Viral suppression (VS) in children has remained suboptimal compared to that in adults. We evaluated the impact of transitioning children weighing < 20 kg to a pediatric formulation of dolutegravir (pDTG) on VS in Malawi. We analyzed routine retrospective program data from electronic medical record systems pooled across 169 healthcare facilities in Malawi supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). We included children who weighed < 20 kg and received antiretroviral therapy (ART) between July 2021–June 2022. Using descriptive statistics, we summarized demographic and clinical characteristics, ART regimens, ART adherence, and VS. We used logistic regression to identify factors associated with post-transition VS. A total of 2468 Children Living with HIV (CLHIV) were included, 55.3% of whom were < 60 months old. Most (83.8%) had initiated on non-DTG-based ART; 71.0% of these had a viral load (VL) test result before transitioning to pDTG, and 62.5% had VS. Nearly all (99.9%) CLHIV transitioned to pDTG-based regimens. Six months after the transition, 52.7% had good ART adherence, and 38.6% had routine VL testing results; 81.7% achieved VS. Post-transition VS was associated with good adherence and pre-transition VS: adjusted odds ratios of 2.79 (95% CI 1.65–4.71), p < 0.001 and 5.32 (95% CI 3.23–9.48), p < 0.001, respectively. After transitioning to pDTG, VS was achieved in most children tested within the first 6 months. However, adherence remained suboptimal post-transition and VL testing at 6 months was limited. Interventions to improve VL testing and enhance ART adherence are still needed in CLHIV on pDTG-based regimens.

The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in the general population in Malawi. We present self-reported adverse events (AE) following the receipt of these vaccines in Malawi as part of a national syndromic surveillance survey. We conducted phone-based syndromic surveillance surveys among adults (≥18 years) with verbal consent. We used secure tablets through random digit dialing to select mobile phone numbers and collected data electronically. Survey questions included whether the respondent had received the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported AE post-COVID-19 vaccination. A total of 11,924 (36.0%) out of 33,150 respondents reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July–December 2021; of those, 65.1% were female. About 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. Higher education level and concern about the safety of COVID-19 vaccines were associated with AE self-report (Adjusted Odds Ratio [AOR] 2.63 [95% CI 1.96–3.53] and 1.44, [95% CI 1.30–1.61], respectively), while male gender and older age were associated with reduced likelihood of AE self-report (AORs 0.81, [95% CI 0.75–0.88], 0.62 [95% CI 0.50–0.77], respectively). Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-reporting of AE following COVID-19 vaccination is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.

Malawi recommended COVID-19 vaccines for adults aged ≥18 years in March 2021. We assessed factors associated with receiving COVID-19 vaccines in Malawi as part of a telephone-based syndromic surveillance survey. We conducted telephone-based syndromic surveillance surveys with questions on COVID-19 vaccine receipt among adults (≥18 years old) upon verbal consent from July 2021 to April 2022. We used random digit dialing to select mobile phone numbers and employed electronic data collection forms on secure tablets. Survey questions included whether the respondent had received at least one dose of a COVID-19 vaccine. We used multivariable analysis to identify factors associated with COVID-19 vaccine receipt. Of the 51,577 participants enrolled; 65.7% were male. Males were less likely to receive the COVID-19 vaccine than females (AOR 0.83, 95% CI 0.80–0.86). Compared to those aged 18–24 years, older age had increased odds of vaccine receipt: 25–34 years (AOR 1.32, 95% CI 1.24–1.40), 35–44 years (AOR 2.00, 95% CI 1.88–2.13), 45–54 years (AOR 3.02, 95% CI 2.82–3.24), 55–64 years (AOR 3.24, 95% CI 2.93–3.57) and 65 years+ (AOR 3.98, 95% CI 3.52–4.49). Respondents without formal education were less likely to receive vaccination compared to those with primary (AOR 1.30, 95% CI 1.14–1.48), secondary (AOR 1.76, 95% CI 1.55–2.01), and tertiary (AOR 3.37, 95% CI 2.95–3.86) education. Respondents who thought COVID-19 vaccines were unsafe were less likely to receive vaccination than those who thought it was very safe (AOR 0.26, 95% CI 0.25–0.28). Residents of the Central and Southern regions had reduced odds of vaccine receipt compared to those in the North (AORs 0.79, (95% CI 0.74–0.84) and 0.55, (95% CI 0.52–0.58) respectively). Radio (72.6%), health facilities (52.1%), and social media (16.0%) were the more common self-reported sources of COVID-19 vaccine information. COVID-19 vaccine receipt is associated with gender, age, education, and residence. It is important to consider these factors when implementing COVID-19 vaccination programs.

