Changes
On July 24, 2022 at 2:27:33 PM UTC,
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Updated description of Malawi Integrated HIV Program Report 2020 Q2 from
__COVID-19 Disruptions to the HIV Program__ The first cases of COVID-19 in Malawi were confirmed on 2nd April 2020, one week before the scheduled start of integrated HIV program supervision for Q1 2020. Early epidemiological models predicted rapid spread and severe impact of COVID-19 in Malawi. Fragile health services were not well prepared to prevent infections and deal with cases. The DHA therefore decided to suspend the established quarterly supportive supervision activity in April 2020 in order not to contribute to transmission at visited health facilities and to protect staff. The following report is based on data collected during the following supervision round in July 2020, which combined the Q1 and Q2 reporting periods. This combined quarterly supervision round was extended by one week (13-31 July) to cope with the added workload and the service disruptions. However, considerable challenges have affected the usual completeness and quality of service data. The DHA issued 3 editions of a circular to all HIV service delivery sites (on 3rd, 17th April and 15th June) with specific infection prevention guidance for COVID-19, and policy recommendations aimed at decongesting facilities, and reducing travel and contact exposure for patients and health workers. This included a temporary suspension of non-essential services: routine scheduled viral load monitoring for stable adult patients; VMMC; active index partner tracing; new initiation of IPT and PrEP; Teen clubs and other ART support groups involving social gatherings. The DHA also recommended an enhanced implementation of 6-month ARV dispensing for almost all patient groups. As the COVID-19 impact remained much lower than initially feared, the suspended services were successively reintroduced. There was a noticeable reduction in some HIV service outputs in Q2 compared with Q1 2020: * Total HTS outputs declined by 35% * New ART initiations declined by 32% * The number of blood units collected reduced by 23% * The number of routine viral load samples collected reduced by 5% However, program reports showed no indication for increased ART program attrition or lower adherence compared with previous quarters. __Scale-up of integrated Program performance highlights by the end of June 2020__ * HIV services had reached the following number of sites: * __765__ static and __68__ outreach HIV testing sites. * __755__ (static) ART sites; __590__ of these started at least one pregnant or breastfeeding woman. * __691__ sites with HIV-exposed children in follow-up. * __634,564__ persons were tested for HIV and received their results; 107,507 __(17%)__ accessed HIV testing for the first time; __527,057 (80%)__ were repeat testers and __21,049 (4%)__ of these received confirmatory testing (after having tested positive in the past). __18,882 (3.1%)__ clients received a positive result for the first time1. * A total of __63,600__ people received __105,211__ self-test kits for either primary or secondary use. * __16,049 (94%)__ of 17,095 blood units collected were screened for (at least) HIV, hepatitis B and syphilis. * __162,127 (99%)__ of 164,354 women at ANC had their HIV status ascertained; __10,695 (7%)__ of these were HIV positive. __138,394 (95%)__ of 145,981 at maternity had their HIV status ascertained __10,075 (7%)__ of these were HIV positive. * __18,804__ patients started ART this quarter; __88%__ were classified as asymptomatic / in WHO stage 1 and started under the “Test & Treat” policy. * __846,164__ patients were alive and on ART by end of June 2020.2 This means that __79%__ of the estimated 1,072,534 HIV positive population was on ART. 3 ART coverage was __75%__ (44,355/ 58,752) for children4 and __79%__ (801,909 / ,013,782) for adults. * __76,921 (94%)__ of viral load results from routine monitoring were <1000 copies/ml. Viral suppression rates for routine samples among children (0-14 years) and adults (15+ years) were __71%__ and __95%__, respectively. * __71%__ of adults and __76%__ of children were retained alive on ART at 12 months after initiation. * Out of __811,825__ patients on first line adult ART __34,256 (4%)__ were on TDF/3TC/EFV and __752,779 (94%)__ had transitioned to TDF/3TC/DTG. * __11,876 6 (>99%)__ of an estimated 10,3643 HIV infected pregnant women in Malawi were on ART this quarter. __9,943 (84%)__ of these were already on ART when getting pregnant and __2,293 (24%)__ started ART during pregnancy/delivery. * An additional __798__ breastfeeding women started ART in WHO stage 1 or 2. * __76%__ and __70%__ of women started while pregnant or breastfeeding were retained on ART at __6 and 12 months__ after initiation, respectively. * __9,112 (7%)__ of infants discharged alive from maternity were known to be HIV exposed, __8,808 (97%)__ of these received ARV prophylaxis (nevirapine). A total of 12,413 HIV exposed children were newly enrolled for follow-up this quarter; __10,417 (84%)__ of these were enrolled before age 2 months. * Out of the total 1,072,534 estimated