The fifth annual countrywide Situational Analysis (SA) of HIV/AIDS services in Malawi for 2006 was conducted between March and June 2007. Information was collected by a team from the HIV Unit, supported by M&E and HTC staff from Lighthouse and from CDC Malawi and joined by the respective District HTC and PMTCT coordinators. A total of 167 health facilities across the country were visited, including all central and district hospitals and the main mission hospitals and non-governmental organizations (NGOs) in Malawi. The team also collected aggregated data from a further 183 rural hospitals, health centres, clinics and stand-alone HTC sites and 45 associated outreach sites from the District Health Offices.

A comprehensive inventory of HIV-related health services was taken in all districts. This identified a total of 351 static HTC sites, 290 HTC outreach sites and 274 mobile locations where HTC was offered during 2006. Malawi conducted its first national HIV testing week from 17th to 22nd July 2006, during which HTC was offered on full-time basis at all static sites and at 384 outreach and mobile locations. During this week, an additional 84,300 HTC encounters were recorded over and above the estimated 50,200 HIV tests that occurred in July.

Information collected in the SA survey was augmented with operational data that had been collected at 297 HTC site supervision visits between 2nd October and 21st December 2006 by a team of senior Lighthouse HTC counsellors.

The SA 2006 included a comprehensive assessment of PMTCT services. This identified 56 facilities with ANC and maternity services and 4 facilities with ANC only that had provided HIV testing for pregnant women and given ARV prophylaxis to infected mothers and exposed babies. A total of 138,000 HIV tests were performed at ANC and 19,200 (13%) were positive; 10,300 maternal doses of nevirapine were dispensed at ANC. Extrapolated to the national level PMTCT coverage at ANC was: 26% of pregnant women tested; (14% HIV positive); 14% of HIV positives were given ARV prophylaxis. At maternity sites, HIV status was ascertained for 34,000 women and 7,500 were HIV positive (18%); 5,500 women and 6,800 babies received ARV prophylaxis. Extrapolated to the national level, PMTCT coverage at maternity facilities was: HIVstatus ascertained for 6% of deliveries; 7% of HIV infected mothers and 9% of exposed babies given ARV prophylaxis.

Blood for transfusion was collected by 56 facilities and 53 facilities were able to provide complete records about all blood units collected and screened for HIV during 2006. The Malawi Blood Transfusion Service as a central supplier of blood units to health services had collected 24,298 (36%) of the total of 68,301 units recorded in the SA 2006; 49 facilities had screened 100% of units for HIV and 4 facilities had screened between 94% and 99%. A total of 26 blood units had no record for HIV screening; 5,014 units (7%) were HIV positive. 27 facilities provided data on post-test counselling of blood-donors and 8 had informed any donors of their test result. A total of 1,611 donors were post-test counselled.

A total of 26,700 TB cases were registered in 2006 and 17,000 (66%) were tested for HIV; 11,700 (66%) of patients tested were HIV positive and 11,500 (98%) of HIV positives were started on cotrimoxazole prophylaxis. An estimated equivalent of 60% of TB patients who were tested and who were HIV positive started on ART. Extrapolated to the national level 38% of all TB patients believed to be HIV positive started ART.

There were 141 ART clinics by the end of 2006 (103 public sector, 38 private sector), making available ART in all districts in Malawi. During 2006, 46,400 patients newly registered for ART and by the end of 2006, a cumulative total of 85,200 ART patients had ever been registered. Treatment outcomes were good and as of the end of December 2006, 60,000 patients were alive and on ART in Malawi.