Evaluating a Multi-Strategy Intervention to Increase Pre-Exposure Prophylaxis (PrEP) Uptake Among Key Populations in Phalombe District, Malawi
1
Phalombe District Health Office, Blantyre, Malawi
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
In Malawi, continuation of pre-exposure prophylaxis (PrEP) among key populations (KPs) remains suboptimal despite availability, with routine facility data showing a drop-off after initiation. In Phalombe District in 2025, HIV-negative clients enrolled on PrEP included 131 men who have sex with men (MSM), 322 female sex workers (FSWs), and 137 male sex workers (MSWs). Low continuation threatened the population-level impact of PrEP in this high-burden setting. To address this gap, a multi-strategy intervention was implemented to improve PrEP continuation after enrolment in care.
METHODS:
The programme was implemented from January to September 2025 in Phalombe District, Southern Malawi, focusing on high-activity KP hotspots, including fishing communities along Lake Chilwa and Mpoto Lagoon, and the tourist hubs. The intervention targeted MSM, FSWs, and MSWs and combined the QuickrESS digital platform with peer-led strategies. Key components included recruitment and training of peer educators and navigators, establishment of community PrEP support groups, real-time defaulter tracking through QuickrESS, peer-led follow-up and reminders, and ongoing education and adherence counseling delivered within community settings.
RESULTS:
The integrated approach significantly improved PrEP continuation among KPs. Real-time defaulter tracking via QuickrESS enabled timely follow-up, reducing loss to follow-up and strengthening accountability. Peer educators and navigators, drawn from KP communities, played a critical role in building trust, addressing stigma, and providing tailored adherence support. Community-based PrEP groups reinforced peer encouragement and practical problem-solving around side effects and mobility. Overall, PrEP continuation increased from 45% at baseline to 87% within nine months of implementation.
CONCLUSIONS:
Integrating digital tracking systems with peer-led, community-based support can substantially strengthen PrEP persistence among key populations in high-burden settings. These findings support scaling up QuickrESS-enabled peer navigation across similar hotspots in Malawi, with future efforts focused on sustainability, integration into routine services, and adaptation for other HIV prevention and care interventions.
In Malawi, continuation of pre-exposure prophylaxis (PrEP) among key populations (KPs) remains suboptimal despite availability, with routine facility data showing a drop-off after initiation. In Phalombe District in 2025, HIV-negative clients enrolled on PrEP included 131 men who have sex with men (MSM), 322 female sex workers (FSWs), and 137 male sex workers (MSWs). Low continuation threatened the population-level impact of PrEP in this high-burden setting. To address this gap, a multi-strategy intervention was implemented to improve PrEP continuation after enrolment in care.
METHODS:
The programme was implemented from January to September 2025 in Phalombe District, Southern Malawi, focusing on high-activity KP hotspots, including fishing communities along Lake Chilwa and Mpoto Lagoon, and the tourist hubs. The intervention targeted MSM, FSWs, and MSWs and combined the QuickrESS digital platform with peer-led strategies. Key components included recruitment and training of peer educators and navigators, establishment of community PrEP support groups, real-time defaulter tracking through QuickrESS, peer-led follow-up and reminders, and ongoing education and adherence counseling delivered within community settings.
RESULTS:
The integrated approach significantly improved PrEP continuation among KPs. Real-time defaulter tracking via QuickrESS enabled timely follow-up, reducing loss to follow-up and strengthening accountability. Peer educators and navigators, drawn from KP communities, played a critical role in building trust, addressing stigma, and providing tailored adherence support. Community-based PrEP groups reinforced peer encouragement and practical problem-solving around side effects and mobility. Overall, PrEP continuation increased from 45% at baseline to 87% within nine months of implementation.
CONCLUSIONS:
Integrating digital tracking systems with peer-led, community-based support can substantially strengthen PrEP persistence among key populations in high-burden settings. These findings support scaling up QuickrESS-enabled peer navigation across similar hotspots in Malawi, with future efforts focused on sustainability, integration into routine services, and adaptation for other HIV prevention and care interventions.
| eISSN: | 2654-1459 |
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