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, 15th June and 17th August) 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 during Q4 as COVID case numbers remained low during Q4 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 December 2020: Scale-up of integrated HIV services had reached the following number of sites: * 763 static and 152r outreach HIV testing sites. * 754 (static) ART sites; 607 of these started at least one pregnant or breastfeeding woman. * 701 sites with HIV-exposed children in follow-up. 768,126 persons were tested for HIV by a trained provider and received their results; 154,465 (20%) accessed HIV testing for the first time; 614,661 (80%) were repeat testers and 25,267 (4%) of these received confirmatory testing (after having tested positive in the past). 22,634 (3.0%) clients received a positive result for the first time. A total of 119,205 people received 204,952 self-test kits; 84,867 (41%) of these were for use by the recipient and 120,85 (59%) for onward distribution to sex partners or other people. 19,919 (89%) of 22,381 blood units collected were screened for (at least) HIV, hepatitis B and syphilis. 150,492 (98%) of 154,299 women at ANC had their HIV status ascertained; 9,481 (7%) of these were HIV positive. 134,184 (95%) of 141,805 at maternity had their HIV status ascertained 10,692 (8%) of these were HIV positive. 21,655 patients started ART this quarter; 87% were classified as asymptomatic / in WHO stage 1 and started under the “Test & Treat” policy.