Malawi’s health Ministry taking over HIV care associated with fewer deaths

Malawi’s Ministry of Health began leading advanced HIV disease (AHD) care after previously relying on external partners, and researchers found this change coincided with a decrease in patient deaths.

A study examined outcomes at 22 health facilities in the country’s Central Region, comparing the time before and after the handover. Researchers found that twelve-month mortality decreased from 9.4 percent to 5.5 percent among patients enrolled before and after the Ministry took full leadership.

The evaluation focused on 1,044 patients with advanced HIV, assessing mortality and how consistently patients continued with their care. Data came from patient records covering January 2020 to December 2024, split into a pre-transition period and a post-transition period. Patients qualified for AHD care based on their CD4 count (a measure of immune system health), the severity of their illness, or their age. However, the transition also led to some declines in certain areas of care.

Uptake of CD4 testing dropped significantly, from 80.7 percent to 46.0 percent. Diagnoses of tuberculosis and the use of preventative tuberculosis therapy also decreased. Researchers noted the median age of patients entering AHD care increased during the study period, but clarified this reflected who was eligible for care, not a change in program rules. They cautioned that the study could not definitively prove the handover caused the lower death rate, only that the two events occurred together.