LEARN MORE ABOUT THE BLANTYRE PREVENTION STRATEGY
BPS is in its sixth year of implementation. A summary of each year’s BPS project objectives and outcomes is provided below as well as the publications, conferences, reports, and other project learning disseminated that year.
YEAR 6
May 2025 - April 2026
Efforts in Year 6 include continued District and City-led leadership of BPS-supported activities while planning for integration into full local support throughout the year; strengthening the mentorship and supervision of all BPS program elements in the district; completing documentation; developing the BPS adaptation toolkit; and sharing learning from the project. In addition, Blantyre will continue to support injectable PrEP delivery through the PathToScale initiative.
Frontiers of Reproductive Health Journal
“Using quality improvement to close HIV prevention gaps and strengthen district health systems: Blantyre, Malawi’s approach and early implementation” Sara M. Allinder, Edward Moses, Moses Enock, Gift Kawalazira, Rose Nyirenda, Andrew Gonani, Yohane Kamgwira, Bruce Agins, Richard Birchard, Joseph Murungu, Deborah Hoege, Charles B. Holmes, and Martias Joshua
​This paper provides a case study in how QI methodology, especially a QI collaborative approach, was applied in Blantyre as an innovative technique to support sub-national leadership in strengthening HIV prevention. It 1) outlines how BPS adapted an approach that was largely untested in HIV prevention, created the structures and processes needed for quality PrEP delivery in Blantyre, and provided the inputs to facilitate the strengthening of the sub-national system; 2) explores outputs, processes, and early experiences with implementation, including the broader impacts of the QI approach on district health leadership, national health objectives, and the sustainable integration of QI-driven HIV prevention services into district systems; and 3) illustrates how the QI approach offers an innovative method to increase data access and use, utilize community and client insights to improve service delivery and demand generation, and address facility and provider barriers to PrEP uptake and continuation.
International Journal of Health Policy and Management
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It was proposed in the original Blantyre Prevention Strategy design that elected ward councillors would be uniquely positioned to support access to and sustained use of services, through identifying and addressing structural drivers of HIV within Blantyre city with the ultimate goal of encouraging sustained use of HIV prevention services. This paper describes the outcomes of a formative study, conducted through BPS, which was designed to investigate a range of stakeholders’ understanding of the HIV epidemic landscape in Blantyre, including the structural drivers of HIV, and to identify strategic opportunities to engage city councillors in addressing those drivers in Blantyre. The study found that engaging local elected officials in Malawi could serve as an important opportunity to optimize ward-level HIV prevention efforts, galvanize community engagement around prevention, and utilize city council structures to tackle structural drivers of HIV.
Kigali Satellite
Leadership in Action: Strengthening HIV Prevention Systems and Advancing Innovation in Malawi ​​
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At the 2025 International AIDS Society science meeting in Kigali, Rwanda, the Government of Malawi and the Center for Innovation in Global Health (CIGH) at Georgetown University co-hosted a satellite session on Malawi’s demonstrated leadership in strengthening its HIV prevention systems at national and district-level and systematically advancing the introduction of injectable PrEP. Representatives from NAC, the Blantyre District Health Office, CIGH, and the Malawi Network of AIDS Service Organizations (MANASO) shared insights, successes, and challenges from their experience expanding access to HIV prevention choices while addressing the systemic needs required for sustainable health systems.
BPS learning shared in year six:
YEAR 5
May 2024 - April 2025
“The key question before us is not only what must be sustained, but how we ensure its sustainability in the face of evolving challenges. Malawi’s experience with the Blantyre Prevention Strategy has demonstrated that sustainability cannot be achieved through short-term interventions alone. A health systems approach is essential—one that coordinates resources and strengthens long-term capacity across the entire continuum of the HIV response. Sustaining progress requires structural solutions, ensuring that HIV prevention, diagnosis, treatment, and care are embedded within a resilient, adaptive, and nationally owned health system.” - Dr. Martias Joshua, Chief of Health Services responsible for Reforms in Malawi’s Ministry of Health, in remarks delivered at the opening of the February 2025 Sustainable HIV Prevention Initiative convening in Lilongwe
In Year 5, the Blantyre’s District and City health teams demonstrated leadership and resilience in the face of major challenges to its HIV response and broader health system. The health teams led planning and implementation of BPS activities in the district, with limited expert partner support. BPS has cultivated a culture of partnership, data-use and decision making, and mutual accountability that has shown highly favorable results, including demonstrating comparative improvements in HIV testing, PrEP uptake, and connectivity and linkages between all levels of the system in Blantyre. That culture supported the district’s resiliency during a challenging period.
