This is the 9th quarterly HIV Program report after implementation of the 2011 Integrated Clinical HIV Guidelines in July 2011. A summary of the key achievements between July and September 2013 is provided below:

• Scale-up of integrated HIV services had reached the following number of sites:

  • 825 static (607 within and 218 outside of health facilities) and 534 outreach HTC sites

  • 675 (static) ART sites

  • 590 PMTCT sites (Option B+)

  • 628 Pre-ART sites

  • 605 sites with HIV-exposed child follow-up

• 405,278 persons were tested and counselled for HIV and 36,807 (9%) were HIV positive; 145,572 (36%) people tested for the first time.

• 12,646 (95%) of 13,299 blood units collected were screened for HIV, hepatitis B and syphilis.

• 128,022 (83%) of 153,561 women at ANC had their HIV status ascertained; 9,988 (8%) of these were HIV positive. 122,392 (93%) of 132,279 women at maternity had their HIV status ascertained; 9,337 (8%) of these were HIV positive.

• 25,551 patients started ART during this quarter; this is similar to the previous quarter (26,802).

• 459,261 patients were alive and on ART by end of September 2013. This is equivalent to 74% coverage of the estimated 602,000 population in need of ART (all ages).1 Estimated ART coverage among children (<15 years) and adults was 47% and 81%, respectively.

• 78% of adults and 80% of children were retained alive on ART at 12 months after initiation.

• 309,127 (73%) of 424,961 on first line adult ART were on regimen 5A (TDF/3TC/EFV).

• The proportion of ART patients with documented side effects declined from 7% to 2% compared with the previous quarter.

• A total of 11,788 HIV positive pregnant women were on ART: 5,041 (43%) of these were already on ART when getting pregnant and 6,747 (57%) started ART during pregnancy/delivery. This is equivalent to 75% ART coverage among the estimated 15,750 HIV infected pregnant women in Malawi this quarter. 6,429 (95%) of pregnant women started ART due to Option B+ (in WHO clinical stage 1 or 2) and 318 (5%) due to a low CD4 count and/or WHO clinical stage 3 or 4.

• An additional 1,831 breastfeeding women started ART due to Option B+ (in WHO stage 1/2)

• 6,057 (79%) of 7,677 women started under Option B+ were retained at 6 months after ART initiation; 6,630 (72%) of 9,205 were retained at 12 months after ART initiation.

• 8,564 (7%) of infants discharged alive from maternity were known to be HIV exposed, 7,941 (93%) of these received ARV prophylaxis (nevirapine). 5,734 (67%) were enrolled in exposed child follow-up before age 2 months.

• A total of 10,258 HIV exposed children and 8,884 pre-ART patients were enrolled for followup in HIV Care Clinics (HCC) during this quarter.

• 162 medical staff were newly trained and certified in PMTCT/ART this quarter. This brings the total number trained in the 2011 guidelines to 5,985.

• 1,243 HTC providers were re-trained using the HTC Skills Intensive Training curriculum, bringing the total number re-trained to 3,776.

• A total of 921 staff at 235 sites in 19 districts received clinical mentoring during. 104 staff graduated, 250 were in intensive and 350 in continuation phase this quarter.