Progress 34 x008fpact Mx008btx008bgatx008bon 33 Cx008ax008bx008edren x008bn x008bnstx008btutx ID: 118376
Download Pdf The PPT/PDF document "1. STATUS AT A ANCE ....................." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Progress 1. STATUS AT A ANCE .................................................................... 6 1.1. ncusveness of te staeoders n te report wrtng process ........................................... 6 1.2. Status of te epdec ................................................................ 6 1.3. Te poc and prograatc response ............................ 7 1.4. Overvew of ARPR and eat Sector V ndcators ......................................................... e;äääääãͺ 2. OVERVE OF TE ADS EPDEMC ..................................... 26 3. NATONA RESPONSE TO TE ADS EPDEMC ....................................................................... e;äääääã26 3.1. ntroducton ................................................................................ 26 3.2. Preventon .................................................................................... 27 3.2.1. Non Boedca nterventons ........................................ 27 3.2.1.1.audio .................................................. e;ääääääääääää....................................... 27 3.2.1.2.Audio .................................................. e;ääääääääääää............. 27 3.2.1.3.Interventions .................................................. e;ääääääääääää........ 2ͺ 3.2.1.4. .................................................. e;ääääääääääää.................................................. e;äääã2ͺ 3.2.1.5.Qualitativequalityeffectivenessbiomedicalinterventions .................................................. e;ääääääääääää............................... 2Í» 3.2.2. Boedca nterventons .................................................. 2Í» 3.2.2.1. .................................................. e;ääääääääääää........................................... 2Í» 3.2.2.2.SexuallyInfections .................................................. e;ääääääääääää.. 2Í» 3.2.2.3.Safety .................................................. e;ääääääääääää........... 3â 3.2.2.4.MaleCircumcision .................................................. e;ääääääääääää....................... 3â 3.2.2.5.Transmission .......................................... 3â 3.2.2.6.Qualitativequalityeffectivenessinterventions .................................................. e;ääääääääääää............................... 31 3.3. Treatent, care, and support .............................................. 32 3.3.1. Antretrovra Terap ÈARTÈ ......................................... 32 3.3.2. Cotroaoe Propas and sonad Preventve Terap ...................................... 32 3.3.3. TB and V coâManageent ............................................ 32 3.3.4. Count oeâbased Care ........................................ 33 3.3.5. Quatatve Assessent of te effectveness of treatent, care and support ........... 33 3.4. pact Mtgaton ...................................................................... 33 Cdren n nsttutona care ........................................... 34 3.4.2. Count based cd care centres ........................... 34 3.4.3. Te soca cas transfer progra .................................. 34 3.4.4. Scoo attendance aong orpans ............................... 35 3.4.5. Addressng oter basc needs for OVC ........................ 35 3.4.6. Quatatve Assessent of te effectveness of pact tgatons actvtes ........... 35 4. BEST PRACTCES ........................................................................... 36 4.1. Potca cotent .............................................................. 36 4.2. Prograe peentaton ............................................... 36 4.2.1. ART Scae up ........................................................................... 36 4.2.2. Soca Cas Transfer ............................................................ 36 5. MA OR CAEN ES AND REMEDA ACTONS ........................................................................ e;äääã37 5.1. Progress ade on te e caenges reported n te 2â12 Progress Report .............. 37 6. SUPPORT FROM TE COUNTRǯS DEVEOPMENT PARTNERS .............................................. 3ͺ 6.1. e support fro deveopent partners ....................... 3ͺ 6.2. Actons needed deveopent partners to ensure aceveent of targets ..................... 3Í» 7. MONTORN AND EVAUATON ENVRONMENT ....................................................................... 3Í» 7.1. An overvew of te current ontorng and evauaton ÈM&EÈ sste ........................... 3Í» 7.2. Caenges faced n te peentaton of a copreensve M&E sste ................... 4â 7.3. Reeda actons panned to address te M&E caenges beng eperenced ............ 41 7.4. Te need for M&E tecnca assstance and capactâbudng ............................................ 42 ͺ. ANNEES .................................................. e;ää....................................... 43 ͺ.1. ANNE 1: Consutaton/preparaton process for te countr report ............................... 