Malawi HIV Country Profile: 2016

WHO/HIV/2017.59 Malawi HIV Country Profile: 2016

Demographic and socioeconomic data 90-90-90 progress towards 2020 targets

18.1 million 1 140 US$ Needles distributed per person who inject drugs per year ... 100% Total population (2016) $ GNI per capita, PPP (2015) 100%100%100% UNPOP World Bank 68% 100% Percentage condom use among sex workers with most recent client 85% 634 11.4 % 49% 80% 80%80%80% 70% Maternal mortality per $ Health expenditure, total 80% 66% HIV prevalence among men who have sex with men (%) 17% 100 000 live births (2015) (% of GDP) (2014) 59% World Health Stat., WHO World Bank 60% Estimated ART coverage 60%60%60% HIV prevalence among sex workers (%) 25% 64 years 29 US$ children and adults Life expectancy at birth Health expenditure per 40% (2015-2020) $ capita (2014) 40%40%40% UNPOP World Bank 4.5 0.48 20%20%20%20% Total fertility rate (births Human Development 84% per woman) (2015-2020) Index Value (2015) UNPOP UNPOP 0%0%0%0% 3 441 PLHIVPLHIVPLHIVPLHIV PLHIVPLHIVPLHIV PLHIVPLHIVPLHIVPLHIV Number of births (thou- Estimated % of pregnant women diagnoseddiagnoseddiagnosed receivingreceivingreceiving virallyvirallyvirally diagnosed receiving virally r 900 diagnosed receiving virally r sands) (2015-2020) 400 a living with HIV who received ARVs a ART suppressed e ARTART suppressedsuppressed e UNPOP ARTARTART suppressedsuppressedsuppressed y y for PMTCT ART suppressed r 800 r e

e 350 p

r p

n e

n 700 o p

Estimated number of people newly Estimated number of deaths due to o 300 r s n r s e o e

p 600 r s p

infected with HIV r

AIDS e r

250 e p e p

r p

500 e 120 000 100 000 r s r s p a

l a 200 l l l r s

o 400 a o l d r l 100 000 d a S 80 000 o 150 S e d U 300

U y

S n i n

i 80 000 U

100 e e n c 200 i 60 000 c

r i r i e p c

60 000 n r i 50 100 n a p i a

40 000 i d n d e a i 40 000 e 0 0 M d M e 2010 2011 2012 2013 2014 2015 2016 2010 2011 2012 2013 2014 2015 2016

20 000 M 20 000 [ZDV+3TC+NVP] [150+200+300] [TDF+FTC+EFV] [600+200+300] [TDF+FTC]+[LPV/r] [ZDV+3TC]+[ATV/r] [TDF+3TC]+[ATV/r] 0 0 [TDF+3TC+EFV] [600+300+300] [ZDV+3TC]+[LPV/r] [TDF+3TC]+[LPV/r] 2000 2005 2010 2016 2000 2005 2010 2016 Trend since 2010 Trend since 2010 Elimination of mother-to-child Value Epidemiological HIV data Value [range] transmission (EMTCT) of HIV and syphilis [range] Year Estimated number of people living with HIV 1 000 000 [970 000 - 1 100 000] Antenatal care coverage - at least one visit (%) 95% 2015-2016 Estimated number of children aged 0 to 14 Antenatal care coverage - at least four visits (%) 51% living with HIV 110 000 [91 000 - 120 000] 2011 % of pregnant women with known HIV Estimated number of women (15+) living with HIV 550 000 [520 000 - 590 000] 91% 2015 status Estimated adult (15-49) prevalence 9.2% [8.6% - 9.7%] Antenatal care attendees who were tested 56% 2016 Estimated number of deaths due to HIV 24 000 [20 000 - 31 000] for syphilis (%) Estimated number of children dying due to HIV 4 100 [2 700 - 5 300] Antenatal care attendees who tested positi- 1% 2016 Estimated number of people newly infect- ve for syphilis (%) ed with HIV 36 000 [31 000 - 45 000] Estimated number of children newly infec- Antenatal care attendees who tested positi- 100% 2016 ted with HIV 4 300 [2 200 - 6 200] ve for syphilis and who received benzathine penicillin IM (%) Estimated incidence rate per 1 000 unin- 2.29 [1.96 - 2.86] fected population Reported number of pregnant women living 46 400 2016 with HIV who received antiretrovirals for PMTCT Estimated % of pregnant women living with Antiretroviral therapy (ART) 84% [72% - 95%] 2016 HIV who received antiretrovirals for PMTCT*2 Reported number of people receiving ART 679 000 % of infants born to women living with Estimated ART coverage 66% [62% - 70%] HIV receiving a virological test within two 31% [27% - 36%] 2016 months of birth (EID)*1 Reported number of children receiving ART 53 400 Final mother-to-child transmission rate 1 7.8 Estimated ART coverage (children, 0-14)* 49% [41% - 55%] including breastfeeding period*3 2016 * Tracing indicators for elimination of mother-to-child transmission. A colour scheme (green, orange, red) is used to indicate if the country is on target to meet 2020 targets: ¹90% ²95% ³Less than 5 WHO/HIV/2017.59 WHO/HIV/2017.59 Malawi HIV Country Profile: 2016

