An Advanced HIV Disease Differentiated Care Model in Malawi

Overview

Advanced HIV Disease in Malawi

In Malawi, deaths among people living with HIV began to plateau in 2016.1 Among people living with HIV in Malawi, over 40% have a CD4 < 200, meeting the criteria for advanced HIV disease (AHD).1 Further, 11.7% of those newly initiated onto antiretroviral therapy (ART) presented with AHD in 2019.2 These trends clearly indicated that despite significant national commitment and widespread availability of ART, the current national strategy was not adequately addressing the needs of people living with HIV (PLHIV) with AHD.

The Advanced HIV Disease Differentiated Care Model in Malawi

To address this, the Ministry of Health, CDC Malawi, and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), through support from the Bill and Melinda Gates Foundation, joined together to support the national scale-up of a refined package of AHD care, and to establish an AHD-focused quality improvement (QI) collaborative. The project launched in October 2020 across seven districts in Malawi, three of which were existing EGPAF-supported districts; the other four were districts served by other PEPFAR implementing partners. Lead by dedicated AHD focal points and district ART coordinators at the district health authority (DHA), EGPAF and other partners, including facility-based QI teams, closely collaborated to ensure that the needed activities were implemented with fidelity and closely monitored.

Implementation Design

The project model made investments in several areas in order to:

• Overcome challenges in access and availability
• Improve diagnostic access and efficiencies within the clinics
• Improve patient flow processes across the various service delivery points (inpatient, outpatient, and ART clinics)
• Improve capacity of health teams to screen, diagnose, and treat with intensive trainings, job aids, and systematic on-site mentorship
• Provide accelerated services through Quality Improvement activities targeted towards AHD screening, diagnosis of opportunistic infections (OIs), treatment of OIs, and viral load suppression
• Improve patient literacy, patient quality of care, and support services
• Invest in data systems to support service delivery and rapid adaptations to continuously refine the models of care