Executive Summary (July-September 2020)

COVID-19 Disruptions to the HIV Program

The first cases of COVID-19 in Malawi were confirmed on 2nd April 2020 and early epidemiological models predicted rapid spread and severe impact of COVID-19 in Malawi.

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.

Access to most HIV services recovered slightly during Q3 as COVID case numbers remained low during Q3 2020 but it remained below targets and lower than in the pre-COVID period.

Scale-up of integrated Program performance highlights by the end of June 2020

• Scale-up of integrated HIV services had reached the following number of sites:
  • 763 static and 104 outreach HIV testing sites.
  • 754 (static) ART sites; 604 of these started at least one pregnant or breastfeeding woman.
  • 698 sites with HIV-exposed children in follow-up.
• 697,991 persons were tested for HIV and received their results; 117,885 (17%) accessed HIV testing for the first time; 580,106 (83%) were repeat testers and 22,638 (4%) of these received confirmatory testing (after having tested positive in the past). 20,206 (3.0%) clients received a positive result for the first time.
• A total of 108,030 people received 186,485 self-test kits for either primary or secondary use.
• 16,164 (95%) of 16,961 blood units collected were screened for (at least) HIV, hepatitis B and syphilis.
• 155,128 (99%) of 158,524 women at ANC had their HIV status ascertained; 10,253 (7%) of these were HIV positive. 138,044 (94%) of 147,191 at maternity had their HIV status ascertained 10,190 (7%) of these were HIV positive.
• 19,384 patients started ART this quarter; 78% were classified as asymptomatic / in WHO stage 1 and started under the “Test & Treat” policy.