The fourth countrywide survey of HIV/AIDS services in Malawi for 2005 was conducted between 13th February and 17th March 2006. Information was collected by a team of Lighthouse counselors who visited 62 health facilities throughout the country, covering all central and district hospitals and the main mission hospitals and non-governmental organizations (NGOs) in Malawi. The survey team also collected aggregated data from a further 188 rural hospitals/ health centres / clinics providing testing and counseling services, which were attached to these main facilities.

Data were collected from a total of 250 facilities which performed HIV testing during 2005. This includes 249 sites which provided HIV testing with counseling (HTC) and feedback of results: central, district, mission and rural hospitals; clinics and health centres, stand-alone sites, NGOs. The Malawi Blood Transfusion Service is included as a facility which performs HIV testing as a screening for all potential blood donors without feedback of results.

In total, these facilities had performed 482,364 HIV tests, including 359,065 in patients and voluntary counseling and testing (VCT) clients, 58,152 in potential blood donors, 52,904 in pregnant women in the prevention of mother to child transmission (PMTCT) programme and 12,243 in TB patients.

HIV prevalence in patients/VCT clients was 25%, 11% in blood donors, 13% in antenatal women and 69% in TB patients. In the sub-group of 56,860 VCT clients tested at the 6 MACRO sites, HIV prevalence was 13%.

The 2005 survey included data on 40 facilities providing PMTCT; a total of 52,904 tests were performed by these sites and the HIV prevalence was 13%. Nevirapine was dispensed to 5,054 pregnant women, representing 72% of those tested positive.

Forty-three out of the 45 public TB management facilities were captured in the 2005 survey and these facilities had recorded 26,019 TB cases. Routine registration of TB patients for HIV testing was carried out by 41 facilities. A total of 12,243 TB patients were tested, representing 47% of all cases registered. HIV prevalence amongst these was 69% and 7,747 (92%) were started on cotrimoxazole (CTX) prophylaxis.

There were 60 sites providing HAART and 24,678 patients started on ART during 2005, contributing to a cumulative total of 37,840 patients who had ever received ART since free antiretroviral drugs became available in the public sector.

The 249 HTC sites in the 2005 situational survey employed a total of 989 counselors, 537 of whom were recorded as full-time counselors. A detailed assessment of HTC services was carried out at 62 sites; 55 of these sites operated daily, 60 had a dedicated room for patient counseling and 58 used the standard national HTC register. Half of these sites used standard lists to record systematically all patients referred for further care. One fifth of assessed HTC facilities were affected by stock-outs of test kits during 2005.