Key populations

Needles distributed per person who inject drugs per year ...

Percentage condom use among sex workers with most recent client 85%

HIV prevalence among men who have sex with men (%) 17%

HIV prevalence among sex workers (%) 25%

Median annual price of ARV drug regimens for adults

First line Second line

200 600 year r r 900 e r

400 a a p e

y 500 n y r o 800 r e s e 35r 0150 p

e r p

n e p

n person per year 700 o r p 400 r

o e

300 e r s n p r s p

e o

e s s p 600 r r r s p r a a e r l l e

25l 0

100 l 300 p e p o

o r p

500 d d e

r s r s S p S a

l a 200 U l l U

l r s

o 400

n 200 n a o i i l d

r l d e e a S o c 150 c S

i 50 e i d U

r 300 r

U y

S p p n

i n

100 i U n n

100 e a a e n c i i 200 i c

d d r i r i e e p c

M M e n r i 50 100

n 0 a p i a

i 2010 2011 2012 2013 2014 2015 2016 2010 2011 2012 2013 2014 2015 2016 d n d e a i e 0 0 M d

M [ZDV+3TC+NVP] [150+200+300]mg [TDF+FTC+EFV] [600+200+300]mg [TDF+FTC]+[LPV/r] [TDF+3TC]+[LPV/r] [ZDV+3TC]+[LPV/r] e 2010 2011 2012 2013 2014 2015 2016 2010 2011 2012 2013 2014 2015 2016 M [TDF+3TC+EFV] [600+300+300]mg [TDF+3TC]+[ATV/r] [ZDV+3TC]+[ATV/r] [ZDV+3TC+NVP] [150+200+300] [TDF+FTC+EFV] [600+200+300] [TDF+FTC]+[LPV/r] [ZDV+3TC]+[ATV/r] [TDF+3TC]+[ATV/r] [TDF+3TC+EFV] [600+300+300] [ZDV+3TC]+[LPV/r] [TDF+3TC]+[LPV/r]

National HIV policies and plans

95% 2015-2016 Implementation of national policy on HIV self-testing (HIVST) Policy on HIVST but still not implemented 51% 2011 Treatment initiation threshold children Treat All regardless of age Treatment initiation threshold adults and adolescents Treat All regardless of CD4 count 91% 2015 Implementation of Treat All adults and adolescents Implemented in many (>50%) treatment sites 56% 2016 Dolutegravir (DTG) as part of 1st line ARVs for adults and adolescents DTG introduced in national guidelines (or confirmed plans for 2018) Implementation of lifelong ART to pregnant & breastfeeding women Implemented countrywide 1% 2016 Implementation of national policy on viral load monitoring Fully implemented Completion of HIV services cascades Completed a national HIV cascade 2016 100% Adaptation of WHO Key Population guidelines in national plans Partially National M&E plan or strategy for HIV Yes, but not updated in the past two years 46 400 2016 Method to de-duplicate key data (i.e. unique identifiers) No

84% [72% - 95%] 2016 Nationally-representative quality assessment of facility-level ART data Yes

31% [27% - 36%] 2016

7.8 2016 Sources: Global AIDS Monitoring (UNAIDS/WHO/UNICEF), Spectrum estimates (UNAIDS/WHO) and WHO HIV Country Intelligence Tool, 2017 * Tracing indicators for elimination of mother-to-child transmission. A colour scheme (green, orange, red) is used to indicate if the country is on target to meet 2020 targets: ¹90% ²95% ³Less than 5