Malawi

Eastern and southern Africa (ESA) is the world’s most heavily HIV-impacted region, with adolescent girls and young women (AGYW) disproportionately affected. To support the scale-up of PrEP amongst AGYW in ESA, in September 2021 UNICEF and partners released the implementation brief “Improving the Quality of Pre-Exposure Prophylaxis Implementation for Adolescent Girls and Young Women in Eastern and Southern Africa,” highlighting considerations to help improve the quality and coverage of AGYW PrEP programming.

The PrEP landscape has evolved significantly in the three years since the original brief was released, both in scale and variety. This updated brief summarises the most recent evidence on AGYW PrEP provision, serving as a supplement to the original 2021 implementation brief.

The report outlines the progress and achievements in the triple elimination of vertical transmission of HIV, syphilis, and hepatitis B in Eastern and Southern Africa (ESA) over the last two decades. The data mentorship programme aims to strengthen national health management information systems, improve data quality, and build the analytical skills of government staff working towards elimination. It employs a unique partnership model with the private sector, academia, and government officials, focusing on capacity building through virtual and in-person mentoring, online learning platforms, and workshops. The programme has shown early successes, with mentees from various countries implementing operational plans to improve data quality and analysis in their respective countries.

Empowered mentees are taking up leadership roles that directly support national programmes and 'Path to Elimination' validation processes. The geographical expansion of the programme and the continuous exposure of mentees to technical learning opportunities will further enhance each country’s preparedness towards the 'Path to Elimination' and validation. The design, approach and delivery of this programme can be used as a blueprint for building national and regional capacity, skills building, and mentorship. While this particular data mentorship programme focuses on vertical transmission and the Path to Elimination, the principles of data quality, data sources, collection and reporting, data visualisations, and data use remain consistent across healthcare programmes and can be applied more broadly to build data use capacity in maternal, newborn, child and adolescent health and sexual and reproductive health.

In 2019 it was estimated that 1.2 million children (0-14) were living with HIV in Eastern and Southern Africa, yet more than a half million of these children (504,000) were not receiving lifesaving treatment. Children with HIV need to achieve viral load suppression if they are to lead long and healthy lives. Population-based surveys in Malawi, Uganda and Zimbabwe found that children on treatment fare worse in achieving viral load suppression compared to adults; 42 per cent vs 67 per cent, 39 per cent vs 84 per cent and 47 per cent vs 86 per cent respectively. Ending AIDS will not be possible without accelerating progress for children.

UNICEF, in collaboration with governments and partners, supported a mixed method study that included literature review, assessment of laboratory data in Malawi, Uganda and Zimbabwe and interviews with health workers and caregivers in Malawi to find out what is behind these low rates. The study found that one out of every three children who had a viral load test had not achieved viral load suppression. Support networks for caregivers and children improved adherence and made a difference towards outcome. The full report describes the methodology, key findings, challenges and proposes concrete recommendations to improve treatment outcomes for children with HIV. The accompanying advocacy brief summarizes the key findings and provides action-oriented next steps

HIV-sensitive Social Protection: With focus on creating linkages between social cash transfer programmes and HIV services describes an intervention aiming to strengthen the linkages between HIV services and national social protection programmes and provides lessons learned from implementing the intervention in four countries. The focus of the programme is on families with children and adolescents, vulnerable to, or affected by HIV and AIDS. The programme, funded by the Government of the Netherlands, is now being implemented in Malawi, Mozambique, Zambia and Zimbabwe in close collaboration with national, provincial and district level governments.

‘Walking in our shoes; Perspectives of pregnant and breastfeeding women living with HIV on access to and retention in care in Malawi, Uganda and Zambia’ highlights the key factors that facilitate retention in care for women living with HIV and calls for increased focus on rights and dignity in care.

The report, presents the findings of community-led research related to the viewpoints and experiences of women who were initiated on antiretroviral treatment during pregnancy or breastfeeding and explores their perspectives on factors that have enabled them to successfully adhere to their treatment and retain in care.