Blantyre Early HIV Treatment Initiative (BETHI)

Of the estimated 978,482 people living with HIV (PLWH) in Malawi, approximately 137,000 reside in
Blantyre District. Although Blantyre District accounts for only 14% of PLWH in Malawi, it is responsible for 32% of the national gap in treatment coverage. Specifically, only 55% of PLWH in Blantyre District are estimated to be on ART, indicating significant gaps in HIV diagnosis and treatment initiation. These gaps vary significantly by sex. HIV incidence among adolescent girls and young women (AGYW) in Malawi is 8 times higher than incidence among their male counterparts, pointing to deficiencies in diagnosis, ART initiation, care engagement, and viral load suppression among the primary sexual partners of AGYW—15-40 year old males.

Ensuring that all PLWH in Blantyre District, regardless of age and sex, are engaged in HIV care that results in achievement of VLS is crucial for reaching the UNAIDS’ 90-90-90 targets for Malawi. With funding through U.S. President’s Emergency Plan for AIDS Relief, as part of the Health Resources and Services Administration’s Quality Improvement Capacity for Impact Project, UCSF-HEALTHQUAL partners with
MaiKhanda Trust and the Blantyre District Health Office to implement BETHI, a quality improvement collaborative with the aim of improving same-day ART initiation, viral load monitoring, VLS, and TPT uptake among PLWH in Blantyre District, Malawi.

Implementation Timeline

Results

The Blantyre Early HIV Treatment Initiative (NAMPROPA) was implemented beginning in July 2017 in 29
high-burden sites in Blantyre, Malawi. In total, BETHI sites provide ART services to >90,000 PLWH in
Blantyre District—nearly 1/10 of all PLWH in Malawi. Key outcomes of BETHI include:

• Proportion of newly diagnosed PLWH who initiated ART on the same day of diagnosis increased 19% (58% vs. 81%)

• Rates of viral load monitoring increased by 8% (13% vs. 21%)

• Rates of viral load suppression increased by 25% (58% vs. 83%)