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Our Global Voices Posts

Precision Public Health: Using Malawi Population-Based Impact Assessment (MPHIA) Data to Reach HIV Epidemic Control in Malawi

Posted on by Nellie Wadonda-Kabondo and Danielle Payne
CDC-Malawi team
CDC-Malawi team


The Malawi Population-Based HIV Impact Assessment (MPHIA) is Malawi’s first nationally representative HIV survey that measures national HIV incidence, pediatric HIV prevalence, and viral load suppression. MPHIA has provided detailed information on the current status of the HIV epidemic and the uptake of HIV prevention, care, and treatment services in Malawi.

CDC-Malawi team
CDC-Malawi team

In his remarks during the MPHIA National Launch, Dr. Peter Kumpalume, the former Malawi Minister of Health, highlighted the importance of quality population-based data in supporting the UNAIDS 90-90-90 targets as reflected in the Malawi National Strategic Plan. The findings from MPHIA, were released on World AIDS Day, December 1, 2016, by the First Lady of Malawi Gertrude Mutharika.

MPHIA results show commendable progress towards achieving the 90-90-90 goals, with estimates at 73-90-91. However, the 1st 90 of ensuring individuals know their HIV status remains a challenge. MPHIA data revealed that Malawi has done well in providing HIV services to women more than 30 years of age but was lagging behind in young women and in men. The data also showed that most areas of highest HIV prevalence were on track to reach 90-90-90 except for a few urban areas and areas with low HIV prevalence. Through MPHIA, it was also demonstrated that once people know their HIV status, 90% of them initiate antiretroviral therapy and are able to suppress the virus.

MPHIA data have been used to identify program gaps in specific geographic areas and subpopulations and has also served to triangulate existing data and estimates. The MPHIA data were used to update estimates of HIV prevalence and people living with HIV at regional and district levels using small-area estimation and Spectrum models. In addition, MPHIA was the first national survey to directly measure HIV prevalence among children; previously, modeled estimates of children living with HIV were used for program planning.

MPHIA results have also been used in high-level strategic planning such as the national Global Fund application. The data were foundational to PEPFAR Malawi Country Operational Plan (COP17) planning, as they were used to inform where to scale up HIV testing and ART programs, who to reach by age and sex, and how to reach them efficiently.

These data have therefore guided PEPFAR and the national program in putting more emphasis on reaching the first 90 with intensified case finding in men and adolescents and in specific geographic locations. PEPFAR partners have also been asked to report age and gender disaggregated data to ensure that the right subpopulations and geographic locations are being targeted in PEPFAR programs. As Malawi moves toward HIV epidemic control, MPHIA and subsequent analyses have allowed Malawi to practice precision public health to reach those individuals most in need of HIV testing and clinical care.

Posted on by Nellie Wadonda-Kabondo and Danielle PayneLeave a commentTags , , , ,

Looking Ahead to a Measles and Rubella Free World

Robert Linkins, MPH, PhD

Vaccines fight diseases and save lives. Think of achievements like smallpox eradication, a polio-free world close at hand, and 2-3 million deaths prevented each year through routine immunizations. Yet despite a safe and effective vaccine against measles and rubella, these deadly viruses continue to steal the health and lives of children all over the world. Read More >

Posted on by Robert Linkins, MPH, PhDLeave a comment

Optimistic in the Face of Ongoing Tragedy: Progress toward a World Free of Human Rabies

During her presentation at 2017 PARACON meeting on how to plan and budget for a mass dog vaccination campaign, Emily Pieracci asked who was committed to ending rabies.

