Sarah Salinger, FHI 360

For the first time, with the PrEP ring and CAB PrEP entering markets alongside oral PrEP, women have multiple HIV prevention methods to choose from. Now prevention programs face another first: how to deliver those options in ways that ensure informed choice and foster effective use.

To help answer that question, MOSAIC embedded a quality improvement collaborative (QIC) into its flagship CATALYST study. Through the CATALYST QIC, the study is refining and making context-specific improvements to an enhanced service delivery package that offers PrEP method choice to women at 28 public health sites across five countries—Kenya, Lesotho, South Africa, Uganda, and Zimbabwe.

As an implementation study, CATALYST is utilizing quality improvement methods as an innovative, solutions-focused mechanism for delivering PrEP method choice in settings where previously only one PrEP method was available. At each site, QI advisors and coaches support QI teams comprised of PrEP nurses, pharmacists, and other clinic staff. These teams are identifying areas of improvement and ideas for changes that could strengthen the delivery of PrEP choice, testing those changes, and analyzing the improvements with QI data. QI teams share what they have learned at country-level and regional learning sessions and document them in QI briefs (Figure 1).

Figure 1. The CATALYST QIC process



The CATALYST QIC began by identifying a set of objectives (Box 1) to guide QI teams in addressing challenges related to PrEP service delivery and introducing PrEP method choice. QIC team members met with and obtained buy-in from ministries of health in all CATALYST countries through a series of QI charter meetings where the objectives—and indicators for measuring progress toward them—were agreed upon. QI advisors then visited CATALYST sites to pilot test the indicators and data sources and trained the site QI teams so the QI effort could be launched.

A journey with the QIC has been the most interesting, with lots of learning, bringing teams together, identifying barriers in PrEP implementation process, and brainstorming different change ideas for successful implementation of an enhanced service delivery [package] for PrEP choice. [The] QIC has made a huge impact to Lesotho Ministry of Health and PrEP implementing partners through gathering and sharing of different insights and learning.

Mamaphau Kubutu, QI Coach, Lesotho


Now, the QIC is in full swing. The QI coaches have formed close connections with the providers at the sites as they work together to integrate QI for PrEP choice delivery into their day-to-day responsibilities. Ongoing activities include:

  • All sites are implementing a QI client exit survey to use as a data source for measuring progress toward achieving key QI objectives.
  • Coaches visit their QI teams on site several times a month to review data collection efforts and progress on the Plan-Do-Study-Act (PDSA) cycles they use to test change ideas and to help troubleshoot implementation challenges.
  • In each country, the QI advisor meets with the QI coach(es) biweekly for virtual capacity strengthening and to share updates on the change ideas being tested in other CATALYST sites.
  • Each country hosts two country-level learning sessions per year, so QI team members, members of the CATALYST research team, and representatives of the Ministry of Health can meet to discuss country-level lessons and plan for the months ahead.
  • QI coaches document their support to the site QI teams in coaching reports that inform the development of QI briefs. These briefs compile key lessons and country-level QI data, which also serve as a data sources for the CATALYST process evaluation.

Increasing PrEP awareness through group health education [about PrEP and HIV prevention in the clinic waiting areas] among AGYW together with in-depth, individualized PrEP counseling… [is showing improvement]… in making AGYW informed of PrEP choices available.

Mamaphau Kubutu


The CATALYST QIC will soon hold its first cross-country learning session. Representatives from all 28 CATALYST sites will gather virtually and will be joined by representatives of ministries of health, USAID missions, and CATALYST study management to discuss QI lessons, best practices, and implementation challenges. The QIC will continue to test site-specific changes that help introduce PrEP method choice for CATALYST participants while also improving PrEP services for all clients. Combined with evidence from the CATALYST study, the lessons from the QIC will ultimately inform programmatic recommendations for scaling up the delivery of PrEP choice.

Featured Image: The CATALYST Quality Improvement team poses during the charter meeting in Mombasa, Kenya, December 2022 (MOSAIC).