PLHIV by end June 2020: * An estimated __91%__ of PLHIV knew their status (diagnosed)
to__COVID-19 Disruptions to the HIV Program__ The first cases of COVID-19 in Malawi were confirmed on 2nd April 2020, one week before the scheduled start of integrated HIV program supervision for Q1 2020. Early epidemiological models predicted rapid spread and severe impact of COVID-19 in Malawi. Fragile health services were not well prepared to prevent infections and deal with cases. The DHA therefore decided to suspend the established quarterly supportive supervision activity in April 2020 in order not to contribute to transmission at visited health facilities and to protect staff. The following report is based on data collected during the following supervision round in July 2020, which combined the Q1 and Q2 reporting periods. This combined quarterly supervision round was extended by one week (13-31 July) to cope with the added workload and the service disruptions. However, considerable challenges have affected the usual completeness and quality of service data. The DHA issued 3 editions of a circular to all HIV service delivery sites (on 3rd, 17th April and 15th June) with specific infection prevention guidance for COVID-19, and policy recommendations aimed at decongesting facilities, and reducing travel and contact exposure for patients and health workers. This included a temporary suspension of non-essential services: routine scheduled viral load monitoring for stable adult patients; VMMC; active index partner tracing; new initiation of IPT and PrEP; Teen clubs and other ART support groups involving social gatherings. The DHA also recommended an enhanced implementation of 6-month ARV dispensing for almost all patient groups. As the COVID-19 impact remained much lower than initially feared, the suspended services were successively reintroduced. There was a noticeable reduction in some HIV service outputs in Q2 compared with Q1 2020: * Total HTS outputs declined by 35% * New ART initiations declined by 32% * The number of blood units collected reduced by 23% * The number of routine viral load samples collected reduced by 5% However, program reports showed no indication for increased ART program attrition or lower adherence compared with previous quarters. __Scale-up of integrated Program performance highlights by the end of June 2020__ * HIV services had reached the following number of sites: * __765__ static and __68__ outreach HIV testing sites. * __755__ (static) ART sites; __590__ of these started at least one pregnant or breastfeeding woman. * __691__ sites with HIV-exposed children in follow-up. * __634,564__ persons were tested for HIV and received their results; 107,507 __(17%)__ accessed HIV testing for the first time; __527,057 (80%)__ were repeat testers and __21,049 (4%)__ of these received confirmatory testing (after having tested positive in the past). __18,882 (3.1%)__ clients received a positive result for the first time1. * A total of __63,600__ people received __105,211__ self-test kits for either primary or secondary use. * __16,049 (94%)__ of 17,095 blood units collected were screened for (at least) HIV, hepatitis B and syphilis. * __162,127 (99%)__ of 164,354 women at ANC had their HIV status ascertained; __10,695 (7%)__ of these were HIV positive. __138,394 (95%)__ of 145,981 at maternity had their HIV status ascertained __10,075 (7%)__ of these were HIV positive. * __18,804__ patients started ART this quarter; __88%__ were classified as asymptomatic / in WHO stage 1 and started under the “Test & Treat” policy. * __846,164__ patients were alive and on ART by end of June 2020.2 This means that __79%__ of the estimated 1,072,534 HIV positive population was on ART. 3 ART coverage was __75%__ (44,355/ 58,752) for children4 and __79%__ (801,909 / ,013,782) for adults. * __76,921 (94%)__ of viral load results from routine monitoring were <1000 copies/ml. Viral suppression rates for routine samples among children (0-14 years) and adults (15+ years) were __71%__ and __95%__, respectively. * __71%__ of adults and __76%__ of children were retained alive on ART at 12 months after initiation. * Out of __811,825__ patients on first line adult ART __34,256 (4%)__ were on TDF/3TC/EFV and __752,779 (94%)__ had transitioned to TDF/3TC/DTG. * __11,876 6 (>99%)__ of an estimated 10,3643 HIV infected pregnant women in Malawi were on ART this quarter. __9,943 (84%)__ of these were already on ART when getting pregnant and __2,293 (24%)__ started ART during pregnancy/delivery. * An additional __798__ breastfeeding women started ART in WHO stage 1 or 2. * __76%__ and __70%__ of women started while pregnant or breastfeeding were retained on ART at __6 and 12 months__ after initiation, respectively. * __9,112 (7%)__ of infants discharged alive from maternity were known to be HIV exposed, __8,808 (97%)__ of these received ARV prophylaxis (nevirapine). A total of 12,413 HIV exposed children were newly enrolled for follow-up this quarter; __10,417 (84%)__ of these were enrolled before age 2 months. * Out of the total 1,072,534 estimated PLHIV by end June 2020: * An estimated __91%__ of PLHIV knew their status (diagnosed)