Blantyre District’s technical leadership was shared beyond Blantyre as well. District Coordinators supported dissemination of best practices and learning to other districts, including engaging in learning sessions held in Lilongwe District in support of the PathToScale initiative. In addition, NAC, with BPS Secretariat support, launched the Strengthening District Health Systems for Sustainable HIV Prevention Working Group, which will support adaptation of the BPS model in additional districts beginning in Year 6. Work also began in Year 5 to develop a web-based toolkit for other districts in Malawi and elsewhere who might be interested in adapting the BPS model.
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Read the BPS 5 Year Annual Report for more detail on activities undertaken during year five:​​​​​​​​​​​
BPS learning shared in year five:
Capital Radio Malawi
"Blantyre DHO, DHSS shine in MALGA awards"
​In October 2024, the Blantyre District Health Office and its Director of Health and Social Services (DHSS), Dr. Gift Kawalazira, received awards from the Malawi Local Government Association (MALGA) for their outstanding contributions to decentralized health service delivery.
BMJ Global Health
“A health systems approach to more effective decentralised HIV prevention: development of Malawi’s Blantyre Prevention Strategy” Gift Kawalazira, Yohane Kamgwira, Sara M Allinder, Chimwemwe Mablekisi, Rose Nyirenda, Deborah Hoege, Alinafe Mbewe, Suzike Likumbo, Tyler Smith, Grace Kumwenda, Betha O Igbinosun, Charles B Holmes
This article provides the conceptual basis for, and early implementation experience of, the Blantyre Prevention Strategy. It shares early learnings from BPS, which offer lessons for other low- and middle- income countries seeking to implement HIV prevention strategies that bolster their health system capacity and integrate with broader health responses.
African Population & Health Research Centre
In February 2025, the Africa Population and Health Research Centre (APHRC) published findings from its external evaluation of BPS conducted during 2024. APHRC found that “BPS improved district leadership, [which contributed] to better coordination and delivery of HIV prevention programming.” “Community-oriented platforms facilitated community health communication.” Launching the PrEPUP! quality improvement (QI) collaborative “created a platform to strengthen QI at the district and facility levels”. The BPS-supported HIV data pipeline and PALMS dashboards “improved data access and use by consolidating information from multiple sources, simplifying visualization and decision-making”. In addition, “The onset of BPS coincided with a shift in the HIV Testing and Counselling trend - changing from a downward decline to a steady rise – with an average of around 533 individuals tested for HIV each month.
BPS at AIDS 2024, the International AIDS Conference
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As part of the International AIDS Society conference held in Munich, Germany, the Government of Malawi and Georgetown University’s Center for Innovation in Global Health (CIGH) hosted a satellite session on Tuesday, July 23, 2024. The session, titled "Enabling Effective HIV Prevention Through Capacitated District-based HIV Prevention Systems," was co-chaired by Dr. Gift Kawalazira, Director of Health and Social Services, Blantyre District Council, and Sara Allinder, CIGH Deputy Director and BPS Program Director. Dr. Samson Mndolo, Secretary of Health, Malawi Ministry of Health opened the session, which featured speakers from the Blantyre District Health Office, the Malawi National AIDS Commission, and Dr. Charles Holmes, CIGH Director and BPS Principal Investigator. During the session, the speakers highlighted how the BPS model is supporting data-informed activities to support PrEP delivery, including gathering community insights to inform quality improvement at facilities; how the BPS model is underpinning the introduction of injectable PrEP through the PathToScale implementation science initiative; and plans to adapt the BPS model to other districts.​ Also featured during the conference was an abstract on improved QI capacity in public health facilities:
YEAR 4
May 2023 - April 2024
In Year 4, Blantyre District and BPS partners gained significant ground towards institutionalizing BPS program elements at district level, with benefits across a range of HIV prevention interventions. By mid-year, District Coordinators from the DHO took responsibility for most BPS activities, leading to rapid acceleration in programmatic activity and multi-sectoral engagement across the district. The BPS model further extended beyond HIV prevention by cross-training health care and focal persons from other facility departments in data use for decision making, surveillance, QI, health promotion, and community insight gathering. Critically, DHO-based QI mentors expanded their coaching at facilities to include other health services such as Maternal and Newborn Health (MNH), Early Infant Diagnosis, TB, and HIV treatment, and individuals from different health programs, e.g. Laboratory and Cervical Cancer, joined the pool of QI mentors. QI affinity groups on sexually transmitted infections (STIs) and family planning (FP) facilitated further integration of HIV prevention in these health services, including PrEP delivery. Blantyre also began offering long-acting, injectable Cabotegravir (CAB-LA) as HIV PrEP, through Malawi’s PathToScale injectable PrEP initiative, leveraging the existing systems platform established through BPS.