The global disruption caused by the SARS-CoV-2 pandemic profoundly affected healthcare systems, particularly impacting People Living with Human Immunodeficiency Virus (PLHIV). This study investigated the repercussions of SARS-CoV-2 infection on access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ARV) in Malawi, emphasizing the critical need to sustain uninterrupted HIV services during health crises. Employing mobile phone-based syndromic surveillance, this study assessed the influence of SARS-CoV-2 on healthcare access for PLHIV across nine districts supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Telephone-based interviews were conducted to analyze demographic factors, challenges encountered in accessing HIV services, and adherence to ARV medication, illuminating the pandemic’s effects on ARV uptake. The findings revealed that approximately 3.9% (n = 852) of 21981 participants faced obstacles in accessing crucial HIV services during the pandemic, resulting in approximately 1.2% (n = 270) reporting multiple missed doses of ARV medication in a particular month. After adjusting for various variables, males exhibited a higher likelihood of service inaccessibility than females (Adjusted Odds Ratio [AOR] = 1.39, 95% CI: 1.20–1.60, p < 0.001). Age also played a significant role, with individuals aged 35–49 years and those aged 50 years or older demonstrating reduced odds of service failure compared with the reference group aged 18–34 years. Only a small proportion of PLHIV reported disruption in HIV care access, which may be because Malawi did not initiate stringent travel restrictions during the SARS-CoV-2 pandemic. Nonetheless, enduring challenges have been observed in retaining younger PLHIV and men in HIV-care settings. Thus, targeted strategies are imperative for effectively engaging and sustaining these populations in HIV care during and after health crises.

Background: Tuberculosis preventive treatment (TPT) is recommended for people living with HIV (PLHIV) to reduce the tuberculosis (TB) incidence in regions with a high prevalence of TB. We evaluated the uptake and completion of TPT among newly initiated antiretroviral therapy (ART) patients in a programme setting in Malawi. Objectives: To describe TPT initiation and completion rates, and explore factors associated with TPT initiation and completion among newly initiated ART patients. Method: We conducted a retrospective cohort study analysing routinely collected data from 10 ART facilities. We included all patients who initiated ART between January 2023 and March 2023, with follow-up for 12 months. We used descriptive statistics to summarise demographic and clinical characteristics, and logistic regression to assess factors associated with TPT initiation and completion. Results: A total of 1289 patients were enrolled; 1015 (78.7%) were eligible for TPT. Of these, 820 (80.8%) initiated TPT; 610 (74.4%) completed treatment. Children (< 10 years), adolescents (10–19 years), patients presenting with WHO HIV clinical stage three or four conditions, and urban residents were less likely to initiate TPT: adjusted odds ratio (aOR) 0.12 (95% confidence interval [CI] 0.06–0.22), aOR 0.30 (95% CI 0.15–0.59), aOR 0.35 (95% CI 0.21–0.60), and aOR 0.56 (95% CI 0.34–0.90), respectively. Patients who received daily isoniazid for 6 months had reduced odds of completing TPT (aOR 0.22; 95% CI 0.11–0.42) compared with weekly isoniazid plus rifapentine for 3 months. Conclusion: High TPT initiation and completion rates were observed among eligible patients initiating ART in Malawi. However, children lag in TPT initiation. Targeted interventions that improve TPT uptake among paediatric patients are required.

Background: Viral suppression (VS) rates in children on antiretroviral therapy (ART) are lower than in adults. We described the effect of enhanced adherence counselling (EAC) on VS among children with high HIV viral load accessing dolutegravir (DTG)-based ART in a programme setting in Malawi. Objectives: This study evaluated the proportion of children with high viral load on DTG-based ART who re-suppressed following EAC and factors associated with VS post-EAC. Method: We included all patients aged < 15 years with a high viral load result (> 1000 copies/mL) after taking DTG-based ART for at least 6 months between January 2022 and March 2023, covering 104 healthcare facilities in Malawi. Descriptive statistics summarised the distribution of demographic and clinical characteristics. Multivariable logistic regression determined the factors associated with VS following EAC. Results: Overall, 1475 participants were enrolled; 884 (59.9%) were aged 10–14 years. A total of 1448 (98.2%) were enrolled in EAC, of whom 787 (54.3%), 308 (21.3%), and 353 (24.4%) completed three, two, and one session(s), respectively. Follow-up HIV viral load results were available for 1091 (74%) participants enrolled in EAC, and 782 (71.7%) achieved VS. Patients from urban areas were less likely to achieve VS post-EAC than those from rural areas (adjusted odds ratio [aOR]: 0.58, 95% confidence interval [CI]: 0.42–0.80). Conclusion: Nearly three-quarters of children with high viral load on DTG-based regimens achieved VS following EAC. Further research on the other contributors of virologic failure among children in Malawi is required.