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Malawi National Strategic Plan for HIV and AIDS 2015

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Malawi National Strategic Plan for HIV and AIDS 2015 2015 - 2020 National Strategic Plan for HIV and AIDS i | Page ii | Page © 2014 National AIDS Commission P.O. Box 30622 Lilongwe 3 Malawi Telephone: +265 (1) 770 022 Fax: +265 (1) 776 249 Email: [email protected] Website: www.aidsmalawi.org.mw All rights reserved The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The National AIDS Commission encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request to the Executive Director, National AIDS Commission. iii | Page DEFINITION OF TERMS AND CONCEPTS Adherence Adverse drug events Community Systems Health System Health System Strengthening Key Population Mentoring Public Health Approach Task-shifting Vulnerable Population ABBREVIATIONS AND ACRONYMS AIDS: Acquired Immune-Deficiency Syndrome ART: Antiretroviral Therapy CHAM: Christian Health Association of Malawi CSO: Civil Society Organization CSS: Community Systems Strengthening DAC: District AIDS Committee EHP: Essential Health Package EID: Early Infant Diagnosis EMHS: Essential Medicines and Health Supplies EWI: Early Warning Indicators FBO: Faith Based Organization FTE: Full Time Equivalent HIV: Human Immune Deficiency Virus HSA: Health Surveillance Assistant HSS: Health Systems Strengthening HTC: HIV Testing and Counselling Ihris: Human Resources Information System KP: Key Population KVP: Key and Vulnerable Populations MoH: Ministry of Health MTCT: Mother to Child Transmission M&E: Monitoring and Evaluation NAC: National AIDS Commission NGO: Non-Governmental Organization NSP: National Strategic Plan OVC: Orphan and Vulnerable Children PHDP: Positive Health, Dignity and Prevention PLHIV: People Living with HIV PMTCT: Prevention of Mother to Child Transmission POC: Point of Care PSM: Procurement and Supply Chain Management QI: Quality Improvement SBCC: Social Behavioural Change Communication TMA: Total Market Approach TWG: Technical Working Group VHC: Village Health Committee VMMC: Voluntary Medical Male Circumcision iv | Page Table of Contents 1 INTRODUCTION AND BACKGROUND ________________________________________________________ 1 1.1 INTRODUCTION ___________________________________________________________________________ 1 1.2 VISION AND MISSION _______________________________________________________________________ 2 1.3 REGIONAL AND GLOBAL COMMITMENTS _______________________________________________________ 2 1.4 THE NSP REVISION RATIONALE _______________________________________________________________ 2 1.4.1 THE NSP REVISION PROCESS _______________________________________________________________ 3 1.4.2 DESK REVIEW ___________________________________________________________________________ 3 1.4.3 CONSULTATIONS ________________________________________________________________________ 4 1.4.4 TECHNICAL WORKING GROUPS (TWGs) ______________________________________________________ 4 1.4.5 STEERING COMMITTEE (SC) ________________________________________________________________ 4 2 GUIDING PRINCIPLES OF THE 2015-2020 NSP _________________________________________________ 5 2.1 APPLICATION OF AN INVESTMENT APPROACH ___________________________________________________ 5 2.2 FOCUS ON EVIDENCE-BASED INTERVENTIONS FOR MAXIMUM IMPACT _______________________________ 5 2.3 IMPROVED TARGETING OF CRITICAL INTERVENTIONS TO KEY AND VULNERABLE POPULATIONS ____________ 5 2.4 QUALITY IMPROVEMENT (QI) ________________________________________________________________ 5 2.5 SERVICE INTEGRATION ______________________________________________________________________ 6 2.6 MULTI-SECTORAL INCLUSION ________________________________________________________________ 6 2.7 COMMUNITY ENGAGEMENT _________________________________________________________________ 6 2.8 HUMAN RIGHTS ___________________________________________________________________________ 7 2.9 GENDER _________________________________________________________________________________ 7 3 COUNTRY CONTEXT AND EPIDEMIOLOGY ____________________________________________________ 8 3.1 HIV PREVALENCE __________________________________________________________________________ 8 3.2 HIV INCIDENCE ____________________________________________________________________________ 9 3.3 FACTORS INFLUENCING HIV TRANSMISSION IN MALAWI __________________________________________ 12 3.4 COMBINATION PREVENTION ________________________________________________________________ 17 4 KEY CHANGES IN THE NSP 2015-2020 ______________________________________________________ 18 4.1 ELIMINATION OF HIV: REFOCUSING THE NSP AROUND THE 90-90-90 TARGETS ________________________ 18 4.2 TARGETED HIV PREVENTION ACTIVITIES IN