Why BPS? A new approach is needed for HIV prevention. Malawi has led a successful HIV treatment response but did not reach the UNAIDS goal of a 75% reduction in new HIV infections by the end of 2020. Like many countries, Malawi has suffered from a lack of effectiveness and cohesion in the systems needed to support a dynamic prevention program, which presents a grave risk to addressing persistent reservoirs of infection and to controlling the HIV epidemic over the long-term.
What is BPS? The Blantyre Prevention Strategy (BPS), co-developed with local and national government and a consortium of partners, supports the development of an optimal system for the sustained prevention of HIV infection that is fully embedded in local structures. It is funded through a five-year grant from the Bill & Melinda Gates Foundation to Georgetown University’s Center for Innovation in Global Health (CIGH) (Washington, DC), with sub-grants to government and expert partners. The grant terms are May 1, 2020, to April 30, 2025.
What are the goals? BPS aims to catalyze development of an innovative and data-driven HIV prevention delivery system at the district level that is 1) equipped to detect and target risk, generate demand, effectively deliver prevention products and interventions, and enable effective and sustained use of prevention products by the end user; 2) monitors program performance and impact; and 3) embeds key functions within local systems for sustained performance.
BPS is working to 1) to support establishment of a district-based system that will enhance deployment and uptake of novel and existing HIV prevention interventions and products, and 2) to institutionalize HIV prevention as a cohesive, effective, and sustainable country-led response with coordinated external support. All with the goal of bringing down new infections and supporting sustained epidemic control.
BPS aims to develop a replicable model for effective HIV prevention focused on embedding critical systems and capabilities into local government, civil society, and other partners. The aim is for these systems investments to bolster the success of existing partners, while testing and iterating to create opportunities for greater district ownership and a more economical, effective, and replicable long-term HIV response. BPS is working in complement to existing investments by government, PEPFAR, the Global Fund, and Gates Foundation.
How? The mechanisms by which BPS will achieve improved functioning of the HIV prevention cascade elements of targeting, demand, delivery, and sustained use include investments through government and longstanding partners that will strengthen six key enablers of the health system: governance, technical leadership, data systems, community engagement, civil society engagement, and multi-sectoral partnerships.
Key activities include:
- A data pipeline that pulls in existing and novel data sources into user-centered dashboards of synthesized information for informed decision making through the Prevention Adaptive Learning and Management System (PALMS). Government, HIV prevention service providers, and other local partners already are using PALMS for regular data review, trouble shooting, and decision making – improving the targeting and delivery of services as well as the patient experience.
- An IDSR-HIV pilot that is embedding capacity within the district health office to identify recent infection and/or proxy risk for infection by geographical area and sub-population, improving targeting of prevention interventions to populations most at risk.
- A grassroots human-centered design (HCD) model using community labs that is soliciting user preferences and community feedback to inform better programming and creating a feedback loop between communities, the district and city health offices, and facilities.
- The PrEPUp! Collaborative – the first quality improvement (QI) collaborative focused on pre-exposure prophylaxis (PrEP) – involved all PrEP providers in Blantyre. It is building capacity at facilities and at the district/city health offices to implement QI approaches for HIV prevention.
- Building linked networks – in four sub-geographies of the district – 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, optimized to implement the core capabilities of the HIV prevention cascade and address gaps in service delivery.
Who? The BPS Consortium is leveraging the institutional and technical capacity and core strengths of its partners to ensure that BPS is an embedded function of the National AIDS Commission, Ministry of Health, and the Blantyre City and District Councils.