ScanForm + Malawi HTS
WHATMalawi HIV Testing Services (HTS) Pilot
WHEN

March - August 2021
WHERE

9 facilities (shown on the map below)
WHY

As Malawi continues to roll out newprograms and consolidates HIV/AIDS
epidemic control, the HTS registers
require updates to generate timely andaccurate summary statistics in accordance with the new 3-test algorithm.

PilotFacilities

Background•

Beginning in 2017, a dedicated HTS touch-screen
module has been introduced to large facilities
in Malawi with permanent electronic medicalrecords (EMR).

•Real-time use of the module by HTS providers washindered because of infrastructure challenges(power and network outages), limited workstations and dozens of testing locations across facilities.

•The Department for HIV and AIDS (DHA) sought
a way to convert client-level data from paper
registers at all HIV testing sites into electronicsummaries that are fully compliant with DHA andstakeholder reporting requirements, and are also
EMR-compatible.

•To address these needs, the DHA uses ScanForm,a paper-based technology that digitizes handwritten data from a picture taken with a smartphone,
and automates all downstream data processing.

Challenges

1HIV testing providers tally data by hand from multiple paper registers
to create detailed facility reports.
•••

2

As HIV programs and reporting requirements expanded in scope andcomplexity, the previous HTS register became insufficient.
••

•

3

On average, facility reports took 2 days to complete each work month.
Increased likelihood of human error from manual transcription and summarization.
Compromised quality of client services.

Disaggregated reporting by HTS modality
required maintaining a copy of the original HTS register at each testing location.
◦ Many facilities used >3 registers atonce, leading to confusion and loss ofdata.
Many program-relevant details werenever accessible for analysis while clientreferral outcomes could not be captured
due to space constraints.
Designed for the 2-test algorithm which
captured personal identifiable information (PII) for both the initial and confirmatory test results, if given consent.
◦ Only 3% of initial tests are positive and proceed to confirmatory testing.

Malawi is transitioning to a 3-test algorithm for HTS.
•In 2019, the World Health Organization (WHO) recommended a 3-test algorithm when positivity among tested is <5%.
◦ Malawi positivity rate has been <5% since 2016.
◦ Up to 1,900 false positive test results may have been given out each year using the oldtesting algorithm.

Why upgrade to ScanForm:
All summary statistics are automatically generated, saving at least
10% of work time each month for HIV testing providers.
•••

Locale-specific artificial intelligence to scan & interpret handwriting that continues to improveover time.
In accordance with DHA reporting requirements, preliminary statistics are prepared weekly,
with final monthly reports sent by the 2nd of the month.
Increased speed, reliability, and accuracy of analytics and visualizations.

Adaptable paper-based solution that is complementary and interoperable with EMRs.
••••

Designed in collaboration with the DHA and includes all required indicators.
PII is never digitally captured. Unique identifiers are generated to link records across registers
State-of-the-art cybersecurity for phones and data systems that are compliant with General
Data Protection Regulation standards.
Client-level electronic data allows routine field performance evaluation of the new 3-test algorithm, including client and provider characteristics associated with discrepant test outcomes.

Unrivaled remote support supervision enabled by automatic alerts
and monthly data quality reports.
•“Data quality algorithm flagged inconsistent client records for review by national HTS program
staff. Several inconsistencies were actually service delivery mistakes that prompted feedback to theprovider and corrective action.
- M&E office testimonial

This new [ScanForm] register made us serious andcompetent when filling it because you did not wantto make mistakes. When the mistakes are uploaded, thequery report is sent back to you so to avoid that, you justmake sure that you crosscheck your work.

- focus group discussion feedback from Clinton Health Access Initiative, 2021

Impact
100% of HTS providers reported that data collection is faster withScanForm.
•••

95% of HTS providers rated the quality of technology as good or very good.
The ScanForm made our lives easy. We stopped producing a report which is the hectic part of our work.*
I can say that I like ScanForm because [my] workload has been reduced.*

More robust data collection with improved data quality.
•90% of ScanForm register pages were filled and scanned without any issues flagged forhuman verification.

More efficient use of paper.
•~ 77% of the previous HTS register was filled in with unneeded information from negative
initial test results, including sensitive client PII.

All three ScanForm registers will be scaled up nationally in Malawi
to 750+ facilities.
•••

86% of HCW would recommend ScanForm for their facility
We want the ScanForm Technology to start as soon as possible.*
Change is possible. There is always room for change. That is when you move with technology. We
should not be rigid when new things are coming.*

Are you ready to upgrade
to ScanForm?

Contact us:
https://scanform.qed.ai
scanform@qed.ai
QED | https://qed.ai

This project is supported by the WHO, The Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) throughCDC under the terms of cooperative agreement #NU2GGH002298. The findings and conclusions are those of the authors and do
not necessarily represent the official position of the funding agencies.
* - focus group discussion feedback from Clinton Health Access Initiative, 2021