Ambassador Palmer’s August 2, 2016 Remarks at Ministry of Health Test and Treat Launch

  • Honorable Minister of Health, Dr. Peter Kampalume
  • Secretary for Health, Dr. McPhail Magwira.
  • WHO Country Representative Dr. Eugene Nyarko
  • UNAIDS Resident Representative, Ms. Amakobe Sande and other representatives of international organizations
  • The Executive Director of the National AIDS Commission, Mr. Davie Kalomba
  • Ladies and Gentlemen

I’m delighted to join in the launch of Test and Treat in Malawi and revised guidelines for HIV testing and treatment services.

Malawi’s public health approach to HIV treatment – involving community organizations and community health workers in care and treatment – truly is a model for the rest of the world. You pioneered revolutionary interventions such as Option B+ to reduce Mother-to-child transmission of HIV and literally changed worldwide standards of care. You were the first country, too, to formally integrate the UNAIDS 90-90-90 goals into your National Strategic Plan on HIV/AIDS and TB.

Today, Malawi will again be on the forefront – one of the first countries in the world to adopt Test and Treat.

There are so many reasons Test and Treat is important, but first and foremost, the practice to date of putting patients on Anti-Retroviral Therapy only when they reached a certain CD4 count meant that we were saying “Come find out if you have a disease but then only come back to us for treatment when you’re really sick, when your quality of life is affected – then and only then we can give you ARTs.”…….. Not a particularly appealing sales pitch.

With Test and Start, we can reach out to people – all kinds of people – young people, older people, married people, homosexuals, unmarried people, and say – Come, get tested. If you’re negative, we’ll give you strategies to stay negative. If you’re positive, we can put you on medicine right away that will save your life, protect your quality of life, and help you protect your families and the people you love from infection. The prevention that immediate treatment facilitates also means, therefore, that Test and Treat has the potential to reduce the number of new HIV infections in Malawi.

But unmet need for treatment is still high. Globally only 17 million people are on treatment out of the estimated 37 million people in need. Test and Treat can help close this gap.

For Test and Start to be most effective, for us to reach the UN’s ambitious 90-90-90 goals, to achieve and AIDS free generation,  we need to make sure we are targeting our HIV testing in the right places for the right populations. The revised HIV testing strategy being launched today promotes quality HIV testing services scaled up at strategic points in health facilities and targeted community based testing to address access barriers.

To implement these bold plans:

  • We must reach those most at risk, including adolescent girls and young women, female sex workers, prisoners and other vulnerable groups through targeted interventions and comprehensive care.
  • We must be creative in ways to reach children, adolescents and men, groups who typically have lower rates of ART coverage.
  • We must combat stigma in our communities and ensure everyone has access to quality health services.  Homosexuals mustn’t be afraid to seek testing and treatment. Young people mustn’t be discouraged – by clinic workers, their parent, their peers, or their schools – from seeking family planning, HIV testing and treatment. If we don’t redouble our efforts to prevent the spread of HIV to Malawi’s growing population of adolescents and the rates of new HIV infections in this age group do not change, the number of People Living With HIV could double.
  • We need to help those that are negative remain HIV free. Coupled with the timely HIV treatment that Test and Treat represents, we also need to strategically implement a mix of prevention strategies including Voluntary Medical Male Circumcision, condom programming and new interventions such as PrEP.

As we march toward the 90-90-90 goals, we need to find creative ways of making HIV services even more accessible so that clients remain in care and adhere to their treatment. In this very tough year, we need to ensure that people don’t fall off of treatment because they can’t afford to get to a health facility or because poor nutrition makes their medicines less effective.

I hope you agree, Minister, that Malawi has a great partner in PEPFAR. I like to say that the Government of Malawi, PEPFAR, and the Global Fund are mafuwa — the proverbial three stones you need under your cook pot. PEPFAR has committed more than 350 billion Malawian Kwacha to Malawi’s HIV response since 2004 and is currently supporting 611,000 Malawians on lifesaving ART.  We will support the government’s implementation of Test and Treat in the districts and facilities with the highest burden of HIV.  Indeed, PEPFAR will support the Ministry of Health in 10 ‘scale-up’ districts to achieve 80% treatment coverage by 2017. That’s a very ambitious target – isn’t it Dr. Kalua? But we’ll be working flat out right beside you.

We’re aware of the crippling health systems gaps that exist in Malawi and the strains that initiatives like Test and Start will place on the health system, so this year for the first time our program includes $8.9 million dollars in investments in critical infrastructure and human resources for health programs.

To sum up, we have very effective interventions in our arsenal. We have a “window of opportunity” to end the HIV/AIDS epidemic, but – no kidding – we are in a race against time! All of us must be committed to ensure timely deployment of these tools and prevent unnecessary hurdles like training boycotts from slowing our progress.

Test and Treat is a game changer. It changes the way people will think about getting an HIV test and early treatment is a critically important means of preventing new infections. On behalf of PEPFAR and the United States government, I offer our very sincere congratulations to the Government of Malawi and the Ministry of Health in particular for your continuing leadership in the fight against HIV/AIDS and on today’s launch of Test and Start.

Zikomo kwambiri!