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Introduction
Education
February 2009 - May 2013
Publications
Publications (40)
Background
Age-mixing (age-disparate [5–9 years difference] and intergenerational [≥ 10 years difference]) partnerships are hypothesized drivers of HIV in adolescent girls and young women (AGYW; 15–24 years). These partnerships are often associated with increased gender inequities which undermine women’s agency and assertiveness. We assessed whethe...
Background:
In 2014, UNAIDS set the goal of ending the AIDS epidemic by 2030 through the achievement of testing and treatment cascade targets. To evaluate progress achieved and highlight persisting gaps in HIV epidemic control in Malawi, we aimed to compare key indicators (prevalence, incidence, viral load suppression, and UNAIDS 95-95-95 targets)...
To determine early COVID-19 burden in Malawi, we conducted a multistage cluster survey in 5 districts. During October-December 2020, we recruited 5,010 community members (median age 32 years, interquartile range 21-43 years) and 1,021 health facility staff (HFS) (median age 35 years, interquartile range 28-43 years). Real-time PCR-confirmed SARS-Co...
Objectives:
In Malawi, a recent infection testing algorithm (RITA) is used to characterise infections of persons newly diagnosed with HIV as recent or long term. This paper shares results from recent HIV infection surveillance and describes distribution and predictors.
Setting:
Data from 155 health facilities in 11 districts in Malawi were poole...
Background
Information on HIV drug resistance (HIVDR) prevalence in people newly diagnosed with HIV is limited. We implemented a cross-sectional study to estimate HIVDR prevalence among pregnant women recently infected with HIV in Malawi.
Methods
The HIVDR study was nested within a routine antenatal clinic (ANC) sentinel surveillance survey. Dried...
Following publication of the original article [1], the authors identified an error in the affiliations stated for the last author, Salem Gugsa. At the time of the manuscript development, the author’s affiliation was assigned to 3 instead of 4. The affiliations assignment is corrected in the author list of this Correction article and the original ar...
Background
The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities.
Setting
At 23 health facilities in Blantyre District, healthcare workers (HCWs) were trained to conduc...
Persons infected with HIV are more likely to transmit the virus during the early stages (acute and recent) of infection, when viral load is elevated and opportunities to implement risk reduction are limited because persons are typically unaware of their status (1,2). Identifying recent HIV infections (acquired within the preceding 12 months)* is cr...
Introduction
Late diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015–2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmis...
Background:
Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression.
Methods:
In half of the surveyed households, children ages ≥18 mo...
Nationally representative household surveys of the general population can provide critical assessments of the status of HIV epidemics and the impact of national HIV programs. With lessons learned from earlier surveys, PEPFAR has supported HIV-focused surveys in high burden countries to measure known HIV status, access to HIV treatment, and viral su...
Background: The population-based HIV impact assessment (population-based HIV impact assessments) surveys are among the first to estimate national adult HIV incidence, subnational prevalence of viral load suppression, and pediatric HIV prevalence. We summarize the survey methods implemented in Zimbabwe, Malawi, and Zambia, as well as response rates...
Introduction: The global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months.
Methods: We analysed data from the population-based HIV impact assessment (PHIA) surveys...
Introduction: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a target of ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) to have viral load suppression (VLS). We examined factors associated with nonsuppressed viral Load (NVL).
Methods: We included PLHIV receiving ART aged 15-59 years from Eswatini, Les...
: Exposure of infants to antiretroviral drugs for prevention of mother-to-child transmission can induce resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Data from nine national surveys of pretreatment drug resistance in children newly diagnosed with HIV show high levels of resistance to NRTIs included in first-line anti...
Objectives
Achieving the Sustainable Development Goals will require data-driven public health action. There are limited publications on national health information systems that continuously generate health data. Given the need to develop these systems, we summarised their current status in low-income and middle-income countries.
Setting
The survey...
Background
No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities.
Objective
To understand the prevalence of chronic r...
Study questionnaire.
