Malawi is approaching epidemic control. The 2018 UNAIDS Spectrum estimates demonstrate strong progress to the globally endorsed 90-90-90 goals, currently estimated at 90-84-90. PEPFAR Malawi’s targeted strategy for investment will complement significant Global Fund resources to propel the National Program toward epidemic control by 2020.
PEPFAR Malawi focuses on rapidly scaling critical interventions to reach the 336,000 individuals living with HIV who are not yet virally suppressed. Epidemiological and programmatic data indicate that of those 336,000 people:
1. 32% are unaware of their HIV status: This requires intensified case finding approaches utilizing the most efficient modalities for optimized testing. As demonstrated in PEPFAR Malawi’s targeting strategy, this includes active index testing1 , HIV oral self-testing, optimized provider initiated testing and counseling (PITC, including antenatal care or ANC) and, immediate linkage to anti-retroviral treatment (ART).
2. 41% are aware of their HIV status, but not on ART: Evidence-based case management strategies will improve linkage to care to >95% and reduce 12-month ART loss to follow-up to ≤1%.234 . This involves standardized counseling for those newly diagnosed to ensure linkage and retention on ART and back to care counseling for those who initiated treatment, but struggle with adherence.
3. 27% are on ART but not virally suppressed: Accelerating the transition to Dolutegravirbased regimens and the adoption of an annual viral load testing policy5 both create an enabling environment to empower clients to achieve and maintain a suppressed viral load. Coupled with treatment literacy messaging through existing and emerging platforms, Malawi will not only provide better treatment to those in existing care, but will also create a demand through knowledge around the health benefits of viral suppression.
Primary prevention for those at greatest risk of HIV exposure is also critical to creating an AIDS free generation in Malawi. Expanding to three additional districts for voluntary medical male circumcision (VMMC), including the utilization of kits purchased by the Global Fund, will extend programmatic reach and accelerate saturation6 . This additional investment in VMMC was a specific request in civil society “People’s COP” (Liu Lathu Mu in Chichewa, meaning “Our Voice”). By targeting men ages 15-29, VMMC interrupts HIV transmission, in particular, to adolescent girls and young women (AGYW).
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The President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease.