Funded in May 2020 by the Bill & Melinda Gates Foundation, 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.
The Ministry of Health chose the District of Blantyre, the commercial center of the country, as Blantyre has an intractable HIV epidemic despite substantial investment from bilateral and multi-lateral donors. While these donors increase their investments and programming in Blantyre, scale-up of HIV prevention activities remains low and uptake of critical prevention interventions have not met their targets.
Over five years (May 2020-April 2025), BPS aims to
1. Support establishment of a district-based system in Blantyre that will enhance deployment and uptake of novel and existing HIV prevention intervention and products, and
2. Institutionalize HIV prevention in Blantyre as a cohesive, effective, and sustainable country-led response with coordinated external support.
BPS posits that improved functioning of the HIV prevention cascade capabilities, strengthened by critical health systems enablers, will result in an accelerated decline in HIV infections and long-term epidemic control. Therefore, BPS aims to catalyze development of an innovative and data-driven HIV prevention delivery system at the district level that is:
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;
Monitors program performance and impact; and
Embeds key functions within local systems for sustained performance
By investing in key systems enablers, the BPS approach will strengthen capabilities in local actors that will enhance the HIV prevention response along the HIV prevention cascade. The capabilities include local ability to:
BPS will achieve these key capabilities along the prevention cascade by supporting the Blantyre District, City, and national governments’ investments in six key systems enablers.
Governance: Streamlined district-level governance and oversight structures capable of strong coordination of HIV Prevention activities across the government, private/non-governmental, and donor sectors.
Technical leadership: Coordinated technical capacity within government, and in facilities and community service delivery settings, utilizing the latest HIV prevention science, and informed by data.
Data systems: Infrastructure and data ecosystem that effectively enables data users and local decision-makers to understand population dynamics, acquisition risk, local research findings, and the performance of HIV programs, and make better decisions.
Community engagement: Routinized engagement with a wide variety of communities, including key populations, youth, traditional leaders, and community members, to understand evolving community delivery preferences and ideas to inform policy and program, and more effectively deliver services.
Civil society engagement: Networked civil society and community-based organizations, strengthened to consistently fulfill their roles in service delivery, community mobilization, oversight and monitoring, and advocacy.
Multi-sectoral partnerships: Engaged private sector entities supporting the HIV prevention system providing financial and technical assistance and coordinated service delivery.
Unlike traditional development and global health programs that usually focus on service delivery within a larger ecosystem and are static for their duration, the Blantyre Prevention Strategy invests in the health system for HIV prevention, strengthening prevention capabilities through an iterative approach, driven by local leaders.
Increasing the impact of prevention tools for epidemic control
BPS posits that this systems approach will address some of the weaknesses associated with the deployment of current prevention tools and provide the foundation for improved targeting, demand generation, and quality service delivery for the next generation of tools – such as the Dapivirine Ring and long-acting cabotegravir – as they are approved. Long-acting cabotegrevir (Cab-LA), in injectable PrEP, is one of the highest priority new products, with a regulatory approval anticipated in the next few years. BPS will help build evidence that will enable government to approve and implement policy and guidelines and accelerate the time from regulatory approval to introduction and impact of these products.