{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:03:17Z","timestamp":1767794597447,"version":"3.49.0"},"reference-count":20,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-0026-6"],"award-info":[{"award-number":["INV-0026-6"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,7,21]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Innovative 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 139\u2009million 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\u2014changes in syndromic STI counts (lagged and cross-sectional)\u2014showed 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002568","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T01:45:19Z","timestamp":1757382319000},"page":"e002568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Health facility and contextual correlates of HIV test positivity: a multilevel model of routine programmatic data from Malawi"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9543-9233","authenticated-orcid":false,"given":"Miyu","family":"Niwa","sequence":"first","affiliation":[{"name":"Cooper\/Smith, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan","family":"Green","sequence":"additional","affiliation":[{"name":"Cooper\/Smith, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Smith","sequence":"additional","affiliation":[{"name":"Cooper\/Smith, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Klyn","sequence":"additional","affiliation":[{"name":"Cooper\/Smith, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohane","family":"Kamgwira","sequence":"additional","affiliation":[{"name":"National AIDS Commission, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Allinder","sequence":"additional","affiliation":[{"name":"Center for Innovation in Global Health, Georgetown University, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Hoege","sequence":"additional","affiliation":[{"name":"Center for Innovation in Global Health, Georgetown University, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzike","family":"Likumbo","sequence":"additional","affiliation":[{"name":"Blantyre District Health Office, Blantyre District Council, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles B","family":"Holmes","sequence":"additional","affiliation":[{"name":"Center for Innovation in Global Health, Georgetown University, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gift","family":"Kawalazira","sequence":"additional","affiliation":[{"name":"Blantyre District Health Office, Blantyre District Council, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linley","family":"Chewere","sequence":"additional","affiliation":[{"name":"Department of HIV, STI & Hepatitis, Ministry of Health, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"2026010703064392000_3.2.e002568.1","unstructured":"HIV data and statistics. Available: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/strategic-information\/hiv-data-and-statistics [Accessed 18 Jul 2023]."},{"key":"2026010703064392000_3.2.e002568.2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/QAD.0000000000002096","article-title":"Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat","volume":"33","author":"De Cock","year":"2019","journal-title":"AIDS"},{"key":"2026010703064392000_3.2.e002568.3","doi-asserted-by":"crossref","unstructured":"Hotchkiss DR , Diana ML , Fleischman FKG . How can routine health information systems improve health systems functioning in low- and middle-income countries? Assessing the evidence base. In: Menachemi N , Singh S , eds. Health information technology in the international context. Vol 12. Advances in health care management. Emerald Group Publishing Limited, 2012: 25\u201358.","DOI":"10.1108\/S1474-8231(2012)0000012006"},{"key":"2026010703064392000_3.2.e002568.4","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.08.020307","article-title":"Building integrated data systems for health and nutrition program evaluations: lessons learned from a multi-country implementation of a DHIS 2-based system","volume":"8","author":"Hazel","year":"2018","journal-title":"J Glob Health"},{"key":"2026010703064392000_3.2.e002568.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2016.06.053"},{"key":"2026010703064392000_3.2.e002568.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-05660-1","article-title":"Using routine health information data for research in low- and middle-income countries: a systematic review","volume":"20","author":"Hung","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026010703064392000_3.2.e002568.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-08598-8","article-title":"Routine use of DHIS2 data: a scoping review","volume":"22","author":"Byrne","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026010703064392000_3.2.e002568.8","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czv029"},{"key":"2026010703064392000_3.2.e002568.9","doi-asserted-by":"crossref","unstructured":"Gloyd S , Wagenaar BH , Woelk GB , et al . Opportunities and challenges in conducting secondary analysis of HIV programmes using data from routine health information systems and personal health information. J Int AIDS Soc 2016;19. doi:10.7448\/IAS.19.5.20847","DOI":"10.7448\/IAS.19.5.20847"},{"key":"2026010703064392000_3.2.e002568.10","unstructured":"WHO Packages . DHIS2. Available: https:\/\/dhis2.org\/who\/ [Accessed 27 Jul 2023]."},{"key":"2026010703064392000_3.2.e002568.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000154504.54686.d1"},{"key":"2026010703064392000_3.2.e002568.12","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054706"},{"key":"2026010703064392000_3.2.e002568.13","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26049","article-title":"Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta-analysis","volume":"26","author":"Saleem","year":"2023","journal-title":"J Int AIDS Soc"},{"key":"2026010703064392000_3.2.e002568.14","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001403"},{"key":"2026010703064392000_3.2.e002568.15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.2989\/16085906.2023.2197883","article-title":"Assessing the impact of the COVID-19 restrictions on HIV testing services in Malawi: an interrupted time series analysis","volume":"22","author":"Afirima","year":"2023","journal-title":"Afr J AIDS Res"},{"key":"2026010703064392000_3.2.e002568.16","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s10461-023-04139-4","article-title":"HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review","volume":"28","author":"Mude","year":"2024","journal-title":"AIDS Behav"},{"key":"2026010703064392000_3.2.e002568.17","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1007\/s10461-022-03941-w","article-title":"Characterizing the Impact of the COVID-19 Pandemic on HIV PrEP care: A Review and Synthesis of the Literature","volume":"27","author":"Hong","year":"2023","journal-title":"AIDS Behav"},{"key":"2026010703064392000_3.2.e002568.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-022-00496-7","article-title":"The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review","volume":"20","author":"SeyedAlinaghi","year":"2023","journal-title":"AIDS Res Ther"},{"key":"2026010703064392000_3.2.e002568.19","unstructured":"Blantyre Prevention Strategy . Center for innovation in global health. Available: https:\/\/cigh.georgetown.edu\/our-work-2\/innovation-in-hiv-prevention\/blantyre-prevention-strategy\/ [Accessed 28 Jul 2023]."},{"key":"2026010703064392000_3.2.e002568.20","unstructured":"Home . Blantyre prevention strategy. Available: https:\/\/blantyreprevention.mw\/ [Accessed 28 Jul 2023]."}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-002568","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:08:26Z","timestamp":1767784106000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-002568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bmjph-2025-002568"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-002568","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}