Introduction
The Government of Malawi through the Ministry of Health chose Blantyre district, the commercial center of the country, as the initial geography of interest to implement the Blantyre Prevention Strategy (BPS) project. Despite substantial investment from bilateral and multi-lateral donors in large NGO-directed interventions, Blantyre has a relatively intractable HIV epidemic including an HIV prevalence rate higher than the national average (14.2% vs 8.9% MPHIA data. The structural risk environment in Blantyre is characterized by high rates of poverty and low formal employment, yet a concentration of private sector agriculture, energy, and real estate companies with a growing middle class and increasing economic investments. These economic opportunities result in frequent economic migration, with survival and transactional sex being the norm, and rates of gender-based violence.
Developing a New Model in Blantyre
The BPS commenced in May 2020 aiming at firstly, to support establishment of a district-based system that will enhance deployment and uptake of novel and existing HIV prevention interventions and products, and secondly, institutionalize HIV prevention as a cohesive, effective, and sustainable country-led response with coordinated external support. Already, the BPS has supported the district in creating a coherent local management system that is able to deploy HIV prevention services and tools more effectively. One way BPS has fostered that local system is by developing networks led by district and city health offices in local communities within the district that bring together political and community leaders, local governance and public health structures, public and private health clinics, community-based organizations, and civil society to address gaps in service delivery, demand generation, and health communications. These partners share data and work to solve challenges facing them.
In addition, BPS has been instilling district-level functions that enable the local response to: a) Detect and target risk factors within and services to individual communities using timely and high-quality data, b) Generate demand for HIV prevention by collecting community insights and raising local awareness, c) Effectively deliver quality and accessible prevention products and interventions, d) Support sustained use of prevention products through periods of risk
Some key elements of the BPS include:
- A data pipeline that pulls together existing and new data sources into user-friendly dashboards in the Prevention and Adaptive Learning Management System (PALMS) which supports data-driven decision making at the local and national levels.
- An Integrated Disease Surveillance and Response (IDSR) pilot that is embedding capacity within the district health office to identify infection HIV risks by geographical area and sub-population, improving intervention targeting. The pilot includes stakeholders from the community all the way to national levels, bringing a multi-level response that helps rapidly and effectively direct resources and services to identified populations.
- Grassroots community labs use human-centered design (HCD) methods to create communication channels between communities, the district and city health offices, and facilities to gather insights about HIV prevention service demand barriers and inform better programming.
- Quality improvement collaborative “PrEP UP” for successful sustainability and scale-up of HIV prevention products and services including oral PrEP.
- Structural Risk Reduction Working Groups provide Blantyre City and District Councilors with education and training on HIV and related data to empower leadership within their communities.
The BPS Consortium and Partner Entities
A Consortium of expert partners supports the government in the implementation of the key elements/ work streams of the BPS. These include: Cooper/Smith, Population Services International and Family Health Services, UCSF-HealthQual, Pakachere Institute of Health and Development Communication, Kamuzu University of Health Sciences, Harvard University, and the MeSH Consortium (London School of Hygiene and Tropical Medicine and the UNC Malawi Project).
Additionally, BPS collaborates with other partners working in and supporting Blantyre including, the Clinton Health Access Initiative (CHAI), Fast-Track Cities, the U.S. President’s Emergency Plan for AIDS Relief (including the U.S. Agency for International Development and the Centers for Disease Control and Prevention) and its implementing partners (e.g. EGPAF, FHI 360, JHPIEGO, MACRO, iTECH), and a number of local civil society, community, and service delivery partners (e.g. the Blantyre Civil Society Network, CEDEP, Lighthouse, MANASO, Rainbow Alliance, and Umunthu Foundation).