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Blantyre Prevention Strategy: A New Subnational HIV Prevention Systems Model in Malawi

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National and district governments came together with partners to create Blantyre Prevention Strategy (BPS) — a decentralized model for subnational HIV prevention systems. The decentralized model strengthened local leadership to utilize data-driven decision making for improved coordination and service delivery. BPS is closing gaps in Malawi’s HIV prevention efforts by building capacities for data use, surveillance, quality improvement, demand generation, and communications. It's an adaptable model for country-led, sustainable HIV prevention that can be utilized in other localities.

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Transforming Blantyre's HIV response

The Blantyre Prevention Strategy arose from a shared understanding that 20 years into the global HIV response, the world was still struggling to achieve effective HIV prevention. In 2022, UNAIDS reported 1.3 million new HIV infections, nearly three-times global goals for 2020. ​The Blantyre District Health Office serves a population of more than 1.5 million people. When the BPS project began, the HIV rate in Blantyre was XX% — highest in Malawi and nearly double the national average at the time.

 

HIV prevention consists of many interventions targeting different risk groups, ages, and demographics. In the absence of a systemic approach, this leads to fragmentation across partners and lack of sustainability. Blantyre is one of many districts and regions with a growing urban center that has struggled with these and other issues — including weak data systems for HIV prevention and insufficient local data use, poor risk assessments and targeting, and inconsistent community demand.

 

BPS was designed to leverage the trend towards health systems decentralization and reflect the best thinking from public health leaders in Malawi and around the world. BPS’s innovative approach has improved HIV service delivery in Blantyre by creating a more unified health system that links political and community leaders, public and private health clinics, community-level entities, and others, under city and district leadership. 

“The greatest challenge that we faced was an uncoordinated response among stakeholders in the HIV response.”

Dr. Gift Kawalazira, Director of Health and Social Services, Blantyre District

"[BPS] brought everyone together on the table to start looking at the vision we wanted to see for Blantyre as a district…I would say that we are collaborating a little bit more, we are working better, we are coordinating, and we are networking better than we used to do before."

Grace Kumwenda, Chief of Party for Pakachere Institute for Health Development Communication

By  building essential technical capabilities and systems capacities — including governance and technical leadership, digital health, quality improvement, and community and corporate engagement — BPS is enabling Blantyre’s HIV system to:

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Detect and target risk factors within, and services to, individual communities using timely and high-quality data.

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Generate demand for HIV prevention by collecting community insights and raising local awareness.

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Effectively deliver quality and accessible prevention products and interventions.

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Support sustained use of prevention products through periods of risk.

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The following case studies demonstrate how BPS’s systems strengthening approach has brought together a fragmented HIV prevention landscape to establish a nimble, locally led HIV prevention response system capable of detecting and targeting disease risks, generating demand for HIV prevention services, delivering prevention products and interventions, and supporting sustained use of prevention tools and products.

Blantyre Prevention Strategy in action:

Access to and use of real-time data improves service targeting and delivery

How PrEP continuation signals from Quality Improvement (QI) Collaborative led to investigation, community insights, QI change ideas, and response 

Multi-sectoral collaboration improves community engagement, service delivery, and data-informed decision making

Engaging political leadership — work with city & district councilors

 Adaptation — expanding service delivery for current prevention tools and improving introduction and scale-up of cutting-edge tools like injectable PrEP 

Section 1

Access to and use of real-time data improves service targeting and delivery

The importance of access to current, accurate data cannot be overstated. Yet effective data usage relies on a comprehensive, accessible, and usable information pipeline. BPS created the Prevention and Adaptive Learning Management System (PALMS) to pull existing and new data into user-friendly dashboards that support data-driven decision making at

all levels — policy, technical leadership, implementation, and community.PALMS has become an essential tool for functionality of the district’s HIV prevention response and an

“After the coming of Blantyre Prevention Strategy, we started learning about how we can utilize our data to make sure that we know which areas we need to focus more and take our resources more... every month, we look at the data, and then we analyze the data, and then we take our activities there. …This has helped us to reduce or to have more outcomes based on where exactly the problem is. …PALMS and the BPS has helped Zingwangwa Health Center as a team to focus more on areas that we need to.” 

Mirriam Hanjahanja
Senior Nursing officer, Zingwangwa Health Center

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integral part of every element of the BPS model. Most importantly, it is empowering District Coordinators and health management team, facilities, and communities to take ownership of Blantyre’s HIV response. 