43 ͺ.2. ANNE 2: Natona Cotents and Poc nstruent ÈNCPÈ ...................................... 44 ͺ.3. ANNE 3: st of partcpants wo attended te vadaton eetng ................................ 45 ANC Antenata Cnc ART Antretrovra Terap BCC Beavour Cange and Councaton BC Beavour Cange nterventons CBO Count Based Organsaton CDC Centre for Dsease Contro and Preventon CEDEP Centre for Deveopent of te Peope COA Coaton of oen vng wt ADS CSO Cv Servce Organsaton DFD Departent for nternatona Deveopent ED Ear nfant Dagnoss oba ADS Response Progress Report BV ender Based Voence oM overnent of Maaw TC V Testng and Counseng EC nforaton, Educaton and Councaton RT ndependent Revew Tea EA ega Envronent Assessent SE fe Ss Educaton MANET Maaw Networ of Peope vng wt V MD Mennu Deveopent oas MDS Maaw Deograpc and eat Surve MoF Mnstr of Fnance Mo Mnstr of eat MAA Maaw nterfat ADS Assocaton MSM Men avng Se wt Men MTCT Moter to Cd Transsson M&E Montorng and Evauaton NAC Natona ADS Cosson NAPAM Natona Assocaton of Peope vng wt V and ADS NASA Natona ADS NSP Natona V and ADS Strategc Pan OPC Offce of te Presdent and Cabnet OSC One Stop Centre PV Peope vng wt V PMTCT Preventon of Moter To Cd Transsson PS Popuaton Servces nternatona ST Seua Transtted nfectons TB Tubercuoss TV Teevson UNADS Unted Natons ont Progra on V and ADS UNCEF Unted Natons Cdrenǯs Fund VMMC Vountar Medca Mae Crcucson VPP Vountar Poo Procureent VSU Vct Support Unt GLANCECopaton of ts report was ed b te Maaw Natona ADS Cosson ÈNACÈ wc s a overnent of Maaw È oMÈ agenc responsbe for coordnatng and ontorng te natona response to te V and ADS epdec n Maaw. Under te gudance of NAC, two ndependent Maawan consutants coated, revewed and anaed reevant poces, strateges, data and reports to generate recent V and ADS ndcators for Maaw. t te ep of NAC te aso dentfed e staeoders n te natona V and ADS response and ntervewed te usng te Natona Cotent and Poc nstruent ÈNCPÈ seâstructured questonnare. Te staeoders ncuded representatves fro te foowng consttuences; governent, Natona ADS Cosson, uan rgts watcdogs, deveopent partners, UN agences, cv socet organatons, te prvate sector and peentng partners. Foowng te ntervews, te consutants prepared a draft report on te fndngs and presented te to a group of staeoders ÈAnne 1.2È at a vadaton eetng ed at ongwe ote on 2ͺ Marc 2â14. Durng te eetng, te staeoders crtqued and vadated te coped ndcators and quatatve fndngs fro te NCP ntervews. Based on coents and nputs fro te staeoders, te draft report was revsed and crcuated to te stepidemicTe frst case of ADS was dagnosed n Maaw n 1ͻͺ5. Snce ten V prevaence ncreased sgnfcant and reaced a pea of 16.4% n 1ͻͻͻ aong persons aged 15â4Í». Tereafter, te prevaence as been decnng stead, reacng 12.â% n 2ââ4 and 1â.6% n 2â1â. Te 2â1â Maaw Deograpc and eat Surve ÈMDSÈ found tat V prevaence vared ared b se, age, urbanârura resdence, geograpca ocaton and oter caracterstcs. Feaes ad a ger V prevaence tan aes È12.Í»% vs ͺ.1% n 2â1âÈ, wt te argest dspart beng n te 15â1Í» ear od age group È3.7% n woen and â.4%È. n addton, V was ore prevaent n urban countes È17.4%È copared to rura countes ÈÍ»%È. Aso, te Soutern regon ad a prevaence of 14.5% wc was twce as g as tat n te Nortern and Centra regons. Snce 2â1â, tere asnǯt been an natona representatve surve n Maaw to estate V prevaence. UNADS estates tat, b te end of 2â12, 1,1ââ,âââ Maawans were vng wt V 66,âââ acqured new V nfecton and 46,âââ ded as resut of Vâreated condtons. Te an ode of transsson of V s troug eteroseua ntercourse, estated to account for ͺͺ% of a new V nfectons we oterâtoâcd transsson accounts for NSO/MACRO, Maaw Deograpc and eat Surve, 2ââ4; NSO/MACRO, Maaw Deograpc and eat Surve, 2â1â. ~1â% of te nfectons. Approate 2% of nfectons are beeved to be transtted troug bood transfusons and contanated edca and sn percng nstruents. Atoug Maaw as a generaed V epdec, Beavoura Surveance Surves ÈBSSÈ conducted n 2ââ4 and 2ââ6 ndcate tat specfc soca and occupatona groups ave ger V prevaence tan te genera popuaton. Tese ncude feae se worers, feae border traders, ongâdstance truc drvers, poce offcers, estate worers and fseren ÈFgure 1.1È. Men wo ave se wt en ÈMSMÈ n Maaw aso ave a g V prevaence È21%È.V ncdence s estated to be popuatons at ger rs of V eposure suc as se worers, cents of se worers and MSM. owever, te contrbuton of tese groups to te nuber of new nfecton s estated to be ver ow, accountng for <1% of a new V nfectons. Coabtng Vâdscordant partners, prevous assued to be a ow of a new V nfectons n Maaw. Te V and ADS response n Maaw s guded b te V and ADS Poc wc was recent revsed and aunced n u 2â13. Te poc s operatonaed troug te Natona V and ADS Strategc Pan ÈNSPÈ 2â11â2â16 wc provdes a fraewor for Maaw Boogca and Beavoura Surveance Surve and Coparatve Anass, 2ââ4 and 2ââͺ. Bara S., et a. DzV prevaence, rss for V nfecton, and uan rgts aong en ÈMSMÈ n Maaw, Naba, and Botswanadz Pos One, Vo 4 È3È, e4ͻͻ7, 2ââÍ». Departent of Nutrton, V and ADS, Natona V Preventon Strateg, 2ââÍ»â2â13. HIV Prevalence by occupational groups17%24%20%17%14%22%10%20%30%40%50%60%70%80%MalmareacheecondachersMale Police Officerale e WorkFishermenTruck DriversFemale TrderFemalex