EXPANDING SERVICE DELIVERY FOR CURRENT PREVENTION TOOLS AND IMPROVING INTRODUCTION AND SCALE-UP OF CUTTING-EDGE LIKE INJECTABLE PrEP
The PathToScale Injectable PrEP Initiative in Malawi, launched on 1st September 2023, is leveraging BPS and Malawi’s HIV prevention clinical and implementation capacity, to test the delivery of long-acting injectable cabotegravir (CAB-LA) to prevent HIV as PrEP. The initiative, with implementation funding from The Bill & Melinda Gates Foundation and CAB-LA product through PEPFAR, aims to enroll 9,900 Malawians in an implementation science study in 36 public and private clinics and key population-focused drop-in centers across Lilongwe and Blantyre. The 6-month lead-in phase started in March 2024. What is particularly innovative about Malawi’s initiative is that it includes a focus on foundational systems and addressing policy and other barriers to full implementation of CAB-LA, creating a path to scale through the life of the initiative.
In 2023-24, BPS partners successfully supported the adaptation of the three core BPS program elements - data access and use, community insights, and QI - to Lilongwe to support the PathToScale study. Blantyre District Coordinators were engaged as experts and peer mentors to the Lilongwe DHO and contributed to co-development exercises in Lilongwe. The BPS data system, community insights gathering model, and QI processes have become central to Malawi’s testing and scale-up of injectable PrEP. Lilongwe District Coordinators have already shared initial examples of how the BPS program elements enable them to have more effective insight into HIV prevention programming across the district and at facility level.
Chimwemwe Mablekisi,
Director of Programmes, National AIDS Commission (Jan 2024 interview)
The Ministry of Health disseminated the first national PrEP guidelines in December 2020. Initial scale up followed in early 2021. Chimwemwe Mablekisi, Director of Programmes for the National AIDS Commission, is a member of the BPS Project Management Team. She talks about the importance of understanding issues related to uptake of PrEP and continuation of its use by those who access it. Collecting insights through the BPS-supported Through community labs, it has helped to increase uptake of PrEP by identifying community myths and other barriers to PrEP uptake and continuation and addressing them through quality improvement changes at facilities.
PathToScale Consortium partners including Government of Malawi, Georgetown CIGH, UNC-Malawi Project, Johns Hopkins Project, PSI/Family Health Services, UCSF-HealthQual, Cooper/Smith, USAID, CDC, and others met in January 2023 in Lilongwe, Malawi, to develop the PathToScale injectable PrEP implementation science initiative​​
Rose Nyirenda,
Director, Directorate for HIV/AIDS, STI, and Viral Hepatits, Malawi Ministry of Health — (Jan 2024 Interview)
BPS gives Malawi an opportunity to adapt learnings to the priorities that will be incorporated in the HIV sustainability framework. BPS helps sustain the gains that made as a country, but at the same time also fill the gaps at the national level. The learnings from BPS are are key in sustaining the response.
