1136/bmjgh-2024-016880 - DOI - PMC - PubMed
    1. Ngongo Bahati P, Kidega W, Ogutu H, Odada J, Bender B, Fast P, et al. Ensuring quality of services in HIV prevention research settings: findings from a multi-center quality improvement pilot in East Africa. AIDS Care. (2010) 22(1):119–25. 10.1080/09540120903012569 - DOI - PubMed
    1. Urwitz V, Vuylsteke B, Apers H, Hales D, Wentzlaff-Eggebert M, Nöstlinger C. A multicountry European study on succeed: a general quality improvement tool in HIV prevention. Health Promot Int. (2020) 35(5):935–46. 10.1093/heapro/daz081 - DOI - PubMed
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Take the Rights Path World AIDS Day 2024 Report. (2024). Available at: https://rightspath.unaids.org/?_gl=1%2a9y7kpw%2a_ga_T7FBEZEXNC%2aMTczNjI... (Accessed November 12, 2024).

LinkOut - more resources