# Project 2 - Improving HIV prevention among postpartum women in Lilongwe, Malawi: the postpartum prevention package [Parent Title: PREVENTING INFANT INFECTIONS WITH IMPLEMENTATION SCIENCE IN MALAWI]

> **NIH NIH P01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $342,539

## Abstract

PROJECT SUMMARY
Impressive progress has been made towards the ambitious goal of eliminating mother to child transmission
(EMTCT) globally. In efficient EMTCT programs with high rates of ART uptake, an increasing proportion of new
infant infections stem from incident maternal infections; in sub-Saharan Africa nearly one third of infant
transmissions are linked to HIV infections that are acquired during pregnancy or breastfeeding. Driven by
physiological shifts and behavioral changes, including resumption of condomless intercourse, the postpartum
period is a particularly high-risk period for HIV acquisition. In Malawi, one-third of all new pediatric HIV
infections are attributed to women who acquired HIV infection while breastfeeding. Improved postpartum HIV
prevention is needed to prevent pediatric infections. One promising HIV prevention opportunity is HIV pre-
exposure prophylaxis (PrEP). Taken as prescribed, daily oral PrEP effectively prevents HIV and is safe during
breastfeeding. Unfortunately, uptake of and adequate adherence to PrEP among postpartum women in sub-
Saharan Africa, including in Malawi, has been poor. Newer long-acting PrEP formulations, including injectable
PrEP, is a promising and potentially paradigm shifting advance for HIV prevention, offering more discrete and
convenient dosing. However, to maximize the prevention potential of PrEP (oral, injectable, or other), programs
must address shortfalls across the prevention cascade –increasing rates of postpartum HIV testing, reducing
barriers to PrEP initiation, and improving retention in PrEP care by tracing defaulters. This study will test an
intervention that mobilizes an integrated, task-shifting strategy to improve effective PrEP use among
postpartum women in Malawi. Leveraging maternal attendance at early infant vaccination visits, the integrated
intervention deploys effective strategies to increase HIV testing, promote partner engagement, enhance
access to oral or injectable PrEP, and retain women in PrEP care. The intervention uses task-shifting to
integrate HIV testing and PrEP services into infant vaccination visits, and builds on the highly-effective
community-facility linkage model “peers”, expanding tracing to include PrEP defaulters. In Aim 1, investigators
evaluate the effectiveness the integrated “postpartum prevention package” intervention, examining primary
outcome of PrEP persistence at 12 months among breastfeeding women. Secondary outcomes include PrEP
uptake, PrEP adherence, and seroconversions. Aim 2 focuses on implementation outcomes, examining fidelity
to and acceptability of the integrated intervention among postpartum women, a subset of their male partners,
clinic providers, and policymakers. In Aim 3 investigators conduct a cost-effectiveness analysis using
effectiveness outcomes and prospectively collected costs, modelling cost per new PrEP initiation and per
person retained on PrEP. A budget impact analysis identifies drivers of cost, informing Minis...

## Key facts

- **NIH application ID:** 10841709
- **Project number:** 5P01HD112215-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Sarah E. Rutstein
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $342,539
- **Award type:** 5
- **Project period:** 2023-05-15 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10841709

## Citation

> US National Institutes of Health, RePORTER application 10841709, Project 2 - Improving HIV prevention among postpartum women in Lilongwe, Malawi: the postpartum prevention package [Parent Title: PREVENTING INFANT INFECTIONS WITH IMPLEMENTATION SCIENCE IN MALAWI] (5P01HD112215-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10841709. Licensed CC0.

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