kerFemale Primary TeachersFemale Second TeacheremalecersOccupational GroupHIV Prevalence peentaton of V and ADS nterventons across varous sectors. Te V Poc and NSP are ned to varous aws and strateges wc are not Vâspecfc but provde te overa ega and poc fraewor. e peces of egsatons and strateges wc a drect and ndrect pact te preventon and anageent of V and ADS ncude: Te Consttuton of Repubc of Maaw, Te Pena Code, Te Pubc eat Act, Te Cd Care, ustce and Protecton Act, Te Marrage Act, Te Preventon of Doestc Voence Act, Te Deceased Estate Ès and nertanceÈ Act, Te ender Equat Act, Te Dsabt Act, Te Occupatona Safet, eat and efare Act, Te Epoent Act and Te abour Reatons Act. Te Maaw rowt and Deveopent Strateg È2â11â2â16È s an overa deveopent agenda for Maaw wc aso gudes te peentaton of V and ADS nterventons. Current, Maaw as drafted an V and ADS B wc as at strengtenng te ega fraewor for peentng V and ADS nterventons. Ts draft egsaton was deveoped n a transparent and g consutatve anner to ensure tat t eets te epectatons of e staeoders and aderes to uan rgts standards. t s epected tat te draft egsaton w soon be presented to te Maaw governent cabnet for revew and approva braent for enactent. At nternatona eve Maaw s aso a sgnator of a nuber of conventons and decaratons wc for a furter portant gudng fraewor for natona aws, poces and reguatons reatng to V. e nternatona and regona nstruents sgned and ratfed b Maaw ncude te foowng: Te Unversa Decaraton of uan Rgts ÈUDRÈ 1Í»4ͺ, te 2âââ UN Decaraton of Cotent on V and ADS, and te 2â11 Potca Decaraton on V and ADS. Maaw as snce doestcated tese nternatona conventons and decaratons n ts poces and egsaton. n ne wt te utsectora V and ADS response n Maaw, governent nstres, nonâgovernenta organatons, cv socet organatons and te prvate sector actve partcpate n te peentaton of varous V and ADS nterventon. Consstent wt te Dztree onesdz prncpe, te NAC s responsbe for coordnatng te actvtes of a agences peentng V nterventons and copng Vâreated ndcators. To operatonae te NSP, NAC coordnates te deveopent of an ntegrated Annua orpan ÈAPÈ, wc, aong oter tngs, outnes e actvtes to be peented b partners, perforance ndcators and budgets. Neverteess, t s evdent tat a sgnfcant nuber of V nterventons wc are peented b partners, not funded troug NAC, are not captured n te AP. OverviewGARPRandHealthSectorIndicatorsMaaw contnues to trac te progress ade to aceve te ten targets as agreed n te 2â11 Potca decaraton of V and ADS. Tabe 1.1, beow, sows te trend of ndcators ned to tese targets. t s portant to note tat 2â13 data were unavaabe for ost ndcators wc requred te conduct of a natona representatve surve or sentne surveance. Tese surves are panned for 2â15. 1.1:GARPRandHealthIndicatorHealthareTARGETS20102010201120122013 Target 1: V b 5â% b 2â14 population1.1: Percentage of oung woen and en aged 15â24 wo correct dentf was of preventng te seua transsson of V and wo reect aor sconceptons about V Maes: 75%Feaes: 75% Maes: 44.7% Feaes: 41.ͺ% avaabe Not avaabeNot avaabe 1.2: Percentage of oung woen and en aged 15â24 wo ave ad seua ntercourse before te age Not avaabeMaes: 12.3% Feaes: 14.3% avaabe Not avaabeNot avaabe aged 15â4Í» wo ave ad seua ntercourse wt ore tan one te past 12 onts Not avaabeMaes: Í».2%â.7% avaabe Not avaabeNot avaabe aged 15â4Í» wo ad ore Maes: 6â%Men: 24.6%avaabe Not avaabeNot avaabe For 2â1â te source of nforaton s te 2â1â MDS wose resuts cae out n 2â11 uness specfed. Tese fgures are fro te 2â1â ce anoter DS s conducted Tese fgures are fro te 2â1â ce anoter DS s conducted te past 12 onts wo report te use of a condo oen: 4â%27.3% 1.5: Percentage of en and woen aged 15â4Í» wo past 12 onts and now ter resuts Maes: 75%Feaes: 75% Maes: 51.2% Feaes: 71.6% avaabe Not avaabeNot avaabe 1.6: Percentage of oung peope aged 15â24 wo are vng wt V Maes: 12%Feaes: 12% Maes: 1.Í»%Feaes: 5.2% avaabe Not avaabeNot avaabe 1.7: Percentage of se preventon progras Not avaabeavaabeavaabeNot avaabeNot avaabe 1.ͺ: Percentage of se of a condo wt ter ost recent centNot avaabeavaabeavaabeNot avaabeNot avaabe Fa Pannng Assocaton n Maaw. È2â11È. uncatchables:thesituationanalysisbehaviouralfactors,interventionsworkFa Pannng Assocaton of Maaw and Te stud b FPAM dd not oo at use of a condo wt ter ost recent partner but weter te ave ever used condos or not. Te stud sowed tat a te se worers ntervewed ad ever used condos but tat n soe cases te dd not use condos for vared reasons. 1.