Improving STI and HIV Passive Partner Notification Using the Model for Improvement: A Quality Improvement Study in Lilongwe Malawi

Abstract

Background:In Malawi, passive partner notification is the mainstay method of partner notification (PN). Despite its wide use, the proportion of sexual partners referred for care through this method is very low. We aimed to increase the proportion of sexual partner referral through passive PN.Methods:We implemented a quality improvement (QI) project at Bwaila STI unit in Lilongwe, Malawi between January and June 2017 using a pre- and post- intervention quasi-experimental study design. Pre-intervention, we conducted key-informant interviews and clinic observations and used the findings to design a QI project using expert opinion. The intervention included three change ideas: early start time of the clinic, shortening of the group health talk and expedited clinic flow for sexual partners. Each change idea was tested twice through 1-week long Plan-Do-Study-Act cycles using the model for improvement (MFI) and then combined and tested twice. Process data were collected and monitored using run charts. Post-intervention, we evaluated the proportion of sexual partners who presented to the clinic, to detect a 10% increase at 95% power and α=0.05, between pre- and post-intervention periods.Results:The average duration of the group health talk dropped from 56 minutes to 38 minutes and the duration of clinic stay for sexual partners reduced by 45 minutes (from 1hour 36 minutes to 51 minutes). The average clinic start time improved from 09:02 hours to 08:17 hours. The proportion of sexual partner referral increased by 37% (P=0.04) - from 15.6% to 21.4%. We observed an upward trend in the proportion of sexual partners referred in the post-intervention period.Conclusion:The yield of sexual partners through passive PN was improved using a simple QI intervention implemented using the MFI. However, the proportion of sexual partner referral remains suboptimal. More effort is required to increase the proportion of sexual partner referral in Malawi.

Experiences and preferences with sexually transmitted infection care and partner notification in Gaborone, Botswana

“…This is in line with prior research in Southern Africa, suggesting enhanced counseling, contact slips, extended clinic hours, and expedited clinic flow for sex partners increased partner notification and treatment. 16,17 Additionally, a systematic review found that supplemented notification strategies, such as providing educational information for partners, were as effective in preventing reinfection as EPT. 9 Our study provides further evidence that such low-cost interventions may increase partner treatment.…”

Developing a Field of Study in Implementation Science for the Africa Region: The Wits–UNC AIDS Implementation Science Fogarty D43

“…MSc students publish as well, and in 2017 and 2018, both the FIC and WHO grants supported students to attend international research conferences. The students from the 2016 and 2017 cohorts had 12 publications in peer-reviewed journals (Eboreime, Eyles, Nxumalo, Eboreime, & Ramaswamy, 2019; Eboreime, Nxumalo, et al, 2019; Manyeh, Ibisomi, Baiden, Chirwa, & Ramaswamy, 2019; Manyeh, Nathan, & Nelson, 2018; Matoga, Hosseinipour, et al, 2018; Matoga, Mmodzi, et al, 2018; McGavin et al, 2018; Naidoo, Railton, Jobson, et al, 2018; Naidoo, Railton, Khosa, et al, 2018; Naidoo, Zuma, et al, 2018; Naidoo, Matlakala, et al, 2019; Wambiya, Atela, Eboreime, & Ibisomi, 2018) and eight poster presentations.…”