Background: While women in Malawi continue to experience a high burden of HIV infection, implementation of Option B+ since 2011 has led to substantial improvement in increasing access to antiretroviral therapy (ART) for HIV-positive women. This study aimed at describing the progress in women towards achieving the UNAIDS 90-90-90 targets in Malawi.
Methods: The Malawi Population-Based HIV Impact Assessment (MPHIA) was a two‐stage cluster survey of randomly selected households in Malawi. Data collection occurred from November 2015 to August 2016. Participants answered a questionnaire involving reproductive history, PMTCT/option B+, and HIV testing and care. The survey involved collection of blood samples, home-based counseling and testing (HBCT) using the national rapid HIV test algorithm followed by laboratory-based confirmation using Geenius?. Incidence was measured using the Lag-Avidity EIA. Viral load suppression (VLS) was defined as < 1,000 HIV RNA copies/mL. Descriptive analyses were conducted to examine progress towards 90-90-90 parameters in women and accounted for the study design.
Results: Of 12,231 eligible women ages 15 to 64 years, 9,956 (81.4%), women were interviewed and tested. Seventy-six percent (76.3%, 95% Confidence Interval (CI):74.2-78.9) of women reported knowledge of their HIV+ status. Of the women who knew their HIV+ status, 90.0% (95%CI:87.1-92.9) reported being on ART. Of the women who reported ART use, 92.3% (95%CI:90.4-94.2) had achieved VLS. Progress towards 90-90-90 targets also varied by age, see Table. At population level (irrespective of knowledge of HIV and ART status), prevalence of VLS among HIV+ women 15-64 years was 72.9% (95%CI:69.9-75.9); highest among older women but much lower in young women. HIV incidence among women was 0.48% (95%CI:0.20-0.76), which was about 50% greater in women than men (0.25%, 95%CI:0.05-0.46).

Age GroupDiagnosedOn TreatmentVirally Suppressed
 % (95% CI)% (95% CI)% (95% CI)
15-24 years58.7 (48.4-69.0)76.9 (59.0-94.7)79.3 (68.4-90.2)
25-34 years72.6 (67.5-77.8)88.0 (82.0-94.1)94.5 (92.0-97.0)
35-44 years84.8 (81.0-88.5)91.7 (88.5-94.9)91.7 (88.3-95.1)
45-54 years76.4 (68.8-84.0)95.3 (92.3-98.2)93.6 (89.4-97.7)
55-64 years85.1 (76.7-93.5)94.7 (89.3-100.0)95.3 (88.7-100.0)
[90-90-90 Targets by Age Group among Women]

Conclusions: Although women are at greater risk of HIV infection in the reproductive age group, they seem to get into treatment, stay on treatment, and achieve VLS. However, the first 90 was not reached, suggesting that a reasonable number of women are not accessing Malawi''s PMTCT program and further efforts are needed to diagnose and treat these cases; and prevent new infections.