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BackgroundInnovative and efficient methods are needed to identify remaining people living with HIV unaware of their status. Routine health information system (RHIS) data, widely available in high-burden HIV settings, may help target areas of high risk to deliver timely prevention services. Often underused, RHIS data were leveraged at the facility level to predict changes in HIV test positivity in Malawi.MethodsFrom District Health Information Software-2 from January 2017 to March 2023, we analysed sexually transmitted infection (STI) cases and HIV tests and test results across 563 health facilities in Malawi. A multilevel model was employed to determine whether changes in STI diagnoses were predictive of changes in HIV test positivity. We considered STI types and their incubation periods, and controlled for facility type, ownership, quarter, season, zonal HIV and STI prevalence (2016 Population-Based HIV Impact Assessment).ResultsAmong 139 million HIV tests, overall positivity was 2.8%. Blantyre facilities had the highest positivity (6.0%) while those in the central-east zone had the lowest (1.8%). Key variables—changes in syndromic STI counts (lagged and cross-sectional)—showed weak or no associations with HIV positivity (OR: 1.01, CI: 1.01 to 1.01; OR: 1.00, CI: 1.00 to 1.00). However, contextual covariates, including zonal HIV prevalence (OR: 1.04, CI: 1.04 to 1.04), genital ulcers (OR: 1.16, CI: 1.16 to 1.16) and clinical STI diagnoses (OR: 1.29, CI: 1.29 to 1.29), were positively associated with HIV positivity.ConclusionsIn settings with high STI screening uptake, RHIS data can be used to monitor changes in STI diagnoses and contextual factors to identify HIV hotspots and guide targeted testing, prevention and treatment services.

Malawi has 991,600 people living with HIV and has expanded access to annual HIV viral load testing to enhance care quality for clients. However, significant delays persist in returning viral load (VL) results back to facilities and to clients. To address this, we implemented a digital VL results return (VLRR) application, using existing mobile phone platforms to expedite results return to clients and healthcare providers (HCPs).VLRR is a digital SMS/USSD platform leveraging mobile phones to reduce turnaround time (TAT) and improve access to VL results. To evaluate the VLRR intervention, we: (1) estimated the TAT for digital results return, (2) calculated open rates of digital results, (3) conducted a mixed methods evaluation with VLRR users, and (4) estimated the potential cost savings from avoiding unnecessary sample redraws. From April 2022 to June 2024, HCPs registered 4,067 clients. For each client, TAT was calculated separately for the periods before and after enrollment in the VLRR system. On average during this period, clients received results in 128 days before VLRR enrollment and 48.5 days after enrollment, reflecting a 62.4% improvement. By July 2023, VLRR clients and HCPs received results in an average of 30 and 38 days. The overall open rate for digital results (opened by either a client or HCP) was 60% and nearly 100% of clients and HCPs indicated they wanted to the application to continue. Lastly, if VLRR were scaled nationally, it has the potential cost savings of $1.8-6.7 million USD.VLRR is effective in reducing TAT and improving access to VL results. To enhance uptake and achieve national scale, VLRR can be integrated into Malawi’s existing EMR systems, further reducing TAT and enabling HCPs to deliver higher quality care and improve clinical outcomes.

Malawi has 991,600 people living with HIV and has expanded access to annual HIV viral load testing to enhance care quality for clients. However, significant delays persist in returning viral load (VL) results back to facilities and to clients. To address this, we implemented a digital VL results return (VLRR) application, using existing mobile phone platforms to expedite results return to clients and healthcare providers (HCPs).VLRR is a digital SMS/USSD platform leveraging mobile phones to reduce turnaround time (TAT) and improve access to VL results. To evaluate the VLRR intervention, we: (1) estimated the TAT for digital results return, (2) calculated open rates of digital results, (3) conducted a mixed methods evaluation with VLRR users, and (4) estimated the potential cost savings from avoiding unnecessary sample redraws. From April 2022 to June 2024, HCPs registered 4,067 clients. For each client, TAT was calculated separately for the periods before and after enrollment in the VLRR system. On average during this period, clients received results in 128 days before VLRR enrollment and 48.5 days after enrollment, reflecting a 62.4% improvement. By July 2023, VLRR clients and HCPs received results in an average of 30 and 38 days. The overall open rate for digital results (opened by either a client or HCP) was 60% and nearly 100% of clients and HCPs indicated they wanted to the application to continue. Lastly, if VLRR were scaled nationally, it has the potential cost savings of $1.8-6.7 million USD.VLRR is effective in reducing TAT and improving access to VL results. To enhance uptake and achieve national scale, VLRR can be integrated into Malawi's existing EMR systems, further reducing TAT and enabling HCPs to deliver higher quality care and improve clinical outcomes.