Í»: Percentage of se past 12 onts and now ter resuts Not avaabeavaabeNot avaabeNot avaabe 1.1â: Percentage of se Not avaabeavaabeNot avaabeNot avaabe 1.11: Percentage of en wo ave se wt en preventon progras Not avaabeavaabeavaabeNot avaabeNot avaabe 1.12: Percentage of en condo te ast te te ad ana se wt a ae partner Not avaabeavaabeavaabeNot avaabeNot avaabe 1.13: Percentage of en wo ave se wt en tat ave receved an V test n te past 12 onts and now ter resuts Not avaabeavaabeavaabeNot avaabeNot avaabe Fa Pannng Assocaton n Maaw. È2â11È. uncatchables:thesituationanalysisbehaviouralfactors,interventionsworkFa Pannng Assocaton of Maaw and NOTE: Ts Dzprevaencedz s based on ndvdua reports b se worers and not on boarers. Fa Pannng Assocaton n Maaw. È2â11È. uncatchables:reportsituationanalysisthemagnitude,behaviouralfactors,interventionsworkFa Pannng Assocaton of Maaw and 1.14: Percentage of en wo ave se wt en wo are vng wt V Not avaabeavaabe Not avaabeNot avaabe 1.16.1. Nuber of woen 12 onts and now ter 1,7â2,627 1.16â1a. Percentage of V rapd test ts tat eperenced a stocout n te ast 12 onts Not avaabe 1.17.1. STs: Percentage of woen accessng antenata care ÈANCÈ servces wo 1.17.2. STs: percentage of antenata care attendees 1.17.3. STs: percentage of antenata care attendees Not avaabe Uar, E., . Trapence, ., Cb. Berer and S. Bara. È2ââ7È. sexualbehaviorMalawi. ongwe and Bantre: CEDEP and CoM. Ts stud dd not oo at ndcators 1.11â1.13. Anoter stud s current onâgong aong MSMs. Ts nuber ncudes pregnant woen wo ad V tests as part of EMTCT.. Ts prevaence s e to be based because on 1â% of te antenata attendees were tested. t a be tat eat worers on tested tose wo te tougt ad an ST. 14 postve for sps wo receved treatent 1.17.4. STs: percentage of actve sps Not avaabe 1.17.5. STs: percentage of en wo ave se wt en wt actve sps Not avaabe 1.17.6. STs: nuber of aduts reported wt atent/unnownÈ n te Not avaabe 1.17.7. STs: nuber of sps cases Ève brts 12 onts Not avaabe 1.17.ͺ. STs: nuberof gonorroea n te past 12 onts Not avaabe 1.17.Í». ST s: nuber of uretra dscarge n te Not avaabe 1.17.1â. STs: nuber of Not avaabe 15 aduts reported wt 1.1ͺ. Percentage of pregnant woen wt a wose seua contacts were dentfe for sps Not avaabe 1.22 Percentage of en 15â Not avaabe 1.23. Nuber of ae 12 onts 11,âââ 4â,ͺ35 V aong peope wo nect drugs 2â152.1: Nuber of srnges dstrbuted per person wo nects drugs per ear b neede and srnge prograes 2.2: Percentage of peope wo nect drugs wo report te use of condos Ts data s fro te 2â1â Maaw Deograpc and eat Surve. Respondents were ased weter te were crcucsed or not nforaton was not verfed Ts data was fro Q1 and Q2 of 2â13. No data were avaabe for Q3 and Q4 of 2â13. No studes ave been done on ts n Maaw. at ast seua ntercourse. 2.3: Percentage of peope wo nect drugs wo ast te te nected 2.4: Percentage of peope wo nect drugs tat ave past 12 onts and now ter resuts 2,5: Percentage of peope wo nect drugs wo are vng wt V 2.6. Nuber of peope on opod substtuton terap 2.7. Nuber of NSP and â Nuber of neede and srnge prograe ÈNSPÈ 2.7. Nuber of NSP and Not routne coected V b 2â15 and 3.1: Percentage of V to reduce te rs of oter to cd 65%44%44% 67%73% 3.2: Percentage of nfants vroogca test for V wtn 2 onts of brtNot avaabeavaabe avaabe 1â%3â% 3.3: Moter to cd woen wo now ter and receved ter resuts â abour and dever, and durng te postâpartu perod È<72 oursÈ, ncudng tose wt prevous nown V overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports Te V and ADs Departent n te Mnstr of eat on started coectng ts data n 2â11. overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports Denonator s te epected nuber of pregnant woen per ear Èestated at 6â7,âââ n 2â13È 18 woen attendng ANC wose ae partner was tested for V n te ast 12 onts Not avaabe 3.6. Percentage of nfected pregnant woen assessed for ART egbt stagng or CD4 testng contet of Opton B+ born to Vânfected propas to reduce te frst 6 wees È.e. ear around 6 wees of ageÈ born to Vânfected woen started on CT propas wtn two onts of brt 3.1â. Dstrbuton of feedng practces Not avaabe Te denonator s V eposed nfants dscarged fro te aternt. Te nuerator s a V eposed nfants wo were prescnevrapne. Data Source: overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports Te denonator s te nuber of V eposed nfants wo are 2 onts od. Te nuerator s a cdren ess tan 2 onts wwt nevrapne. Data Source: overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports 19 Èecusve breastfeedng, repaceent feedng, ed feedng/oterÈ for nfants born to Vâ nfected woen at DPT3 3.11. Nuber of pregnant woen attendng ANC at 627,ͺ27 ave 15 on peope vng wt treatent b 2â15 4.1: Percentage of egbe aduts and cdren current recevng Not avaabe63%67% 65%ͺ3% 4.1 â addtona: V terap: Nuber of egbe aduts and cdren wo new ntated ÈARTÈ durng te reportng perod È2â13È 1â2, 56ͺ and cdren wt V nown to be on treatent 12onts after ntaton Not avaabeͺ1%7ͺ% ͺâ%7ͺ% Ts ndcator was estated fro te nuber of woen wo booed at antenata cncs n 2â13. Data Source: overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q1, Q2, Q3 and Q4 Reports overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q3 report 20 4.2b. Percentage of aduts and cdren wt V st ave and nown to be on onts after ntatng treatent aong patents terap durng 2â13 and cdren wt V st ave and nown to be on onts after ntatng treatent aong patents terap durng 2â13 4.3.a. Nuber of eat ÈARTÈ 6ͺͻ Nuber of eat factes tat offer paedatrc ÈARTÈ Not avaabe Not avaabe overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q3 report overnent of Maaw, Mnstr of eat, ntegrated V Prograe Report: 2â13 Q3 report 21 tat eperenced a stoc out of at east one requred ARV n te ast 12 onts. 4.6.a Tota nuber of peope enroed n V care at te end of te reportng Not avaabe 4.6.b Nuber of aduts and V care durng te 1â2,56ͺ 4.7a. percentage