Rabies is a fatal disease that kills an estimated 59,000 people each year, almost half of whom are children. The majority of deaths occur in Africa and Asia. All of these deaths are vaccine-preventable with timely administration of post-exposure prophylaxis (PEP), the shots needed to prevent rabies from developing in bite victims. So why is Read More >

Posted on by Emily PieracciLeave a comment

CDC Global Rapid Response Team Pilots Workshop for Senegal and Burkina Faso

Participants to the Rapid Response Team Management workshop, Dakar, Senegal, August 7-11 The 2014-2016 Ebola epidemic clearly demonstrated the need for trained scientists who can deploy quickly to confront health threats and ensure global health security. While we often think about the emergency response itself, we typically don’t think about the work that happens behind Read More >

Posted on by Global Rapid Response TeamLeave a comment

Making some noise about noncommunicable diseases in Rwanda

We weren’t sure what to expect when the Rwanda Biomedical Center requested a training for their noncommunicable disease (NCD) program managers. We had never delivered this particular curriculum before, but after three months of preparation, our journey from Atlanta began. After landing in the capital Kigali, we faced a bumpy three-hour drive into the mountains Read More >

Posted on by Kristy Joseph, MA, CDC Global NCD BranchLeave a comment

Parasitologist for the People

LT Knipes chats with school children who have been enrolled and are waiting to be tested for lymphatic filariasis and malaria in Nord Est Department, Haiti.

Global health emergencies are a constant in today’s world. In recent years, we have seen the impact of natural disasters, mass migrations, famines, conflicts, and more. When there are large population movements, we see rapid spread of infectious disease. When there is famine, those affected have a compromised immune system, allowing them to contract illnesses easier. For these reasons it is vital that public health staff from the Centers for Disease Control and Prevention (CDC) is on the scene. Read More >

Posted on by Adrienne Lefevre, MPH, CHESLeave a commentTags , , , ,

Are Ebola response investments making an impact? CDC Epidemiologist reflects on West Africa then and now

The first time I deployed to West Africa was in September 2014, at the height of the Ebola epidemic in Sierra Leone. I have witnessed many disease outbreaks in my public health career, but this one was more devastating than I could ever have imagined. It eventually took more than 11,000 lives. What was happening Read More >

Posted on by John T, Redd, MD, MPH, FACP, CAPT, US Public Health Services, CDCLeave a commentTags , , , ,

Vaccination remains the most cost-effective strategy to get on track with hepatitis B elimination in resource-limited settings

Midwife providing the 5-in-1 pentavalent vaccine (diphtheria-tetanus-pertussis [DTP], hepatitis B, and Haemophilus influenzae type b) during a routine vaccination session in Myanmar In the 1990s, the Western Pacific Region had one of the highest prevalence rates of chronic hepatitis B infection in the world (>8%). As a result, in 2005, it was the first World Read More >

Posted on by Dr. Rania Tohme, Team Lead, Global Immunization DivisionLeave a commentTags , , , ,

Training the Future Public Health Workforce in Malawi: Field Epidemiology Training Program (FETP)

8. Malawi FETP-Frontline Cohort 2 trainees with mentors and guests during graduation ceremony: Photo courtesy: Kiran Bhurtyal, CDC

At 4:00 PM on July 12, 2016, I received an urgent email from the CDC Malawi office asking if I had any information on a typhoid outbreak in Malosa in southern Malawi. The U.S. Embassy in Malawi was planning a visit to Malosa by the Second Lady of the United States, and they had received reports of an unusually high number of typhoid cases there. Fortunately for me, one of our trainees from the Field Epidemiology Training Program (FETP) had presented on the same outbreak earlier that day during the FETP graduation ceremony.  Read More >

Posted on by Kiran Bhurtyal, CDC MalawiLeave a commentTags ,

Polio Eradication and Beyond: What the Polio Endgame Means for Public Health

Melisachew Adane

The end of polio is in sight, with fewer cases of wild polio virus being reported yearly. Today, polio is on the cusp of eradication, with cases in only a few high-risk areas of three countries—Afghanistan, Nigeria, and Pakistan. This brings the eradication effort to its final chapter, otherwise known as the polio endgame. The Read More >

Posted on by Manish Patel, MD (CAPT, USPHS)Leave a commentTags , , ,
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