Background: Although Malawi has a generalized epidemic, previous studies have shown that the prevalence varies widely by geography, gender and other socio-economic indicators. We recently conducted a survey to measure national and subnational prevalence and viral load suppression in Malawi to understand the progress in controlling the epidemic.
Methods: Malawi conducted a Population-based HIV Impact Assessment survey between November 2015 and August 2016, stratified by seven geographical zones (Central East, Central West, and Lilongwe City in the Centre, Blantyre City, South East, and South West in the South and North). This household level survey assessed HIV prevalence in 0-64 year olds and viral load suppression in 15-64 year olds. The estimates and confidence intervals accounted for the survey design. Home-based HIV rapid testing using the national algorithm and Geenius supplemental test for confirmation at satellite labs were conducted. HIV positive samples were centrally tested for viral load suppression and recency of infection using LAg-Avidity EIA. Viral load suppression was defined as < 1,000 HIV RNA copies/mL.
Results: The weighted national HIV prevalence among 15-64 year olds was 10.6% [females (12.8%) and males (8.2%)]. By region, HIV prevalence was highest in the South particularly Blantyre City (18.2%) and lowest in Central East (5.3%) and Central West (5.8%). HIV prevalence in the Lilongwe City (11.8%) was higher than the other two zones in the Centre. Blantyre City had both the highest prevalence and the lowest viral load suppression among adults living with HIV, as seen in table.

ZoneHIV Prevalence % (95% C.I.)% HIV Population Virally suppressed
North7.3 (5.8-8.7)66.9 (60.7-73.1)
Central-East5.3 (4.0-6.6)63.7 ( 51.1-76.3)
Central-West5.8 (4.9-6.8)70.4 (63.0-77.9)
Lilongwe City11.8 (10.4-13.1)65.5 (60.3-70.7)
South East15.6 (13.4-17.8)68.8 (62.3-75.3)
South West15.9 (14.0-17.8)70.3 (65.4-75)
Blantyre City18.2 (16.4-19.9)59.5 (53.6-65.5)
Total10.6 (9.9-11.2)67.6 (65.0-70.2)
[Geographical distribution of HIV indicators in Mal]

Conclusions: The HIV epidemic in Malawi continues to show geographical variation and gender disparities with the Southern Region being the most affected and with some of the largest gaps in achieving the viral load suppression target. This suggests that the HIV program in Malawi needs strengthening in the Southern Region particularly Blantyre City.

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