“BPS has really changed the tone within the district in terms of direct usage. And as for me, as an ICT person, yeah, I feel proud to be part of it, and also to see the fruits of the trainings that we did with the teams from the facilities bearing fruits in terms of the data review meetings that they're conducting.” 

Gosten Njunga
ICT Programmer, Blantyre DHO

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Using real-time data to improve service targeting and delivery

Suzike Likumbo
Coordinator for Quality Improvement, Blantyre District

Blantyre, Malawi has been devastated by HIV, but until recently STI coordinators like Suzike Likumbo have had no access to the data they need to identify and respond to local outbreaks. The Blantyre Prevention Strategy has allowed them not only to see these crucial statistics, but has also trained them on how to interpret the data and coordinate their response with partners in the community. In 2022, Likumbo and her team used this data to identify an alarming STI spike at Bangwe Health Centre. The BPS approach allowed them to zero in on the source of new infections, targeting their interventions for maximum impact. Working together with local organizations, they were able to mount a response that combined HIV testing, STI screenings and management, condom distribution, and STI education. For Likumbo and her team, the Blantyre Prevention Strategy has been transformative.

Section 2 Title
Section 2

How PrEP continuation signals from Quality Improvement (QI) Collaborative led to investigation, community insights, QI change ideas, and response

During a quality improvement collaborative “learning session” when all facilities came together to share lessons on PrEP implementation in Blantyre, the BPS team and partners noted a pattern of poor PrEP continuation across many facilities. Below are the ways this was addressed: 

  • Further incorporation of community insights and participation in the planning and implementation of HIV prevention activities

  • Launching community labs in low PrEP retention catchment areas 

  • Creating more targeted PrEP counseling based on community misconceptions and stigmas 

 

By using the feedback loop between community insights and service delivery, Blantyre has seen service delivery improvements, such as an increase in PrEP uptake. By prioritizing shared learning across facilities through the quality improvement collaborative, client-centered service delivery, and targeted data usage through PALMS, HIV prevention service delivery in Blantyre is improving.
 

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Across all facilities participating in the BPS quality improvement (QI) collaborative, there was a rapid increase in PrEP uptake as compared to the non-QI collaborative sites.

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Use of QI Change ideas to increase PrEP delivery in different entry points

Edward Moses
QI Consultant, UCSF HealthQual

The QI approach BPS took was unique in that it focused on prevention, rather than just care and treatment. Prevention data has often been very separate from other reported data, but with BPS's innovative approach — and the PALMS platform — these data streams were able to come together, allowing the QI collaborative facilities to learn from each other and then disseminate the results more broadly. 

Section 3

Multi-sectoral collaboration improves community engagement, service delivery, and data-informed decision making

The principal goal of the Network Model is to implement the core capabilities of the HIV prevention cascade. It links together the networks of political and community leaders, local governance and public health structures, public health clinics, private (for-profit and not-for-profit) clinics and other service delivery, community-based, and civil society organizations, under the coordination of the district and city health offices. The linked networks in 15 district sub-geographies formed under the Network Model are working together through cluster committees to utilize data, experience, and community insights to address gaps in service delivery, health communication, and demand generation.

BPS’s innovative approach has created a more unified local health system that brings all partners and stakeholders together under city and district leadership — improving delivery of HIV prevention services in Blantyre. The Network Model approach aims to link and strengthen multiple, fragmented channels across sectors, bring community groups into program planning and implementation, leverage network resources, and ensure data-driven, coordinated HIV prevention activities are targeted.
 

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Multi-sectoral collaboration improves community engagement, service delivery, and data-informed decision making

Ernest Takomana
Assistant Environmental Health Officer, Bangwe Health Center, Blantyre DHO

The network model is comprised of multiple non-government organizations, CBOs, faith-based organizations, and more — with the goal of increased collaboration and coordination on everything from usage of resources to data-based decision-making. The network model has helped with the prioritization and understanding of the data. 

Section 4

Engaging political leadership — work with city & district councilors

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Section 5

Adaptation — expanding service delivery for current prevention tools and improving introduction and scale-up of cutting-edge tools like injectable PrEP

Chimwemwe Mablekisi
Statistical Officer, Blantyre DHO

PrEP, being a new intervention, we have to consider issues of uptake, but also retention as well. Through community labs, it has helped to increase uptake of PrEP, but also even continuation of PrEP through those quality improvements.

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