Curtains come down on MSF-funded HIV/AIDS project in Malawi

MALAWI— Médecins sans Frontières (MSF) in an official statement announced that it has closed its HIV/AIDS project in Malawi after 25 years.

MSF popularly known as Doctors without Borders, first began its HIV/AIDS prevention and control activities in Malawi in 1994 in the district of Mwanza before expanding to Chiradzulu in 1997, where 20 percent of the district’s adult population was estimated to be HIV-positive.   

In August 2001 MSF started a program to provide free access to Anti-Retroviral Therapy (ART) at Chiradzulu’s district hospital, the first free ART program in the country.

Before this date, no HIV treatment was available in the country, and medical action regarding people suffering from AIDS was limited to preventing and treating opportunistic infections.

According to UNAIDS, some 86,000 people died of AIDS-related causes in Malawi in 2001.  

Fred Minandi, a retired farmer, proudly recalls that he was the fourth patient to receive ART in the Chiradzulu project on 16 August 2001 at the age of 41. 

“In those days (1990s-2000s) it was very bad, people were dying. I lost my brother and my sister to AIDS. When I was sick, I had no hope. At that time no one was receiving ART until MSF began providing it,” Minandi explained.

The farmer recalled that in 1999, he went for an HIV test at Chiradzulu district hospital and more so since he was not working anymore and had been suffering from opportunistic infections since 1997.

Unfortunately, he tested positive for the virus, but he met with MSF counselors who told me they were going to begin dispensing ART.

“I was lucky to be one of the first patients to receive treatment. After a month, I was able to start work again,” Minandi acknowledges.

A story of courage and hope in a dark time

MSF reports that the work the project has done paved the way to advocate for cheaper drug prices and ensure access to ART in low-income countries.

Additionally, it proved it was possible to tackle HIV in poor rural settings and that patients would comply with the strict HIV treatment routine, an idea fraught with cynicism at the time.

In July 2002, Minandi was invited to speak at the 14th International Conference on HIV/AIDS in Barcelona, where MSF’s presentation on “Access to ART in MSF programs” included the Chiradzulu experience. 

By the end of 2003, more than 2,000 patients were on ART in the Chiradzulu program, at an average rate of 200 new patients per month, showing clinical results comparable to those found in high-income countries. 

As the years went by, scaling up the number of patients receiving ART was made possible by simplifying treatment approaches, decentralizing care to peripheral healthcare facilities, and task-shifting certain tasks from medical to para-medical staff.

Additionally, advances in treatment strategies also allowed patients in stable condition who had been on treatment for at least a year to have their medical consultations once every six months instead of every two to three months.

A continuum of care from testing to treatment interventions

The collaboration between MSF and the Ministry of Health, along with this model of decentralization and task-shifting, contributed to shaping policies and guidelines in Malawi on the care and treatment of people living with HIV. 

By 2009, every health structure in the Chiradzulu district could provide a range of services for HIV/AIDS patients, from testing to prevention of mother-to-child transmission (PMTCT) and treatment of Tuberculosis (TB) co-infected patients.

In 2013, an MSF study in the district showed that 65.8 percent of people needing ART were receiving the appropriate medicines, and a population-based survey revealed that there was also a very low level of new infections (0.4 percent), suggesting that the large provision of HIV treatment had played a role in reducing transmission.

Such progress was made possible by the partnership between MSF and local health authorities and by the patients themselves.

From 2017 to 2011, MSF started dedicated Saturday “Teen clubs” offering HIV care, follow-up, sexual and reproductive health services, and psychological and social support to teenagers living with HIV.

Attendance at these clubs provided a safe, friendly space where teenagers could also benefit from peer support, showed enhanced adherence to treatment, and contributed to a patient’s overall well-being.

For many of these adolescents, attending “Teen clubs” helped them transition from being overwhelmed by a condition they struggle to make sense of to being better prepared to tackle it.

In 2019, as many as 9,200 adolescents attended the clubs in the Chiradzulu district. 

Malawi continues to fight HIV/AIDS, striving the 95-95-95

Malawi has one of the highest HIV prevalence rates in the world, with 990,000 people (UNAIDS, 2021) living with the virus out of a population of nearly 20 million.

Projects such as the one in Chiradzulu set a benchmark in Malawi for HIV care.

In collaboration with MSF and other partners, the country scaled up HIV prevention and treatment programs resulting in great strides.

UNAIDS reports that of 990,000 people living with HIV in Malawi, 93 percent know their status, 91 percent are on ART, and 85 percent have suppressed viral loads, and Malawi has the potential to get to UNAIDS goal of 95-95-95 by 2025.

The MSF notes that overall, 55,000 people who tested positive for HIV were enrolled in the Chiradzulu cohort between 2001 and the closure of the project in 2023.

After over 20 years of collaboration with MSF, Chiradzulu district health authorities and their partners fully took over all patients and activities between 2022 and 2023, ensuring the continuity of HIV treatment and care. 

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