Although Malawi has made progress in scaling up antiretroviral treatment and bringing down HIV prevalence from 14% in 1989 to 9.6% in 2015/16, there has been a slow decline in new HIV infections. While there has been an estimated 57% reduction of new infections from a baseline of 56,000 in 2010 to 32,248 in 2020, (Spectrum Estimates; 2020), the country has not met the UNAIDS fast track target of achieving 75% reduction in new infections by 2020. The National strategic plan 2020 -2025 aims at reducing new HIV infections from 33,000 in 2019 to 11,000 in 2025.
In order to achieve this ambitious target, there is need to sustain the gains made in achieving the UNAIDS 90.90.90 treatment targets and scale up comprehensive evidence based HIV combination prevention approaches targeting those at substantial risk and most affected geographical areas. In expanding use of oral Pre-exposure Prophylaxis (PrEP), the country has adopted public health, human rights and people centred approaches, prioritizing universal health coverage, gender equality, health related rights including accessibility, availability, acceptability and quality.
Implementation will therefore be undertaken in a phased in approach, prioritizing facilities/sites based on estimated number of clients at substantial risk, capacity of facility/site and referral mechanisms, availability of trained and skilled professional health workers, infrastructure and laboratory capacity/proximity. Public health facilities, CHAM, Drop-in Centres, Private and NGO facilities will deliver PrEP to allow access to marginalized populations. Additional sites will be set as demand increases and capacity is strengthened.
Drawing lessons from studies implemented in the region as well implementation research among Adolescents Girls and Young Women (AGYW) and Female Sex Workers (FSW) in Malawi, community educators and advocates will be used to increase awareness about PrEP in their communities and sub populations. Additionally, PrEP services will be integrated within HIV, Sexual Reproductive Health, maternal & Child Health, Youth friendly Health services, TB and other clinical care and finally services for key populations.
