Reflections on the Fight Against HIV in Malawi

This year, my staff and I have had the opportunity to spend considerable time in health facilities that our HIV-funded partners support throughout this beautiful country. Some of these facilities are on back-country roads; others are on forest-covered hills, while others sit on the shores of Lake Malawi. For CDC-Malawi, making these trips every quarter has been critical to strengthening our partnership with the Malawi Ministry of Health, ensuring quality in our programming, keeping our technical discussions grounded and practical, and helping ensure each of us is aware of the challenging realities faced by health workers and patients on a daily basis.

It has also highlighted how, against enormous odds, Malawi has been a leader in achieving remarkable successes in the fight against HIV, despite being one of the poorest countries in the world, ranking 181 of 187 countries in GDP per capita. In Malawi, almost one in every four adult urban women are infected, child and maternal deaths remain elevated due to the epidemic, and almost every family in the country has a profound story to tell about how they have been personally affected by this disease.

I find it thrilling that in the next two months, Malawi is set to reach the milestone of 500,000 persons (one of every 30 Malawians) alive and on antiretroviral treatment, something that was simply inconceivable when the program started a decade ago.

This number has more than doubled in the past three years, partially as a result of the scientific recognition that treatment is indeed prevention, but also because of Malawi’s invention and adoption of Option B+, which CDC-Malawi has intensively supported, in solidarity with Malawi’s efforts to fight the epidemic and improve the health of women (watch comments from the President of Malawi). The rapid scale-up of HIV treatment is also a direct result of the proactive systematic conversion of almost all of Malawi’s health facilities to be able to provide chronic HIV care.

In large part due to this rapid growth of HIV treatment, Malawians’ life expectancy has increased dramatically while the number of Malawians becoming infected with HIV has decreased.

Through the President’s Emergency Plan for AIDS Relief (PEPFAR), CDC has been filling a critically important role in Malawi over the past decade. Our work focuses on science, innovation and the scale-up of evidence-based biomedical interventions, while supporting the Government of Malawi’s leadership in the national fight against HIV.

A core strategy for CDC-Malawi has been to support two innovative national information systems, which form the backbone of the national treatment program. The first is an internationally recognized paper-based system which provides exceptionally reliable and comprehensive data quarterly on the epidemic, and the second is a homegrown electronic data system for HIV patients that makes life in very busy health facilities easier for both the healthcare workers and their patients.

Of course, at the same time, despite these successes, many sobering challenges remain. Approximately one in three Malawian adults do not know their HIV status, coverage of HIV treatment for children is unacceptably low, rapidly growing numbers of patients on treatment are stretching the ability to ensure quality care, and there are still too many persons with HIV who cannot access the necessary testing to make sure their treatment is working.

Advances in the health system are essential to address these and other challenges: strengthening training institutions to produce more healthcare workers, improvement of health facility and laboratory infrastructure to support chronic disease management, and better and broader health information and surveillance systems. CDC continues to focus our support to Malawi to address each of these challenges.

This year, CDC is also chairing the Malawi HIV/AIDS Donor Group. In this and other fora, we have enjoyed spirited debates with our partners in Malawi about the next steps in the fight against HIV/AIDS.

Having the unique opportunity and privilege to fully engage at both the national program coordination level as well as in the most remote corners of Malawi has allowed CDC to apply our expertise in science, policy and programs and to test the effectiveness of innovations and new strategies to fight the epidemic. We have also been able to support the Malawian response in the context of constant learning and adjustment. All these have been key to the successes we have seen so far.

I am inspired by the time I spend in the field with health workers, and seeing their energy, commitment, and expertise. I enjoy hearing the stories healthcare workers have to tell—”this patient did not come back because they were only here temporarily visiting family…this one was afraid of what her husband would say, but we talked to him and things are better…this mother was diagnosed in early labor and died a month later but her baby’s test is negative and he is now being cared for by family.”

We know that sustained collaborative work has improved the lives of countless individuals, families, and communities. We have clearly turned the corner of this unprecedented epidemic, and we are part of a larger community intent on maintaining the spotlight on the same goal. We have great hope for a future of continued progress in this fight.