Worldwide in 2014, 36.9 million people are living with HIV. Of these, an estimated 54% are aware of their status and by March 2015, 15 million people were receiving antiretroviral care. Malawi has been one of the hardest hit countries by the HIV epidemic. Current estimates propose 1,100,000 Malawians are living with HIV in 2014, with over half a million (552,808) alive on ART (2,3). The adoption of the UNAIDS 90: 90: 90 targets in 2014 (90% of people living with HIV should know their status, 90% who know their status should be on ART, 90% of those on ART should be virologically suppressed) have been mirrored within the Malawian National Strategic plan (NSP) and concretely mean that 801,900 (73%) of all PLHIV should be virologically suppressed on ART.
Malawi has already embraced decentralisation, task shifting of HIV testing and counselling (HTC) and HIV care, and in most instances, is able to provide a 3 month drug supply. Service intensity however has not been systematically addressed. To achieve the 90-90-90 targets in a health system that has limited human resources and whose clinics are already overburdened, high impact interventions must be identified at each step of the HIV prevention, care and treatment cascade and linkages between the facility and community maximised.