1.
A 15 Year Review of PEPFAR
Support to Malawi: How has it
succeeded
Maureen Luba Milambe
Africa Region Advocacy Advisor, AVAC
Jane Jie Sun Women In Global Health LEAD Fellow
Visiting Scientist
Harvard Department of Global Health and Population
7th October 2019

2.
What happens when girls drop out of school?
School
drop out
Early
marriages
Teen
pregnancies
Age
disparate
relationships
Victims of
Gender
based
violence
Transactional
sex
Victims of
Sexual abuse
Increased HIV
risk

3.
FIGURE 7.2 Number of new HIV infections among FIGURE 7.3 Number of new HIV infections among young people young people (aged 15–
24 years), by sex, Global 1990–2018 (aged 15–24 years) by sex, Eastern & Southern Africa 1990–2018
Source: UNAIDS 2019 estimates.

4.
Age Profile of Recently Infected | Highest % of new infections among youth 13-24
years old (Apr-Aug 2019, N=1,762)
19.4%
17.1%
15.8%
9.7%
12.1%
11.3%
7.3%
8.5%
%0.0
5.0%
10.0%
15.0%
20.0%
0
50
100
150
200
13-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ 0.0%
16.3 %
8.6%
12.5%
6.7%
7.8%
1.6%
4.5%
%0.0
5.0%
10.0%
15.0%
0
50
100
150
13-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
Age
RTRI Long term RTRI Recent % RTRI Recent
Females
Males

5.
§One of the poorest countries in the world
§Total population 18.6 million
§HIV prevalence rate 9.8%

6.
§ In relative terms Government health spending higher than the
rest of the region – 10.8% against 6.9% regional avearage
§ In absolute terms Total health expenditure per capita very low
US$34 versus US$114 in other sub-Saharan African countries
§ Limited fiscal space for additional domestic health spending

7.
1985 the first HIV case in Malawi
Overcrowding facilities
By 1999 prevalence rate 16.2%

8.
>3000 PLHIV on ART

9.
828,329 PLHIV on
ART

10.
How has PEPFARs contributed to Malawi's
success?

11.
Over $800 million invested to support the
HIV/AIDS response in Malawi over the last 15
years
Health systems strengthening; promoting a
broad range of HIV prevention, treatment, and
care activities; and mitigating the social and
economic impact of the disease

12.
The Game Changing Interventions
Implemented To Date

13.
2014
Program
announced
2015
Malawi listed as
one of the
DREAMs focus
countries
2019
On going
implement
ation in
three
districts

14.
A 53% reduction in new HIV diagnoses among
15-19 year-old adolescent girls and an estimated
30% reduction in new HIV diagnoses among 20-
24 year-olds in the 3 focus districts

15.
§Malawi faces critical shortage of HRH,
§0.51 professional health workers per 1,000 inhabitants, one
ninth of WHO requirement to achieve UHC and the SDGs
§PEPFAR investment in pre-service training and salary
support
§Currently supporting 9,902 HCWs at community and
facility

16.
DDE, Unique ID, connectivity specific privilege investments facilitate
tracking transfer between
sites and facilitating LTFU
notifications

17.
Available in real
time
high quality and
reliable data
Accessible to ALL
stakeholders

18.
TLD
Transition
Voluntary
Assisted
Partner
Notification
Recency
testing
TB
Preventive
Therapy
Annual viral
load
Champion for
Evidence
based policies
Pre
Exposure
Prophylaxis

19.
Where are we with the
epidemic?

20.
1,066,811
984,533
828,329
756,761
0
200,000
400,000
600,000
800,000
1,000,000
PLHIV Aware On ART Virally Suppressed
92% %84 %91
%95
%95
%95

21.
What else should
be done?

22.
§DREAMS Expansion
§More efforts around HIV prevention,
§More HRH support
§Sustainability and Increased local ownership of the
program