Malawi has made enormous strides in reducing new HIV infections and AIDS-related deaths over the last 15 years, largely due to sexual behavior change and increased treatment uptake. However, there are still ~33,000 new HIV infections and ~15,000 AIDS-related deaths annually.

Malawi has set the ambitious goal to end AIDS by 2030 and has aligned its national strategic plan with global goals and targets including 90-90-90 fast-track targets for HIV treatment, targets towards the virtual elimination of mother-to-child transmission and reducing new HIV infections. This study examined the alignment between resource allocation and programmatic need to determine whether improvements in epidemiological outcomes are possible through better resource targeting. Through formal epidemiological and resource optimization, it was identified that Malawi allocates resources to districts with high HIV epidemic burden and program areas including antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT), health-facility based HIV testing services (HTS), voluntary medical male circumcision (VMMC) and condom programs that can yield large impact. However, by further increasing the allocation of existing HIV resources to districts with high HIV prevalence and programs with highest impacts, it is possible to obtain further reductions in annual infections and deaths even if the total budget remains stable.