“The Blantyre Prevention Strategy…has empowered the locals. It has been built within the public structures, through the government structures. So even if when the Blantyre Prevention Strategy goes, we have all the confidence that the learnings will continue because it has been embedded through the government system.” – Chimwemwe Mablekisi, Director of Programmes, National AIDS Commission (February 2024 Interview)
Read the BPS 4 Year Annual Report for more detail on activities undertaken during year four:​​​​​​​​​​​
BPS learning shared in year four:
Think Global Health
Ending AIDS by Elevating Subnational Governance in Malawi
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In this commentary, BPS Program Director Sara Allinder discusses that the coherent systems needed to lead effective HIV prevention responses at sub-national level have not been a priority. She argues that BPS demonstrates some of the how and why investing in subnational governance and systems development can contribute to sustainability.
BPS at the 2023 IAS Science Meeting
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As part of the IAS biannual science meeting, the Government of Malawi and CIGH co-hosted a satellite session titled “District-based HIV prevention: Defining the functions of a coherent & sustainable response.” The session in Brisbane, Australia, was co-chaired by Dr. Gift Kawalazira, Director of Health and Social Services, Blantyre District, and Sara M. Allinder, BPS Program Director, CIGH. Speakers included Dr. Rose Nyirenda, Director of the Department of HIV/AIDS and Viral Hepatitis, Malawi Ministry of Health; Patricia Munthali Khomani, BPS Program Officer, Cooper/Smith; and Dr. Charles Holmes, BPS PI and Director, CIGH. The speakers highlighted the innovations achieved through Blantyre Prevention Strategy’s unique approach to building a more effective, district-led health system. The session featured case studies about BPS’s learning in data access and use and in creating linked networks involving community, facility, district, and political leaders through videos featuring Suzike Likumbo, STI Coordinator, Blantyre District, and Grace Kumwenda, formerly of Pakachere IHDC, a local Malawi-based partner.
YEAR 3
May 2022 - April 2023
During Year 3, the District Health Office, facilities, and other key partners demonstrated the BPS-supported HIV prevention functions—from data access and use, to demand generation and community engagement, to quality-improved prevention services and understanding of structural risks—operating and embedded within the district health management system. The most foundational change seen in Blantyre was the increased capabilities to access, use, interpret, and make decisions from data across multiple user groups. In addition, the community lab model became an essential program element for gathering user preferences, improving demand generation approaches and service delivery by linking with the QI collaborative. User preferences from BPS community labs helped inform the updates to the national PrEP guidelines by identifying critical barriers to oral PrEP demand creation and service uptake.
Blantyre District’s Health Promotion Unit also launched the Konda Blantyre, Konda Moyo public education campaign with BPS support. In Year 3, Blantyre District began to embody the envisioned integrated local management system -- one that operates in a coordinated fashion with, and can leverage the capabilities of, multi-sectoral partners; supports more responsive, effective, and efficient delivery channels; shares knowledge widely; accelerates the work of all partners through close partnership; and delivers quality services and more effective introduction of new prevention products. Linked networks were formed in four district sub-geographies under the network model pilot and began working together through cluster committees to utilize data, experience, and community insights address gaps in service delivery, health communication, and demand generation.​
“BPS is helping us do our jobs better and we are seeing coordination where there were previously fragmented responses among partners. BPS is improving engagement between district and city - shared data, shared responsibility.”
– Dr. Gift Kawalazira, Director of Health and Social Services, Blantyre District
BPS learning shared in year three:
BPS at the 2022 International AIDS Society Conference
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As part of the AIDS 2022 conference held in Montreal, Canada, the Government of Malawi and Georgetown University Center for Innovation in Global Health (CIGH) hosted a satellite session on July 31, 2022. The satellite, titled The Blantyre Prevention Strategy: A New Way of Doing Business in HIV Prevention, was co-chaired by Chimwemwe Mablekisi, Director of Programmes, Malawi National AIDS Commission (NAC), and Sara M. Allinder, BPS Program Director, CIGH. The satellite session featured speakers from the Government of Malawi at district and national levels, BPS expert partners, and BPS Principal Investigator Dr. Charles Holmes, Director, CIGH. During the session, the speakers highlighted the unique BPS business model and learning from two years of implementation, particularly in data access and usage as well as innovative approaches to supporting oral PrEP scale up.
