DHSS Project Celebrates Achievements in Fighting HIV in Malawi

The District Health System Strengthening and Quality Improvement for Service Delivery (DHSS) Project shared its achievements on Wednesday, March 7, after five years of work to reduce the burden of HIV/AIDS in Malawi.

Guests gathered at the Bingu International Conference Center in Malawi’s capital, Lilongwe, for an end-of-project event that featured speakers from DHSS, the Ministry of Health, United States Centers for Disease Control and Prevention (CDC), and Management Sciences for Health (MSH), which led the DHSS Project,  

“The name of this project—District Health System Strengthening—is key to the sustainability of initiatives, particularly if we are to achieve a country free of HIV,” said Ministry of Health Department of HIV and AIDS Director Rose Nyirenda. “So let me applaud MSH for being able to reach our objective in district health strengthening.”

MSH President and CEO Marian Wentworth said she was happy to see a strong national HIV program, noting it had served as an example for many countries in the region. “Though we are concluding this project, we will still be working side-by-side with you for other projects in Malawi, supporting the Ministry of Health, strengthening the Ministry’s partners in the districts, and helping to improve their management capacities,” she said. “We are honored to have contributed to your efforts.”

At the event, DHSS presented a video on the strategy of index case testing as well as an end-of-project report and seven technical briefs and a technical highlight that detailed DHSS’s approaches and successes.

The DHSS Project supported the Government of Malawi in implementing the National Strategic Plan for HIV and AIDS in line with the Country Operational Plan, as well as implementation of the Health Sector Strategic Plan, through the project’s work in seven districts of Malawi: Nkhata Bay, Likoma, Blantyre, Chiradzulu, Thyolo, Mwanza, and Neno. DHSS, funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the CDC, worked between 2012 and 2017 to strengthen health service delivery at the district level. 

As Malawi’s population is set to double to 35 million by 2040, demands on the health care system will only grow. With current HIV prevalence of 10.6% and 85% of the population living in rural or hard-to-reach areas of the country, it is especially important to reach Malawians who do not yet know their HIV status so they can start treatment, achieve viral suppression, and minimize the chances of infecting others. By September 2017, the DHSS Project supported approximately 180,000 Malawians in learning their HIV-infected status and 175,000 individuals in starting antiretroviral therapy (ART), leading to more than 150,000 people living with HIV (PLHIV) achieving viral suppression. 

“From the lessons we’ve learned, investing in some key activities will help us to move towards achieving … HIV epidemic control,” said DHSS Project Director Dr. Aziz Abdallah. “We need to support differentiated models of care, including same-day ART initiation as well as mentorship and supervision.”

In addition, best practices used by DHSS included index case testing, provider-initiated testing and counseling, the introduction of health diagnostic assistants and expert clients in diagnostic and counseling task shifting, and creation and support of teen clubs to help retain adolescents in treatment.

“MSH pioneered the family testing day, whereby family members of people living with HIV who were on ART were invited for testing in a health facility, usually on the weekends,” said Nicole Buono, Health Services Branch chief of the CDC in Malawi. “This helped give access to testing for many PLHIV. We will continue to build on this initiative and the successes MSH has made in index testing … and we look forward to continue to learn and build on what was started by MSH.”