This is the text version of the study questionnaire that was uploaded onto smartphones.
(DOCX)
Health passport data.
This is the Excel spreadsheet that contains the diagnostic data that were extracted from the health passports.
(XLS)
Dataset of reported symptoms.
This is the Excel spreadsheet that contains the minimal dataset collected in responses to the study questionnaire.
(XLSX)
Background
The poor face barriers in accessing services for tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) disease. A cluster randomised trial was conducted to investigate the effectiveness of engaging unpaid informal providers (IPs) to promote access in a rural district. The intervention consisted of training unpaid IPs in TB and HIV di...
Trial data for ART initiation.
(DTA)
Trial data for HIV testing.
(DTA)
Completed CONSORT 2010 checklist.
(DOC)
Trial data for TB treatment inititation.
(DTA)
Sample size determination using simulation and random effects modelling.
(DOCX)
In developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis. Chronic airways disease has presentations that overlap with tuberculosis. However, chronic airways disease is often unrecognised due to a lack of diagnostic services. Within developing countries, referral systems at p...
Despite great efforts to control Tuberculosis (TB), progress is compromised by low adherence to medication, leading to prolonged duration of infectiousness and continued transmission. Investigating low adherence is of high importance from TB programmatic perspective. Though data on actual days of missed treatment exist, the effect of such on TB cur...
Background
Early access to tuberculosis diagnosis and treatment remains a challenge in developing countries. General use of informal providers such as storekeepers is common. The aim of this study was to determine the effectiveness and acceptability of a storekeeper-based referral system for TB suspects in urban settings of Lilongwe, Malawi.Methods...
In 2004, Malawi began scaling up its national antiretroviral therapy (ART) program. Because of limited treatment options,
population-level surveillance of acquired human immunodeficiency virus drug resistance (HIVDR) is critical to ensuring long-term
treatment success. The World Health Organization target for clinic-level HIVDR prevention at 12 mon...
Within countries, poorer populations have greater health needs and less access to good medical care than better-off populations. This is particularly true for tuberculosis (TB), the archetypal disease of poverty. Innovations also tend to become available to better-off populations well before they become available to those who need them the most. In...
At the epicentre of the HIV epidemic in Eastern Africa, HIV prevalence has appeared to stabilise in most countries. However, there are indications that the HIV epidemic in Malawi has recently declined.
We analysed sexual behaviour survey data from Malawi between 2000 and 2004 and HIV prevalence data from the national antenatal clinic HIV surveillan...
Malawi is facing a severe HIV and AIDS epidemic with an estimated 12% of its population living with the virus. Health workers are on the front lines of the HIV epidemic and they face the risk of HIV infection in both their personal and professional lives. This mixed method study aimed to explore the enablers and barriers to HIV counselling and test...
This report presents a retrospective evaluation of the school-based malaria treatment programme implemented in Mangochi district, Malawi. The teachers were trained to identify and treat children suffering from malaria. The evaluation was undertaken using the school administrative records. The intervention and comparison schools were matched using p...
Background: Until 2005, the Malawi National Tuberculosis Control Programme (NTP) has been implemented as a vertical programme. However, in the first half of 2005 the NTP reoriented its planning, approach and budgeting in line with the Sector Wide Approach (SWAp). Monitoring of equity performance of the programme requires synthesis of baseline infor...
Until 2005, the Malawi National Tuberculosis Control Programme had been implemented as a vertical programme. Working within the Sector Wide Approach (SWAp) provides a new environment and new opportunities for monitoring the equity performance of the programme. This paper synthesizes what is known on equity and TB in Malawi and highlights areas for...
To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour.
A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a...
In 2003 an estimated 87 000 AIDS deaths and approximately 110 000 new infections occurred in Malawi. This paper aimed to analyse and review HIV prevalence trends in conjunction with other second generation surveillance data including behavioural data and, therefore, to describe trends in HIV prevalence and behaviours related to HIV transmission.
In...