of peope on ART tested for vra oad ÈVÈ wo ave an Not avaabe 4.7 b. Percentage of peope on ART tested for vra oad ÈVÈ wt V eve beow ⤠1,âââ copes after 12 onts of terap È2â13È Not avaabe vng wt V b 5.1: Percentage of ncdent TB cases tat receved treatent for 5â%45%54% 6â%75% Tese fgures are fro te Natona TB Contro Progra. Te 2â1â UA Progress Report sows tat approate 7â% of V nfected TB patents were recevng ART n frst quarter of 2â1â ÈMo, Maaw ART Prograe Report for 2â1â Frst Quarter, p.7È 5â% b 2â15 wo are detected avng actve TB dsease ÈnewÈ Not avaabe. Data s on avaabe for tose on ART and te fgure s 1.6% enroed n V care preventve terap ÈPTÈ V care wo ad TB status assessed and recorded durng ter ast 2â1â/2â11 ÈUS$È2â11/2â12 ÈUS$È2â13 Reac a sgnfcant goba ependture ÈUS$22â24 bonÈ 6.1: Doestc and â1. Preventon progras: 45,ͺͻ1,ͺ6â 2. Treatent and care: 2Í»,376,ͻͺͻ 3. OVC: 5,ͺ61,433 â1. Preventon progras: 43,41ͺ,11ͺ 2. Treatent and care: 47,21â,62ͺ 3. OVC: 5,435,14Í» Not avaabe Note that this number is based on a small cohort of HIV positive individuals (,000) who are accessing pre-ART care Note that the status is assessed by asking TB-related questions to individuals attending HIV care. 2013 data on expenditure is not available. Accordng to te NASA for te perod 2â1â/2â12 ore tan Í»â% of te fundng for te natona response coes fro donors. Detas of fundng b source ave been gven n te secton on cosng te resource gap. 4. Progra anageent and adnstraton: 42,764,ͻͻâ 5. uan resources: 4,ͺͻâ,721 6. Soca protecton and soca servces Èecudng OVCÈ: 7,33ͺ,ͺ11 7. Enabng envronent: 11,65â,572 ͺ. V and ADS Reated Researc: 4,1Í»6,ͺ5ͺ TOTAL:151,972,2344. Progra anageent and adnstraton: 34,ͺͻ1,3â1 5. uan resources: 4,â52,47Í» 6. Soca protecton and soca servces Èecudng OVCÈ: 2,Í»â7,632 7. Enabng envronent: 3,25Í»,433 ͺ. V and ADS Reated Researc: 4,347,6Í»5 TOTAL:145,522,435 6.1: Doestc and 3. Batera contrbutons: 4. Mutatera contrbutons: organsatons and foundatons: organsatons and foundatons: 7. nternatona151,972,2343. Batera contrbutons: 4. Mutatera contrbutons: organsatons and foundatons: organsatons and foundatons: 7. nternatona145,522,435Not avaabe nequates and genderâbased abuse and voence Proporton of everâarred or partnered woen aged 15â4Í» wo Not avaabe1ͺ.5%Not avaabe Not avaabeNot avaabe and ncrease te teseves fro V. seua voence fro a te past 12 onts Enate stga aganst peope affected b Vatttudes towards peope vng wt VNot avaabeMaes: 35.7% Feaes: 1Í».7% avaabe Not avaabeNot avaabe 10:ntegraton 1â.1: Current scoo attendance aong orpans and nonâorpans aged 1ââ14 âNot avaabeMaes: â.Í»5Feaes: â.Í»7 Tota: â.Í»6 avaabe Not avaabeNot avaabe 1â.2: Proporton of te poorest ouseods wo onts Not avaabe2.6avaabe Not avaabeNot avaabe This is a new indicator. The figure indicated for 2010 is based on the Malawi Demographic Survey which looked at Percentage of respondents expressing acceptance attitudes on all four indicators 25 OVERVIEWAIDSEPIDEMICAs sown n Fgure 1.2 beow, V prevaence n Maaw as decned stead snce 1ͻͻͻ. Snce 2â1â, Maaw as not conducted an natonaârepresentatve V surve, ence tere s no recent data on V prevaence n Maaw. Neverteess, te observed reducton n V prevaence occurrng at a te of rapd ncreasng coverage of ART and proved survva of PVs suggests decnng V ncdence. owever, usng ndrect etods of easurng V ncdence, te Mo estates tat ~46,âââ peope acqure V annua.Source: V and Sps Sero âSurve and Natona V Prevaence and ADS Estates Report for 2â1â,RESPONSEAIDSEPIDEMIC3.1.IntroductionTs secton suares progress ade n te peentaton of e nterventons under tree an teatc areas, nae: V preventon; ÈbÈtreatent, care and support, and; pact tgaton. Uness oterwse stated, data provded n ts secton are based on te fndngs of Deceber 2â13 report produced b te ndependent Revew Tea ÈRTÈ for te NAC, wc conducts bâannua revew of te peentaton of te utâsectora natona response to V and ADS. n ne wt Maawǯs fsca caendar, ost quanttatve fndngs n te secton cover te perod fro 1 u 2â12 to 3â une 2â13. At te te of wrtng ts report, ost data fro 1 u 2â13 to 31 Deceber 2â13 were not avaabe. Noneteess, te quanttatve data fro te RT report are suppeented b quatatve fndngs drawn fro nâdept ntervews conducted wt staeoders usng te Natona Cotents and Poc nstruent ÈNCPÈ. Ministry of Health. (2012). HIV and Syphilis Sero Survey and National HIV Prevalence and AIDS Estimates Report for 2010. Lilongwe: Ministry of Health 16.5161618.516.910.61994199519961998199920012003200520072010Trendsprevalencewomen19942010 3.2.Prevention3.2.1.NonBiomedicalInterventionsn an effort to reduce ncdent V nfectons, te overnent of Maaw, as deveoped severa poces, strateges and pans to gude te peentaton of nonâboedca nterventons. Tese ncude te V Preventon Strateg, Abstnence Strateg, Mutua Fatfuness Strateg, Condo Strateg, and te Natona Beavour Cange nterventons Strateg. Besdes focusng on preventon of prar and secondar V nfectons, beavoura cange councaton covers crossâcuttng ssues nae gender, uan rgts and cuture. Modes of councaton under ts nterventon ncuded prnted and audo EC ateras, perforanceâbased nteractve sessons, senstsaton eetngs, debates, aret capagns, vdeo sows and draa perforances. 