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Malawi Operational Plan COP16 Strategic Direction Summary

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Malawi Operational Plan COP16 Strategic Direction Summary July 1, 2016 Malawi Operational Plan COP16 Strategic Direction Summary July 1, 2016 1 July 1, 2016 Table of Contents Goal Statement ..................................................................................................................................4 1.0 Epidemic, Response, and Program Context ..............................................................................5 Figure 1.1.1 Distribution of HIV prevalence by age and sex ..................................................................5 Figure 1.1.2 HIV Prevalence and PLHIV Population Density ................................................................6 Table 1.1.1 Key National Demographic and Epidemiological Data ........................................................9 Table 1.1.2 Cascade of HIV diagnosis, care and treatment (12 months)* ............................................ 11 1.2 Investment Profile ...................................................................................................................... 11 1.3 National Sustainability Profile ..................................................................................................... 14 1.4 Alignment of PEPFAR investments geographically to disease burden ........................................... 15 1.5 Stakeholder Engagement ............................................................................................................ 18 2.0 Core, Near-Core and Non-Core Activities ...................................................................... 19 3.0 Geographic and Population Prioritization ......................................................................... 20 Geographic Prioritization: ................................................................................................................ 20 Population Prioritization: ................................................................................................................. 23 3.3.Voluntary Medical Male Circumcision (VMMC) ........................................................................... 24 4.0 Program Activities for Epidemic Control in Scale-up Locations and Populations ..................... 24 4.1 Targets for Scale-up locations and populations ............................................................................ 25 Program Area Summaries ................................................................................................................. 30 4.2 Priority population prevention .................................................................................................... 30 Adolescent Girls and Young Women (AGYW): .................................................................................... 31 Key Populations: ................................................................................................................................. 32 Reaching Men ..................................................................................................................................... 33 Prisons ................................................................................................................................................. 34 Condom Programming ........................................................................................................................ 34 Gender Based Violence and Stigma and Discrimination ..................................................................... 35 4.3 Voluntary Male Medical Circumcision (VMMC) ........................................................................... 36 4.4 PMTCT ....................................................................................................................................... 38 4.5 HIV Testing and Counselling ..................................................................................................... 39 4.6 Facility and Community Based Treatment, Care and Support ....................................................... 41 4.7 TB/HIV ..................................................................................................................................... 44 4.8 Adult ART ................................................................................................................................ 45 2 July 1, 2016 4.9 Pediatric ART ........................................................................................................................... 47 4.10 Orphans and Vulnerable Children ............................................................................................. 50 5.0 Program Activities in Sustained Support Locations and Populations ............................. 52 5.1 Package of services in sustained support locations and populations ............................................. 52 5.1 Maintenance package of services in other locations and populations ......................................... 52 6.0 Program Support Necessary to Achieve Sustained Epidemic Control ............................................ 52 6.2 Critical Systems Investments for Achieving Priority Policies ......................................................... 61 6.3 Proposed system investments outside of programmatic gaps and priority policies. ...................... 65 7.0 Staffing Plan............................................................................................................................ 67 Appendix A Core, Near Core, Non-Core .......................................................................................... 69 Table A.1 Program Core, Near-core, and Non-core Activities for COP 16 ............................................ 69 Table A.2 Program Area Specific Core, Near-core, and Non-core Activities for COP 15 ........................ 72 APPENDIX B B.1 Planned Spending in 2016 ....................................................................................... 79 Appendix C. Acronym ............................................................................... Error! Bookmark not defined. Appendix D Humanitarian Crisis ....................................................................................................... 83 Appendix E VMMC Demand Creation Strategy .................................................................................. 85 Appendix F Consideration for Differentiated Care ............................................................................ 86 3 July 1, 2016 Goal Statement Despite Malawi being among the poorest countries in the world, ranking 174 out of 187 on the UN Human Development Index, the country is a recognized leader for promoting a public health approach to address the significant national HIV/AIDS epidemic. Beyond having designed and been the first to implement Option B+, Malawi is also the first country to include Test and Start and the 90-90-90 objectives for epidemic control within its National Strategic Plan, initiating rollout in mid- 2016. This commitment to adopt bold strategies has brought Malawi closer towards epidemic control: there are approximately 34,000 new HIV infections compared to the estimated 67,000 HIV- related deaths annually (Spectrum 2014). Reaching saturation (80% coverage) of HIV+ people on antiretroviral treatment (ART), however, remains a major challenge in the context of an increasingly fragile health system. Malawi has made significant progress in expanding ART access through task shifting and decentralization, but treatment scale-up in the highest burden areas is hampered by one of the severest health worker shortages in Africa, with only 28 nurses and 2 physicians per 100,000 population and a crumbling health facility infrastructure. Reaching missed populations, including men, will also require new strategies to accelerate ART coverage over the next two years. Consistent with the principle that USG must maximize investments in areas of high HIV burden, the PEPFAR/Malawi program prioritized support to the Ministry of Health in 427 priority sites representing 60 percent of total sites in the country covering 88% of ART patients and HIV burden. This focused approach, which started in COP 2014 and was refined in COP15 is projected to result in 10 of 28 districts reaching 80% ART saturation by 2017, of which 6 are within the 10 scale up districts; by FY 18 half the districts (14 of 28) in Malawi, comprising 77% of the estimated PLHIV, will have reached saturation including Blantyre and Lilongwe. To achieve these targets, COP16 outlines an even more focused approach with additional aggressive interventions in the three highest HIV burdened districts (Lilongwe, Blantyre, and Zomba) and more intensive and targeted efforts in the remaining seven scale-up districts. Eighteen1 districts will receive sustained PEPFAR support, a shift from 14 in COP 2015. COP16 outlines strategies for increased and targeted HIV testing; the roll out of differentiated care models to enhance efficiency and quality, and more active measures to improve adherence, retention in treatment, and viral suppression. There is an additional focus on community-based service delivery models to facilitate the decongestion of high burden facilities and to more effectively reach men and others who are not actively seeking services at health facilities. Saturation targets cannot be achieved through these programmatic interventions alone. Investment in health infrastructure and the health workforce, focused on the three highest HIV burdened districts, will be critical. PEPFAR/Malawi is submitting a supplementary request with this COP submission to address these challenging bottlenecks
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