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Background: In 2015, adolescent girls and young women (AGYW), aged 15-24 years in Sub-Saharan Africa, accounted for 25% of new HIV infections among adults despite being 17% of the adult population. Nationally representative data on HIV for AGYW in Malawi are limited in scope. This analysis describes the burden of HIV among AGYW in Malawi and their progress towards achieving the UNAIDS 90-90-90 targets.
Methods: The Malawi Population-based HIV Impact Assessment (MPHIA), a national household survey, was conducted from November 2015 to August 2016 to measure national HIV incidence and sub-national viral load suppression (VLS). Participants answered questionnaires and provided blood for home-based HIV testing using the national rapid HIV testing algorithm, followed by laboratory-based confirmation using Geenius HIV 1/2 Confirmatory Assay (Bio-Rad). Viral load measurements < 1,000 copies/mL were considered suppressed. Weighted point estimates and survey-adjusted 95% confidence intervals (CIs), calculated using the Jackknife replication method, are presented for the number of young women living with HIV (using population projections from the Malawi National Statistical Office), prevalence, awareness of HIV status, self-reported antiretroviral therapy (ART) status and VLS.
Results: Of 4,592 eligible women, 3,571 (78%) responded to the questionnaire and provided blood. Of those tested, 169 were HIV positive, resulting in a 3.7% prevalence (95% CI: 2.9-4.5); 1.9% (95% CI: 1.2-2.8) in 15-19 year olds (n=38) and 5.2% (95% CI: 3.9-6.6) in 20-24 year olds (n=131). HIV prevalence was significantly greater in urban (6.3%; 95% CI: 4.4-8.2) compared to rural areas (3.0%; 95% CI: 2.1-3.9). Of the 61,855 (95% CI: 48,119-75,593) AGYW estimated to be HIV infected, 58.6% (95% CI: 49.2-68.3) were aware of their HIV positive status; 76.9% (95% CI: 57.6-96.1) of those aware of their status were on ART, and 79.3% (95% CI: 67.6-91.1) of those on ART were virally suppressed. Overall VLS among all HIV positive AGYW was 52.0% (95% CI: 41.0-62.8%).
Conclusions: These results indicate a gap among AGYW in awareness of their HIV positive status, receiving ART and achieving viral suppression compared to the UNAIDS 90-90-90 targets. Concerted efforts are needed to improve prevention, diagnosis, treatment initiation and adherence among AGYW.

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