By Edwin Mauluka

Delays in viral load testing results and persistent specimen transportation challenges are undermining HIV treatment services in parts of Malawi, raising concerns about the country’s efforts to end AIDS as a public health threat by 2030.

A survey conducted by the Network of Journalists Living with HIV (JONEHA) has revealed significant barriers to accessing viral load testing services in Mulanje, Phalombe and Zomba districts, with nearly half of respondents reporting difficulties.

The findings emerged during a data validation exercise conducted under the Community Monitoring and Engagement for Transformation (COMET) Project, a two-year initiative implemented by JONEHA with financial support from the International Treatment Preparedness Coalition (ITPC).

JONEHA Project Officer Tracy Mwalilino said delays in receiving viral load results and challenges in transporting specimens were among the key issues identified during the monitoring exercise.

“Both of these delay communication of results to recipients of care, especially when the viral load returns high,” said Mwalilino.

She added that interruptions to paediatric HIV support programmes have further compounded the problem.

“In terms of paediatric HIV, programmes such as ANAPA, which supported children with high viral loads, have halted. This leaves a gap because such programmes acted as an incentive for treatment adherence,” she said.

The survey collected data from 997 respondents across the three districts. Of these, 489 reported challenges accessing viral load testing services, highlighting weaknesses in a critical component of the HIV treatment cascade.

Viral load testing measures the amount of HIV in a person’s blood and helps determine whether antiretroviral treatment is effectively suppressing the virus. The test is essential in guiding treatment decisions and monitoring the health outcomes of people living with HIV.

According to the findings, the challenges were most pronounced in Mulanje and Zomba districts.

In Mulanje, 66.9% of respondents reported difficulties accessing viral load testing services. At Kambenje Health Centre, more than 80% of respondents indicated experiencing problems accessing the service.

A similar trend was observed in Zomba, where nearly 60% of respondents reported challenges. Facilities such as Chingale Health Centre and Domasi Health Centre recorded some of the highest levels of concern among recipients of care.

Although Phalombe recorded comparatively fewer complaints, with just over 20% of respondents reporting difficulties, validation meetings conducted in February 2026 revealed that the district had also experienced significant disruptions to viral load testing services.

Mwalilino cautioned against generalising the findings to the entire country, noting that the assessment focused only on selected facilities within the three districts.

“We, therefore, at this point, cannot generalise these findings to the whole country. However, they reflect some of the challenges faced by health facilities across Malawi,” she said.

She warned that such challenges threaten Malawi’s progress towards achieving global HIV treatment targets and ending AIDS as a public health threat by the end of the decade.

According to Mwalilino, delayed viral load results and specimen transportation bottlenecks can leave people with unsuppressed viral loads unaware of their treatment status, increasing health risks and potentially contributing to new HIV infections.

“An unsuppressed viral load undermines the U=U principle — Undetectable equals Untransmittable. In the long term, this can contribute to an increase in new infections and reverse progress towards the 95-95-95 targets,” she said.

The UNAIDS 95-95-95 targets seek to ensure that 95% of people living with HIV know their status, 95% of those diagnosed receive sustained treatment, and 95% of those on treatment achieve viral suppression.

Mwalilino said delays in communicating results can be particularly harmful for individuals with high viral loads because they remain unaware of the need for additional adherence support or treatment adjustments.

Despite the challenges, she said JONEHA’s monitoring and follow-up activities were already helping health facilities identify and address some of the underlying causes of service disruptions, including repairing faulty equipment.

“Going forward, there is a need to closely monitor and regularly maintain equipment to avoid prolonged periods of non-functional machines,” she said.

She also stressed the importance of strengthening adherence support programmes at community level, particularly for children, whose treatment outcomes often lag behind those of adults.

“At the health facility level, there is a need for improved coordination with district authorities to ensure shorter turnaround times for viral load results,” she said. “Districts must also strengthen supply chains for specimen transportation to minimise delays.”

Mwalilino further called for sustained community monitoring to ensure HIV services remain responsive to the needs of recipients of care.

“Through continuous monitoring, including at community level, service delivery gaps can be identified early and addressed before they affect patient outcomes,” she said.

During the validation process, Phalombe District ART Coordinator Harrold Mwaleya attributed some of the disruptions to equipment failures.

“The main challenge we experienced was a breakdown of the viral load testing machine, which affected our ability to process samples,” said Mwaleya.

“When the machine is not functioning, samples cannot be processed, and that creates delays in recipients of care receiving their results.”

Community monitors also found that some recipients of care were uncertain about when their viral load tests would be conducted or when results would be available, suggesting communication gaps between health facilities and patients.

Health experts note that interruptions in viral load testing services can delay critical clinical decisions and make it difficult for healthcare workers to identify patients who require enhanced adherence support or treatment changes.

The COMET Project, which runs from July 2025 to July 2027, seeks to strengthen community monitoring of HIV and tuberculosis services while documenting the real-time effects of the 2025 United States funding freeze on essential health programmes.

According to JONEHA, the project aims to transform community-generated data into actionable evidence that can inform policy decisions and strengthen accountability within Malawi’s health system.

As part of that effort, the organisation plans to develop a public-facing data visualisation dashboard using a Shiny application to track health service trends and provide advocates with evidence to engage policymakers and health managers.

JONEHA says the initiative will also build the capacity of community advocates and local health structures to ensure that the experiences and concerns of service users are reflected in decision-making processes.

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