Leave No One Behind and HIV treatment coverage in Malawi

Background

"Leave no one behind" is the 2030 SDG Agenda. It expresses all UN Member States' resolve to end poverty in all its forms, including exclusion, and reduce inequities and vulnerabilities. According to the 2020 Malawi Population-Based HIV Impact Assessment (MPHIA), the HIV prevalence among adults aged 15–64 is 8.9%. The MPHIA also reveals that Malawi has met the second and third 95-95-95 benchmarks in advance of the target date of 2025, which demonstrates the efficacy of the treatment programmes that are in place in the country. An in-depth investigation into age and sex strata reveals a significant variation in HIV treatment uptake. Furthermore, the number of new HIV infections in babies who have been exposed to HIV has stayed in the thousands for the past five years, which doesn't match the UNAIDS 95-95-95 goal. 

Method 

We used HIV programme data reported through the district health information system for the year 2021. We conducted a descriptive analysis of ART coverage using STATA version 14.1. 

Result 

We calculated ART coverage over time by gender and age group. We also estimated ART coverage differences and ratios. ART guidelines have evolved from "treating the sickest" to "treating all". ART coverage increased from under 2.4% in 2003 to 52.2% in 2015 and 89% in 2021. There have been successes in increasing ART coverage in all populations. However, progress varies by gender and age. There is inequity in ART coverage: women (94%) versus men (81%), and adults (90%) versus children (76%). This inequality has widened over time, and even with expanded ART eligibility criteria. 

Conclusion 

At the global, regional, and national levels, ART coverage has increased for all population categories. Even in an era when countries are on the verge of epidemic control, gains have not been equally distributed by gender. In particular, males and pediatrics are still being left behind. In resource-constrained environments, universality policies may exacerbate inequalities unless countries take safeguards and "put the last first" in order to ensure no one is truly being left behind.