3.2.1.1.PrintandaudiomaterialsDurng te 2â12/13 fsca ear, a tota of 1,â44,2ͺ4 EC ateras were produced and dstrbuted aganst a target of Í»ââ,âââ, surpassng te target b 16%. Te nuber of EC ateras produced n 2â12/13 was sgt ger tan tose produced n 2â11/12 estated at ͻͻ7,4Í»4 copes. n bot ears te target was surpassed. Durng 2â12/13 a cuuatve Í»2 ours of prograes broadcastng V/ADS essages were ared on teevson aganst a target of 2ââ ours, representng a 46% underaceveent. Ts ars a aor reducton, as n 2â11/12 a tota of 322 ours were used for broadcastng V and ADS essages on TV. Troug prograes, sots and nges, a tota of 342 ours of V and ADS essages and nforaton were ared on count rado statons, surpassng a target of 3ââ ours È114 %È. n 2â11/12, on 124 ours were uted to ar V and ADS essages surpassng a set target of 1ââ ours. t s portant to note tat te nubers of ours spent on broadcastng of V and ADS essages on te rado as reported over te perod 2â11â2â13 are an underâestate because one stud on nonâboedca nterventons found tat bot TV and rado statons n Maaw ar V and ADS progras coverng ore tan 4,âââ ours annua3.2.1.2.InteractiveAudioVisualServicesPerforance and nteractve sessons Èdraa, debates, and pubc tasÈ, ncudng pubc ectures and epert tas on V and ADS, were conducted n scoos, countes and worpaces, and aceved te set targets Èͻͻ% of panned actvtesÈ. Targets were surpassed n count obsaton b 346% durng te sae perod. owever, set targets for senstsaton of dstrct eaders Èoca eaders, teacers, parents/guardans, fat eaders, tradtona ntators, out eadersÈ and vounteers traned Èb genderÈ n V preventon nterpersona/nteractve councaton, ncudng sgn anguage, were not aceved wt on 64% of panned actvtes successfu aceved n te 2â12/13 fsca ear. Munta, A.C., P. Mvua, . Mner and P. sndo. È2â11È. situationanalysisbiomedicalinterventionsMalawi. oba: Centre for Soca Researc. 3.2.1.3.BehaviouralChangeInterventionsforyouthsBeavour cange councaton nterventons for oung peope were peented troug varous ntatves, ncudng fe Ss Educaton ÈSEÈ for nâscoo and outâofâscoo oung peope; and te provson of outâFrend eat Servces ÈFSÈ aed at ncreasng outsǯ access to seua and reproductve eat servces. Before 2â1â SE for n scoo out was beng offered rreguar. Te dever of ts subect on a andator bass and ang t eanabe as ensured tat a pups n prar and secondar scoo access ts subect. A students n prar and secondar scoos n 2â13 were terefore eposed to SE. Current te SE currcuu for secondar scoos s beng revsed n order to ncorporate copreensve seuat educaton. A cuuatve tota of 134,735 outâofâscoo outs È135% aceveentÈ were eposed to SE durng te 2â12/13 fsca ear aganst an annua target of 1ââ,âââ. Ts represented a decrease È53% aceveentÈ as n 2â11/12 a cuuatve tota of 264,Í»6ͺ outâofâscoo outs were eposed to SE. For bot ears tese fgures a be underâestates as not a peentng partners report ter actvtes to NAC. n 2â12/13 ost targets under ts nterventon were et and soe surpassed suc as te tranng of out cub eaders and patrons, SE for cub eaders of outâofâscoo outs, out peer educators, and nuber of out senstsaton sessons. nâscoo Èprar, secondar and tertar scoosÈ, and outâofâscoo out eaders and peer educators were traned n nterpersona/nteractve fe ss educaton. 3.2.1.4.CondomProgrammingn 2â12/13 a tota of 2â,Í»57,ͺ7â ae condos were free dstrbuted representng a odest ncrease fro 2â,7ââ,âââ n 2â11/12. Te nuber of soca areted condos decreased fro 11,362,166 n 2â11/12 to Í»,35ͺ,â22 n 2â12/13. Ts trend of decreasng nubers of soca areted condos as been observed over te ast few ears. Te nuber of feae condos dstrbuted decreased fro 1,44â,262 n 2â11/12 to Í»43,ͺ2â n 2â12/13. n 2â12/13 te prooton and dstrbuton of condos dd not eet set targets, but aceved 7Í».5% of te 2â12/13 target for ae condos wc are free dstrbuted and soca areted. Assessng te nuber of condos dstrbuted vsâaâvs te popuaton ndcates tat 5Í».7 condos were dstrbuted per seua actve ae usng condos per ear nstead of te epected 144 condos. neffectve supp can anageent sste was te aor cause of ower tan epected condo dstrbuton. For prvate secondar scoos wc foow te Mnstr of Educaton currcua, te w aso ave ts subect as a copusor subect. TAD. È2â12È. TheindependentreviewMalawinationalresponseHIV/AIDSfinancial20112012. ongwe: Natona ADS Cosson 3.2.1.5.QualitativeAssessmentqualityeffectivenessbiomedicalinterventions Durng te reportng perod, tere was no natona representatve surve to assess te pact of nonâboedca nterventons on beavora cange and V prevaence. Tus, ARPR ndcators on reducton of seua transsson of V coud not be assessed. Aong staeoders, tere were ed vews on te pact of tese nterventons wt soe cang tat soe nterventons were not evdenceâbased. owever, ost respondents acnowedged tat assessent of genune beavora cange s dffcut. Te epressed a wde range of concerns ncudng nadequate targetng of g rs popuatons suc as prsoners, se worers and Men avngâSe wt Men ÈMSMÈ togeter wt ter ntate partners, ted capact Èn ters of ss and nubers of staffÈ at dstrct eve to dever approprate beavora cange nterventons and cronc sortage of condos, especa at te endâuser eve. Most respondents apprecated te good coverage of SE for n and outâof scoo outs n 2â13 and wecoed recent efforts to revse te breadt and dept of SE currcuu to ncude copreensve seuat educaton, especa for secondar scoo students. 