A Decade of Progress in HIV, Malaria, and Tuberculosis Initiatives in Malawi

Objective

Huge investments in HIV, TB, and malaria (HTM) control in Malawi have greatly reduced disease burden. However, the joint impact of these services across multiple health domains and the health system resources required to deliver them are not fully understood.

Methods

An integrated epidemiological and health system model was used to assess the impact of HTM programmes in Malawi from 2010 to 2019, incorporating interacting disease dynamics, intervention effects, and health system usage. Four scenarios were examined, comparing actual programme delivery with hypothetical scenarios excluding programmes individually and collectively.

Findings

From 2010-2019, HTM programmes were estimated to have prevented 1.08 million deaths and 74.89 million DALYs. An additional 15,600 deaths from other causes were also prevented. Life expectancy increased by 13.0 years for males and 16.9 years for females.

The HTM programmes accounted for 24.2% of all health system interactions, including 157.0 million screening/diagnostic tests and 23.2 million treatment appointments. Accounting for the anticipated health deterioration without HTM services, only 41.55 million additional healthcare worker hours were required (17.1% of total healthcare worker time) to achieve these gains. The HTM programme eliminated the need for 123 million primary care appointments, offset by a net increase in inpatient care demand (9.4 million bed-days) that would have been necessary in its absence.

Conclusions

HTM programmes have greatly increased life expectancy, providing direct and spillover effects on health. These investments have alleviated the burden on inpatient and emergency care, which requires more intensive healthcare provider involvement.