Maureen Luba Milambe, A 15 Year Review of PEPFAR Support to Malawi: How Has it Succeeded
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October 7, 2019 On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly. There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health. For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
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Maureen Luba Milambe, A 15 Year Review of PEPFAR Support to Malawi: How Has it Succeeded
- 1. A 15 Year Review of PEPFAR Support to Malawi: How has it succeeded Maureen Luba Milambe Africa Region Advocacy Advisor, AVAC Jane Jie Sun Women In Global Health LEAD Fellow Visiting Scientist Harvard Department of Global Health and Population 7th October 2019
- 2. What happens when girls drop out of school? School drop out Early marriages Teen pregnancies Age disparate relationships Victims of Gender based violence Transactional sex Victims of Sexual abuse Increased HIV risk
- 3. FIGURE 7.2 Number of new HIV infections among FIGURE 7.3 Number of new HIV infections among young people young people (aged 15– 24 years), by sex, Global 1990–2018 (aged 15–24 years) by sex, Eastern & Southern Africa 1990–2018 Source: UNAIDS 2019 estimates.
- 4. Age Profile of Recently Infected | Highest % of new infections among youth 13-24 years old (Apr-Aug 2019, N=1,762) 19.4% 17.1% 15.8% 9.7% 12.1% 11.3% 7.3% 8.5% %0.0 5.0% 10.0% 15.0% 20.0% 0 50 100 150 200 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ 0.0% 16.3 % 8.6% 12.5% 6.7% 7.8% 1.6% 4.5% %0.0 5.0% 10.0% 15.0% 0 50 100 150 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ Age RTRI Long term RTRI Recent % RTRI Recent Females Males
- 5. §One of the poorest countries in the world §Total population 18.6 million §HIV prevalence rate 9.8%
- 6. § In relative terms Government health spending higher than the rest of the region – 10.8% against 6.9% regional avearage § In absolute terms Total health expenditure per capita very low US$34 versus US$114 in other sub-Saharan African countries § Limited fiscal space for additional domestic health spending
- 7. 1985 the first HIV case in Malawi Overcrowding facilities By 1999 prevalence rate 16.2%
- 8. >3000 PLHIV on ART
- 10. How has PEPFARs contributed to Malawi's success?
- 11. Over $800 million invested to support the HIV/AIDS response in Malawi over the last 15 years Health systems strengthening; promoting a broad range of HIV prevention, treatment, and care activities; and mitigating the social and economic impact of the disease
- 12. The Game Changing Interventions Implemented To Date
- 15. 2014 Program announced 2015 Malawi listed as one of the DREAMs focus countries 2019 On going implement ation in three districts
- 16. A 53% reduction in new HIV diagnoses among 15-19 year-old adolescent girls and an estimated 30% reduction in new HIV diagnoses among 20- 24 year-olds in the 3 focus districts
- 17. §Malawi faces critical shortage of HRH, §0.51 professional health workers per 1,000 inhabitants, one ninth of WHO requirement to achieve UHC and the SDGs §PEPFAR investment in pre-service training and salary support §Currently supporting 9,902 HCWs at community and facility
- 18. DDE, Unique ID, connectivity specific privilege investments facilitate tracking transfer between sites and facilitating LTFU notifications
- 19. Available in real time high quality and reliable data Accessible to ALL stakeholders
- 20. TLD Transition Voluntary Assisted Partner Notification Recency testing TB Preventive Therapy Annual viral load Champion for Evidence based policies Pre Exposure Prophylaxis
- 22. Where are we with the epidemic?
- 24. 1,066,811 984,533 828,329 756,761 0 200,000 400,000 600,000 800,000 1,000,000 PLHIV Aware On ART Virally Suppressed 92% %84 %91 %95 %95 %95
- 25. What else should be done?
- 26. §DREAMS Expansion §More efforts around HIV prevention, §More HRH support §Sustainability and Increased local ownership of the program