Malawi's progress towards UNAIDS 95-95-95 fast-track targets: who is lagging?

Abstract

The HIV and AIDS epidemic remains a critical global health challenge. Malawi accounts for 2.5% of global HIV cases and is a focus country in the UNAIDS 95-95-95 fast-track initiative. Despite reaching 92-95-94 in 2020, there is a need to evaluate Malawi's progress as of 2023 to identify gaps and ensure success before the target period ends. This quantitative descriptive study used secondary data from Malawi's Department of HIV and AIDS Management Information System (DHAMIS) database over a 12-year period (2012-2023) and HIV spectrum estimates. It contains aggregate data from HIV service delivery points. Data included key HIV indicators disaggregated by age and gender. Numerators for the 95-95-95 are: people living with HIV (PLHIV) who know their status, PLHIV on treatment, PLHIV on treatment and virally suppressed. Denominators are: the estimated total PLHIV, PLHIV who know their status and PLHIV on treatment. Statistical analysis was performed using Excel, SPSS and Stata to assess differences between groups. Ethical approval and data access permissions were granted by the Ministry of Health. Between 2012 and 2023, the total number of PLHIV increased from 962 043 to 991 600. The percentage of PLHIV aware of their HIV status increased from 73% to 95%, and those on treatment increased from 58% to 95%. By 2023, 87% of children (under 15 years old) knew their HIV status, compared to 96% of adults. Lower percentages of ART initiation and viral load suppression were also noted among children. While both males and females improved across all indicators, men consistently lagged women in all three indicators. The viral suppression gap narrowed after 2019. Malawi has improved in the HIV treatment cascade between 2012 and 2023. Challenges remain in children ART initiation and access to care for men, requiring targeted efforts to achieve equitable treatment for all and meet the UNAIDS 95-95-95 targets.