3.2.2.BiomedicalTe peentaton of boedca preventve nterventons s guded b severa poces and strateges and pans ncudng te V Testng and Counseng ÈTCÈ Scaeâup pan, te Natona Pan of Acton for Scang up of Seua and Reproductve eat V Preventon nterventons for oung Peope, Natona Bood Safet Poc, te VMMC Poc and Natona Pan on scaeâup of VMMC and te PMTCT Scae up Pan. 3.2.2.1.TestingandCounselingV Testng and Counseng ÈTCÈ too pace n ͺ25 statc and 534 outreac stes durng te 2â12/13 fsca ear, a sgt ncrease fro te 7ͺ2 statc stes n te prevous fsca ear, wt ore ART and PMTCT stes avng been ntegrated n te past ear. Te nuber of V tests conducted n te fsca ear was 2,1ͺͺ,Í»52, surpassng te target of 1,ͺââ.âââ b 2â%. n 2â11/2â12 1,42Í»,5ͺ6 peope were tested for V and ts was ower tan 1,773,âââ on tests done n 2â1â/2â11. Te ncreased nubers of peope tested n 2â12/13 was part attrbuted to fewer stoc outs of test ts, as we as te peentaton of an ntensve V Testng ee aed at provng TC access. Tose wo were beng tested for te frst te ranged fro 34% â 3Í»% of te tota, wc s sgt ess tan n 2â11/12. Te annua target of ͺâ,âââ oung peope tested for V troug FS was eceeded n te frst treeâquarters of te 2â12/13 fsca ear, wt Í»6,7ͺâ È52,âÍ»2 aes and 41,4Í»â feaesÈ tested b 31 Marc 2â13. 3.2.2.2.ManagementSexuallyTransmittedn te 2â12/13 fsca ear, two probes ave affected te reportng of data for seuaâtranstted nfectons ÈSTsÈ. Frst, on a nort of dstrcts È5 of 2Í»È subtted reports on ST cases. Second, even wtn tose dstrcts wc reported, t was estated tat on about 7â per cent of a treated STs were beng reported. Aong te reported cases, on about 35% of ST cases were treated accordng to gudenes. A arge proporton of tose ST patents wo were seen were Vâpostve and repeaters, png tat a dagnoss of V ad not canged ter gârs beavour. Aso, tere were reports of stoc outs of ST drugs and sps test ts. Tus, t s e tat a ver arge proporton of STs n Maaw are not beng proper dagnosed and treated, wc a ver we be contrbutng to te contnued g rate of V transsson. To overcoe te caenges eperenced wt Ç®passveǯ reportng n te second quarter of 2â13, a decson was taen to actve coect ST reports durng te ntegrated V Progra Supervson eercse. Based on te data coected at te factes, a tota of 45,Í»4ͺ ST cases were treated n te quarter of 2â13. Consderng te 75% copeteness of reportng, ts nuber s estated to represent a tota of 61,264 ST cases treated. Ts s equvaent to 62% ST treatent coverage of te epected ͻͺ,6ââ ST cases n te popuaton3.2.2.3.BloodSafetyDurng te 2â12/13 fsca ear, Maaw Bood Transfuson Servces ÈMBTSÈ coected 43,â12 unts of bood Ètarget was ͺâ,âââÈ, copared to 56,324 unts n 2â11/12 Èwen te target was 4â,âââÈ. n te 2â12/13 fsca ear, tere were on tree coecton stes n te countr, so dstance and ogstcs apered peentaton of countrâwde bood donaton troug MBTS. To aevate ts probe, te MBTS opened tree satete coecton stes. owever, tese rean nadequate to eet te deand. Furterore, perodc sortages of boodâtestng reagents, as we as bood coecton bags, apered aceveent of targets n te past ear. 3.2.2.4.VoluntaryMedicalMaleCircumcisionDurng te 2â12/13 fsca ear, VMMC was actve peented n on ͺ of te 2Í» dstrcts n Maaw, ost wt support fro PEPFAR. As of 3â une 2â13, 2ͺͻ provders and 3â TOTs ad been traned Ète target was 24â traners and 15 TOTsÈ, wc s an proveent over te prevous ear. At te sae te, 1â5 stes ad been estabsed. Ts s an ncrease over te ͺ2 stes seen ast ear and te 32 stes te ear before, but st we beow te targeted 24â. A target of 1â,âââ VMMCs for te fsca ear 2â12/13 was set but 45,441 crcucsons were reported b 3â une 2â13, surpassng te target b a factor of four. Durng 2â11/2â12 a tota of ͺ,534 edca crcucsons were perfored and ts represented ͺ5% of te tota target È1â,âââ crcucsonsÈ for te ear. Te nuber of crcucsons perfored n 2â12/13 represents a aor ncrease over te 2â11/12 fnanca ear. n 2â12/13 ost of VMMCs were perfored n te fna quarter ÈApr to une 2â13È durng a VMMC capagn n wc ore tan 3â,âââ en were crcucsed. e te target set sees reastc n ters of te avaabe capact n te countr, t s we beow te dea target of 25â,âââ per ear requred to eanngfu prove te prevaence of VMMC aong aes n te genera popuaton. 3.2.2.5.EliminationMotherChildTransmission(EMTCT)Maaw as been peentng an ntegrated ART/EMTCT prograe snce 1 u 2â11 troug te ntroducton of te Opton B+. EMTCT/ART servces are fu ntegrated nto aterna and cd eat servces. As of une 2â13, EMTCT servces were avaabe n 5ͺͺ PMTCT stes ÈOpton B+È stes, an ncrease fro 534 stes n une 2â12, but st not reacng te target of 65â stes. n te 2â13 caendar ear, 4Í»7,61ͺ woen counseed and tested, wc represented ͺ2% of te estated nuber of pregnant woen and fas sgt sort of target of ͺ5%. n te sae caendar ear, 45,ͺ16 woen receved ART, representng 73% of te estated 63,âââ Vâpostve pregnant woen n te countr durng te ear. Ts fgure s cose to te natona target of 75%. n te caendar ear, 2Í»,714 nfants born fro Vâpostve oters were prescrbed nevrapne propas, representng Í»2% of te tota nuber of nfants born to V postve oters deverng n eat factes. n addton, ͺ6% of a coort of 2ͺ,445 V eposed nfants aged 2âonts receved cotroaoe propas. As reported n te prevous ARPR, Ear nfant Dagnoss ÈEDÈ reans a aor caenge n Maaw. n te 2â13 caendar ear, Maaw anaged to test and provde resuts to 3â% of V eposed nfants wtn 2 onts of brt. n te Q3 of 2â13, te edan turnâaround te fro coecton of DBS to dspatc of resuts was 1Í» das, wc suggests a consderabe dea n councatng resuts to te caregvers of Vâeposed nfants. 