Second PrEP UP QI Collaborative Learning Session

About The Blantyre Prevention Strategy Program

The persistent reservoirs of HIV infection threaten long-term epidemic control despite existing effective prevention interventions and emerging novel prevention products. Malawi Ministry of Health in April 2019 recommended national implementation of oral PrEP within the public health system. The introduction of PrEP in Malawi aims to achieve maximum impact in the reduction of HIV infections. There is need to establish district-based system that will enhance deployment and uptake of novel and existing HIV prevention interventions, institutionalized and embedded within local systems and capabilities. Hence the Blantyre Prevention Strategy (BPS) project. Blantyre district through BPS project is one of the selected districts where initiatives are geared to roll out the provision of PrEP. The project is funded by UCSF/HEALTHQUAL.

The PrEP Up Quality Improvement Collaborative (QIC)

MaiKhanda Trust has been subcontracted by UCSF/HEALTHQUAL to implement health facility Quality Improvement Collaborative (QIC) to accelerate the uptake of PrEP in Blantyre as part of the BPS project. The QIC is being implemented in 21 health facilities that include 17 general facilities and 4 drop in centers. The QIC involves a group of 21 health facilities within Blantyre district coming together to learn and motivate each other to improve on common objective in this case PrEP uptake. The QIC is also called PrEP Up collaborative.

Second QIC Learning Session

One of the key drivers to implement the PrEP Up QI collaborative is through conducting series 0f learning sessions. A learning session brings together representatives from all participating facilities in the QI collaborative to share best practices and learn from each other. Learning Session provide a platform for facilities to energize and learn from previous action periods what is working and make the case for new topics. On 31 January 2022 Blantyre DHO with support from MaiKhanda Trust organized the 2nd QIC learning session.

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The 2nd learning session was opened by Blantyre Director of Health and Social Services Dr. Gift Kawalazira. In his remarks he reminded the participants that they were in the second year of BPS project therefore expect participants (health workers) to learn a lot from the implementing partners in order to ascertain the sustainability. He applauded facilities in the collaborative for good data management that include documentation and reporting, now that people are able to access data and know what is happening in the collaborative. Finally, he informed the participants that injectable PrEP has been approved in USA. 

The objectives of the 2nd learning session were:

          Review current performance data on PrEP implementation in Blantyre 

          Share experiences and learning on PrEP implementation from collaborative sites in Blantyre

          Reinforce status-neutral approach to HIV testing with the same approach for engagement regardless of status, and ensure clients who test negative for HIV are screened and referred to PrEP services

          Introduction to spotlights

          Harvest high impact change ideas 

Plan second action period; each site implements their action plan developed during the second Learning Session

Poster Presentation

All participating facilities in PrEP Up QI collaborative are implementing QI projects with an aim of accelerating PrEP uptake.  Facilities were asked to organize, prepare and show case their QI project through storyboards in a form of posters. Each facility was slotted a time to conduct a poster presentation. Participants were given adequate time to listen and ask questions. It was a teach and learn session where participants leant some best practices from other facilities and presenting facility received constructive and helpful criticisms that could help them to improve further in their QI project. 

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The aim statements for the QI projects presented during poster presentations focused on Increased PrEP uptake for new clients and increased PrEP awareness among targeted population. 90% of the facilities in PrEP Up QI collaborative focused on increased PrEP uptake while 10% focused on demand creation (PrEP awareness.

 

Several interventions were suggested and implemented in order to
achieve various QI project aims towards PrEP uptake. The following were among
change ideas facilities implemented as interventions:

       Conducting health talks on PrEP at all entry points

       Escorting clients from point A to point B for PrEP services

       Pasting PrEP posters and distributing leaflets (including in drinking joints)

       PrEP mobilization using peer educator

       Conducting outreach clinics for PrEP services

       Involvement of youth champions

       Health talks using videos and audios

       Involve HAAC for community sensitization

       Conducting CPD sessions on PrEP to health workers

 

       Involve partners for client mobilization 

The following challenges and lessons leant were presented by participating facilities accrued during implementing period of their QI projects on PrEP Up:

Challenges

Meetings not done as planned.

Some facilities focused at ART & STI only as their entry.

Lack of proper documentation to indicate what intervention has led to achieving the aim.

Defaulting of clients due to long distances and relocation of FSW – mobility.

Lack of screening tools (SOPs).

PrEP resources limitation (green cards, posters, leaflets and drugs).

Clients want to start PrEP without HIV testing.

 

Poor client risk assessment for PrEP.

Lessons Learnt

Proper documentation only way facilities can attribute intervention to achievements.

Use of peer educator and PrEP champions for PrEP mobilization works better.

Team work (all cadres are equally important for QI activities).

Working with partners.

Dispensing PrEP in other rooms rather than in ART room is convenient to client.

Providing adequate PrEP information is a way to go.

Collective efforts in QI yield better results.

Working with an aim improves health service uptake.

 

Continuous mentorship and supervision improve QI initiatives.

Facilities will again meet in June 2022 for 3rd round of Learning Session. Facilities will present QI projects implemented between February 2022 to May 2022. In addition, QI teams together with mentors will identify spotlights from their facilities to be showcased at the learning session.

Participants were selected from the following facilities and implementing partners:

General Facilities

Drop In Centers

Partners

Gateway Clinic

MUBAS Clinic

Light House Clinic

Limbe Macro Clinic

Limbe Health center

Ndirande Health center

Mbayani Health center

South Lunzu Health center

Mpemba Health center

Bangwe Health center

Chileka Health center

Chilomoni Health center

Chirimba Health center

Madziabango Health center

Zingwangwa Health center

Mlambe Hospital

Adventist Hospital

Chirimba DIC

Bangwe DIC

Naperi DIC

Nyambadwe DIC

Pakachere

CEDEP

EGPAF

JAPIEGO

Dreams

Yoneco

Rainbow

 

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