Also featured during the conference were the following abstracts detailing early BPS learning related to data access and use, QI, PrEP delivery, and engaging city councilors:​​
AIDS 2022
The first multi-sectoral, user-driven data pipeline to adaptively manage HIV prevention programs in Malawi T. Smith, D. Green, M. Moszczynski, S. Asbah, P. Khomani, S. Ndira, D. Hoege, S. Allinder, Y. Kamgwira, G. Kawalazira, C. Holmes
AIDS 2022
Prepping for PrEP: A readiness assessment among health facilities in Blantyre, Malawi A. Majamanda, S. Allinder, et al.
AIDS 2022
Engaging City Councillors to address social and structural drivers of HIV in Blantyre City: A formative study E. Bosire, S. Allinder, et al.​
MBC News
"Blantyre Councillors take a stance against HIV"
This television news story features efforts by Blantyre City Councilors to support HIV programs following BPS-supported training on HIV and access and use of data.
The Nation Online
"Everyone counts in HIV fight"
​This news article describes BPS and efforts to reduce HIV infections in Blantyre District.
AfricaBrief
"Efforts to Disseminate Health Education, Curb STIs in Mpemba Show Positive Results"
This news article describes BPS-supported, data-informed health education efforts in Mpemba, a rural health catchment area of Blantyre District.
YEAR 2
May 2021 - April 2022
In BPS’s second year, implementation accelerated in all areas. For example, the BPS Consortium launched the PALMS dashboards to make data available to Blantyre District and City staff, facilities, communities, the Ministry of Health, National AIDS Commission, and others from formerly fragmented data sources connected through a new BPS-supported nationally harmonized data pipeline accessible. The Consortium also launched the district-led PrEP-focused QI collaborative at all sites offering PrEP in Blantyre. Layered, cross-work stream collaboration across the BPS Consortium and with other local partners broke existing silos and strengthened relationships between government, facilities, and partners. Working across work streams leveraged knowledge and core competencies of various partners, improved coordination, and began to manifest the systems strengthening at the heart of the BPS model. As part of BPS’s adaptive learning approach, the work stream collaboration during the co-development and initial implementation phase yielded important learning, which the BPS Consortium utilized to adjust work streams and program plans for Year 3, such as designing the network model approach.
BPS learning shared in year two:
O'Neill Institute
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In this commentary, members of the BPS Secretariat from the National AIDS Commission and Center for Innovation in Global Health reflect on the BPS Consortium’s first in-person meetings in November 2021. “Spending two weeks working together in person in Malawi convinced us that we are well on our way to meeting [BPS] objectives and identifying important lessons that can assist other districts and localities in the region improve HIV prevention.”
Academic Press
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Inoculating Cities explores issues related to infectious diseases facing cities across the world due to expanded urbanization. Chapter 5 explores how BPS was designed purposefully to address the urbanization challenges facing Blantyre in its HIV prevention response and describes early project plans and implementation.
YEAR 1
May 2020 - April 2021
The Blantyre Prevention Strategy launched on 1 May 2020. Despite challenges and initial implementation delays due to COVID, coordination structures were created, co-development of BPS program elements began (including for Prevention Adaptive Learning and Management System (PALMS) and the quality improvement (QI) collaborative), and mapping was conducted to understand the public, private, and community HIV prevention service delivery happening in Blantyre District. The Government of Malawi and members of the BPS Consortium shared the project’s goals at a BPS satellite during the virtual International AIDS Society Research for Prevention (R4P) 2021 conference.
O'Neill Institute
Could a Systems Approach be the Disruptor Needed in HIV Prevention?​
This commentary outlines the BPS approach and its promise as a potential disruptor. It describes BPS’s innovative, “business unusual” approach to the critical systems challenges affecting HIV prevention in Malawi’s epidemic epicenter.
BPS learning shared in year one:
R4P Conference BPS Session 2021
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​As part of the HIV Research for Prevention conference held virtually, the Government of Malawi and Georgetown University’s Center for Innovation in Global Health (CIGH) hosted a satellite session on Thursday, January 28, 2021. The session, titled “Optimizing the Delivery of HIV Prevention Services for Maximum Impact and Sustainability: The Blantyre Prevention Strategy,” was co-chaired by Chimwemwe Mablekisi, Director of Programmes for the Malawi National AIDS Commission, and Dr. Charles Holmes, CIGH Director and BPS PI. The session, which highlighted the innovative elements of the Blantyre Prevention Strategy, featured speakers from the Government of Malawi and BPS expert partners.
