Developing a more effective locally led response to the HIV epidemic in Blantyre, Malawi

Abstract Malawi has led a highly successful human immunodeficiency virus (HIV) treatment response that has brought the country close to achieving international goals regarding knowledge of infection status, treatment, and viral suppression. However, new HIV infections persist and the country has much work to do to reduce the rate of infection. Accordingly, a new approach for HIV prevention is needed to accelerate the decline in new HIV infections and sustain epidemic control. The city of Blantyre is the oldest urban center in Malawi and represents the commercial and industrial capital of the country – attracting many young people and migrant workers to the city in search of economic opportunities. Still, within the city, formal employment rates remain low and poverty rates remain high. This has resulted in a unique local-level HIV risk environment. As a result of this, the city’s HIV burden is much higher than that experienced elsewhere in the country. This chapter details an innovative effort to enhance Blantyre’s HIV prevention programs through the development of a multisectoral, district-level system for reducing the transmission and risk of HIV at the local-level.