Key medical figures:
• 75,100 patients on first-line ARV treatment
• 5,900 women enrolled on PMTCT treatment


Malawi is largely dependent on international aid for healthcare. Seventy per cent of general health services and 99 per cent of antiretroviral (ARV) coverage are donor-funded.

Malawi’s HIV rates are among the 10 highest in the world: more than one in 10 people are estimated to be infected. The healthcare system is chronically underfunded and there is a  severe shortage of skilled workers – a 61 per cent vacancy rate for clinical staff. Médecins Sans Frontières (MSF) has therefore been supporting the HIV response, improving care for patients, and also aiming to streng then the existing health system through staff training and technical support, innovative and progressive treatment models, and by implementing operational research.

Chiradzulu programme
The HIV programme based in Chiradzulu district, and decentralised via 10 health centres, had more than 28,000 patients receiving ARV treatment this year. In mid-2013, the first  point-of-care viral load test was installed in a rural health centre, thanks to a UN ITAID grant. This test measures the amount of HIV virus in the blood, which increases when first-line treatment fails, so patients can be switched to a different drug regimen. An MSF study in Chiradzulu showed that 65.8 per cent of people needing ARV treatment were receiving it, and a  population-based survey revealed that there was also a very low level of new infections (0.4 per cent), suggesting that the large distribution of HIV treatment has played a role in reducing transmission

Nsanje project
MSF started providing mentorship and improving health services in Nsanje and Chikhwawa districts in the far south of the country in 2010. In 2013, MSF withdrew from Chikhwawa  and expanded its work in Nsanje, focusing on the needs of specific vulnerable groups. Early treatment through a ‘test and treat approach’ was implemented for sex workers, couples where only one partner had HIV, and HIVpositive breastfeeding women. Prevention of mother-to-child transmission of HIV was also fully integrated in all 14 health clinics. A total of 50 health workers were mentored in 14 sites and 88 per cent of them completed the mentorship programme.

Thyolo programme handover
The scheduled handover of first-line HIV treatment in Thyolo was completed, with the bulk of the HIV services now being delivered by the Ministry of Health. MSF remains in Thyolo to  conduct operational research, to help expand community ARV treatment groups, and to provide technical and clinical services for people in need of advanced or specialised HIV care.

Developing capacity for hard-to-reach rural areas
By the end of 2013, 49 students had enrolled in MSF’s Rural Human Resources for Heath (HRH) Scholarship Programme. With this programme, MSF addresses the shortage of  health workers in the understaffed, hard-to-reach areas of Thyolo, Nsanje and Chikhwawa districts by recruiting local students and paying for their training as mid-level health workers. In  turn, the students agree to work for the health ministry in their home areas for at least five years.

David Chiradzulu
I have been on antiretroviral treatment since February 2002. Two months ago was the first time I  got my viral load measured. Before, I only had my CD4 cells counted. So after more than 11 years, I  am happy to know that my viral load is undetectable and that my treatment is working. I am also  only taking one drug a day now and I feel very good!

No. staff end 2013: 706 | Year MSF first worked in the country: 1986

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