KEY AND VULNERABLE POPULATIONS ______________________ 19 4.3 NATIONAL LEVEL COORDINATION AND PROGRAM MANAGEMENT __________________________________ 19 5 NSP OBJECTIVE 1: 90% OF PLHIV KNOW THEIR STATUS ________________________________________ 20 5.1 ROUTINE TESTING FOR HIV _________________________________________________________________ 20 5.1.1 PRIORITY SETTINGS _____________________________________________________________________ 20 5.1.2 ADDITIONAL STAFF TO CONDUCT PROVIDER INITIATED TESTING AND COUNSELING (PITC) _____________ 21 5.1.3 DIAGNOSING AND TREATING HIV IN PEOPLE WITH PRESUMPTIVE AND DIAGNOSED TB, INCLUDING DRUG-RESISTANT TB ___________________________________________________________________________ 21 v | Page 5.2 TARGETED OUTREACH TESTING FOR KEY AND VULNERABLE POPULATIONS ___________________________ 21 5.3 SELF-TESTING ____________________________________________________________________________ 23 5.4 PEDIATRIC TESTING _______________________________________________________________________ 23 5.5 CONFIRMATORY TESTING __________________________________________________________________ 24 6 NSP OBJECTIVE 2: 90% OF KNOWN HIV-POSITIVES ARE INITIATED ON ART ________________________ 25 6.1 IMPROVE LINKAGES BETWEEN HIV TESTING TO ART _____________________________________________ 25 6.2 ELIMINATE DIAGNOSTIC HURDLES FOR EARLY ART _______________________________________________ 26 6.3 CONTINUE ART SCALE-UP __________________________________________________________________ 27 6.4 PREVENT MOTHER-TO-CHILD TRANSMISSION OF HIV ____________________________________________ 28 6.4.1 PMTCT PRONG 1: REDUCE HIV INCIDENCE AND PREVALENCE IN WOMEN OF CHILDBEARING AGE _______ 29 6.4.2 PMTCT PRONG 2: REDUCE UNPLANNED OR UNINTENDED PREGNANCIES AMONG HIV+ WOMEN _______ 29 6.4.3 PMTCT PRONG 3: INCREASE ART COVERAGE AMONG HIV INFECTED PREGNANT AND BREASTFEEDING WOMEN _______________________________________________________________________ 30 6.4.4 PMTCT PRONG 3: INCREASE INFANT NVP PROPHYLAXIS COVERAGE _______________________________ 30 6.4.5 PMTCT PRONG 4: CARE AND SUPPORT FOR HIV-INFECTED WOMEN AND THEIR FAMILIES _____________ 30 6.5 PEDIATRIC ART ___________________________________________________________________________ 30 7 NSP OBJECTIVE 3: 90% OF PATIENTS ON ART ARE RETAINED IN CARE ____________________________ 32 7.1 PUBLIC EDUCATION _______________________________________________________________________ 32 7.2 OPPORTUNISTIC INFECTIONS (OIs) ___________________________________________________________ 32 7.3 ADDRESS HIV/TB CO-INFECTION _____________________________________________________________ 33 7.3.1 INTENSIFIED CASE FINDING _______________________________________________________________ 33 7.3.2 ISONIAZID PREVENTIVE THERAPY (IPT) ______________________________________________________ 34 7.3.3 TB INFECTION CONTROL _________________________________________________________________ 34 7.3.4 TB/HIV integration ______________________________________________________________________ 34 7.4 FACILITY-BASED ADHERENCE SUPPORT ________________________________________________________ 34 7.5 COMMUNITY-BASED CARE AND SUPPORT _____________________________________________________ 35 7.6 HIV-EXPOSED INFANT CARE AND FOLLOW UP __________________________________________________ 35 7.7 COMMUNITY-BASED ACTIVITIES _____________________________________________________________ 36 7.7.1 MOBILISING AND ENGAGING COMMUNITY LEADERS ___________________________________________ 36 7.7.2 REVITALIZING OF THE VILLAGE HEALTH COMMITTEES __________________________________________ 36 7.7.3 COMMUNITY NETWORKS, LINKAGES, PARTNERSHIPS AND COORDINATION _________________________ 36 7.7.4 STRENGTHENING DISTRICT, REGIONAL AND NATIONAL LEVEL PLANNING AND COORDINATION MECHANISMS ________________________________________________________________________________ 36 7.7.5 IMPROVE AVAILABILITY, USE AND QUALITY OF COMMUNITY-BASED HIV SERVICES ___________________ 37 7.7.6 IMPROVE MONITORING AND REPORTING ON COMMUNITY-BASED HIV SERVICES ____________________ 37 7.8 NUTRITION ______________________________________________________________________________ 37 7.9 SOCIAL AND ECONOMIC PROTECTION FOR ORPHANS AND VULNERABLE CHILDREN ____________________ 38 vi | Page 8 REDUCE NEW INFECTIONS AMONG KEY AND VULNERABLE POPULATIONS ________________________ 39 8.1 VOLUNTARY MEDICAL MALE CIRCUMCISION ___________________________________________________ 41 8.1.1 COUNTRY IMPLEMENTATION _____________________________________________________________ 41 8.2 BLOOD SAFETY ___________________________________________________________________________ 42 8.3 TREAT SEXUALLY TRANSMITTED INFECTIONS ___________________________________________________ 43 8.3.1 NATIONAL
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