Malawi has a population of about 17 million people. HIV prevalence steadily declined from 12% in 2004 to about 10.6% in 2014. It is estimated about 1 million people are currently living with HIV and of these 100,000 are children less than 15 years (27). ART coverage is lower in children than in adults. By September 2015, estimated ART coverage was 50% (50,533 / 101,000) among children (<15 years) in need of treatment and 68% for adults (27). Viral suppression rates in children are lower (70%) compared with adults (90%), suggesting challenges related to ART adherence and high rates of loss to follow up (28).
National data on ART coverage for adolescents (10–19 years) is limited. However, comparing the 2004 and 2010 Malawi Demographic and Health Surveys, HIV prevalence increased among adolescents age 15–19 years, from 0.4% to 2.7% in boys and from 3.7% to 4.2% in girls (29). Malawi decentralized its delivery of HIV services since March 2016: 653 clinics provide comprehensive HIV services. Like other countries in the region, Malawi faces a significant shortage of staff and task shifting has been adopted to mitigate the shortage. HIV testing services are primarily provided by health surveillance assistants and more recently by a new cadre, the HIV diagnostics assistants, hence leaving ART initiation to medical assistants and nurse technicians. The National Health Accounts and the National AIDS Spending Assessment shows that about two-thirds of the health expenditure and about three-quarters of the HIV expenditure are financed by development partners.
ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.
Training and equiping healthcare providers in Malawi with skills and knowledge in the area of paediatric/ adolescent HIV psychosocial care and counseling.