PrEP Appointments at Area 25 Community Hospital, Malawi – ACQUIRE QI Patient Safety Cohort 2 2026

Modesta Nyando shares how the Area 25 Community Hospital team in Lilongwe, Malawi is helping more clients on long-acting injectable HIV pre-exposure prophylaxis (PrEP, CAB-LA) keep their one-month appointments. Monthly data reviews showed that from July to December 2025 only 55 of 125 clients on CAB-LA kept their one-month appointment, a baseline of 40.9%. The team set out to raise this from 40.9% to 70% between January and December 2026. Their process map followed clients as they queue in departments such as antenatal, OPD and family planning, through counselling and screening, HIV testing, the clinician and PrEP assessment. A fishbone analysis and prioritisation matrix showed that the lack of appointment reminders was the top cause. Key drivers were reminding clients of appointment dates, adequate knowledge among providers and clients, and adequate drug supplies. The first PDSA cycle phoned clients after they had missed an appointment. For four weeks no client came back, so the team reviewed the data and adapted the idea: clients are now called two days before their next appointment, and since then clients have been coming back steadily. Reminders will become part of every service provider's routine, reviewed weekly. The team expects better PrEP continuity, fewer new HIV infections, better adherence and timely HIV and STI screening. Their challenges: some health workers forget to call, and some clients give phone numbers that cannot be reached; their key learning is that not every change idea leads to an improvement. Speaking for the hospital's management, Dziwenji Makombe said the team's department is now a place others can benchmark from, and that a little airtime spent on reminder calls has brought clients back and prevented avoidable losses. Team leadership: Violet Innocent Sponsorship: The facility in-charge, hospital matron and QI coaches Mentorship: Feyissa Mama Team: Chimwemwe Mlenga, Dziwenji Mboma, Modester Nyando Chapters 0:00 Introduction 0:27 Problem statement 0:48 Target and baseline 1:14 Current state analysis 1:38 Root causes 1:57 Key drivers and interventions 2:20 Results 3:15 Sustain plan 3:34 Expected impact 4:09 Challenges and learning 4:41 Feedback and celebration This project is part of the 2026 ACQUIRE Quality Improvement-Patient Safety (QI-PS) Experiential Leadership Program, where frontline health workers across sub-Saharan Africa learn improvement science by leading real change in their own facilities. Quality takes a team! Learn more: https://acquirefrontline.org #QualityImprovement #PatientSafety #HIVPrevention #PrEP #RetentionInCare #Malawi #ACQUIRE