Modelling health outcomes of a decade of HIV, malaria and tuberculosis initiatives, Malawi.

Objective: To estimate the outcome of programmes on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria in Malawi across multiple health domains.

Methods: We used an integrated epidemiological and health system model to estimate the impact of HIV/AIDS, tuberculosis and malaria programmes in Malawi from 2010 to 2019. We incorporated interacting disease dynamics, intervention effects and health system use in the model. We examined four scenarios, comparing actual programme delivery with hypothetical scenarios excluding the health programmes individually and collectively.

Findings: From 2010 to 2019, an estimated 1.08 million deaths and 74.89 million disability-adjusted life years were prevented by the HIV/AIDS, tuberculosis and malaria programmes. An additional 15 600 deaths from other causes were also prevented. Life expectancy increased by 13.0 years for males and 16.9 years for females. The programmes accounted for 18.5% (95% uncertainty interval, UI: 18.2 to 18.6) of all health system interactions, including 157.0 million screening and diagnostic tests and 23.2 million treatment appointments. Only 41.5 million additional health worker hours (17.1%; 95% UI: 15.9 to 17.4%) of total health worker time) were needed to achieve these gains. The HIV/AIDS, tuberculosis and malaria programmes required an additional 120.7 million outpatient appointments, which were offset by a net decrease in inpatient care (9.4 million bed-days) that would have been necessary in their absence.

Conclusion: HIV/AIDS, tuberculosis and malaria programmes have greatly increased life expectancy and provided direct and spill-over effects on health in Malawi. These investments reduced the burden on inpatient and emergency care, which requires more intensive health worker involvement.