3.2.2.6.QualitativeassessmentthequalityandeffectivenessbiomedicalpreventiveinterventionsConsstent wt te EMTCT ndcators, ntervewed staeoders unanous agreed tat peentaton of te Opton B+ strateg as been g successfu, especa n ters of screenng te aort of pregnant woen and prescrbng te wt ART. owever, severa respondents epressed concern over te caenges eperenced n te dever of Ear nfant Dagnoss resuts, ossâtoâfoow up and ART copance aong oterânfant pars enroed n EMTCT prograes. Staeoders aso epressed ter satsfacton wt te bod steps Maaw as taen to proote and peent VMMC actvtes. Atoug te acnowedged tat te current nubers of VMMCs perfored were ow, te were encouraged wt te rapd scae up of ts nterventon. Soe were of te vew tat deand for VMMC was ver g but aented te nfrastructura and uan resource caenges n te eat sector, wc w contnue to adverse affect te actua nuber of VMMCs perfored. Most respondents acnowedged tat t w tae an enorous effort to reac te target of 25â,âââ VMMCs per ear and eanngfu ncrease te prevaence of VMMC n Maaw. A few respondents questoned te ac of efforts to proote ear nfant ae crcucson. Most staeoders noted tat te countr ad successfu overcoe te sortage of V test ts wc adverse affected peentaton of TC servces n 2â11/12. owever, a few noted wt concern te ow quat of V test resuts wt a sgnfcant nuber of faseânegatve resuts. Neverteess, te apprecated efforts taen b te Mnstr of eat wt support fro deveopent partners to retran a TC provders and dsengage tose wo perfor poor. owever, te advsed on te need to repace TC provders wo ad been dsengaged because of poor perforance. Tere were ed vews on te avaabt of adequate quanttes of safe bood and good access to ST anageent. Most respondent were of te vew tat access to safe bood was good n urban areas but peraps not n te rura areas. Oters, epressed concern on te quat of ST anageent n eat factes and te eve of ntegraton wt oter Seua and Reproductve eat servces.3.3.Treatment,support3.3.1.Therapy(ART)Maaw as contnued to peent te 2â13 O gudenes on V treatent b adoptng a new CD4 counts tresod for ntatng ART È35â ces/cu.È and swtcng frstâne ART fro d4Tâ to TDFâcontanng regens. ART stes were furter decentraed to prar care factes n te 2â13 caendar ear. Te nuber of statc stes provdng ntegrated ART servces ncreased sgnfcant, fro 3ââ stes n une 2â11 to 6ͺͻ b Deceber 2â13. Te nuber of patents beng ntated on ART ncreased stead durng te 2â13 caendar ear. As of Deceber 2â13, te tota nuber of patents ave on ART was 472,ͺ65, wt 1â2,5ͺ6 ntated n te ear 2â13 aone. Usng te CD4 ce count of â¤35â as a tresod for deternng egbt to ART, s estated tat, b te end of Deceber 2â13, ART coverage n Maaw was about ͺ3%, up fro 65% n 2â12. Survva rate at 12âont for ART patents as reaned stabe at near 7ͺ% n te ear 2â13. Ts s sgt ower tan te survva rate of ͺ5% recoended b O. 3.3.2.IsoniazidPreventiveB te end of Septeber 2â13, 46,41Í» È31%È of a patents ever regstered were retaned n preâART foowâup; 63,Í»15 È43%È ad started ART; 33,434 È22%È ad been ost to foowâup; 1,6ͺ3 È1%È were nown to ave ded. n te trd quarter of 2â13, Cotroaoe Propas Terap ÈCPTÈ coverage aong preâART patents was 4â,7Í»1 Èͺͺ%È. Consderng te ow coverage of cotroaoe propas n te 2â11/12 fsca ear, Maaw sees to ave successfu overcoe te sortages n cotroaoe suppes. A preâART patents wt a negatve screenng outcoe for TB sptos are egbe for sonad ÈNÈ Preventve Terap ÈPTÈ. B te end of Septeber 2â13, 23,234 È5â%È of 46,41Í» patents retaned n preâART were on PT. Ts was a ared proveent fro 27% ÈÍ»,613/35,265È recorded at te end of Septeber 2â12. owever, te proporton of patents on PT n Septeber 2â13 was ess tan 5ͺ% È27,41ͺ/47,12Í»È reported at te end of une 2â13. PT coverage was epected to ncrease furter over te net quarters due to ncreased avaabt of sonad n prar care eat factes. 3.3.3.Managementn te 2â13 caendar ear, 75% Èͺ454/112Í»6È of te estated nuber of ncdent TB cases receved bot TB treatent and ART. Atoug ts fgure fas sort of te O target of ͺ5%, t as ncreased ared fro 6â% reported n 2â12. Ts s e due to te arge proporton È>Í»5%È of TB patents undergong V screenng. n 2â13, TB screenng, usng cnca assessent, was perfored n ͻͺ% of te patents on ART. owever, TB was detected n on 1.6% of patents on ART. Ts ow TB ed suggests poor senstvt of te cnca assessent or dagnostc toos avaabe at te eat fact eve. Soe staeoders epressed concern tat eat worers n an eat factes ave a g case oad of V patents and a eperence te constrants n screenng patents for TB toroug. TB and V prograes at natona eve eperenced caenges n reconcng data suggestng te need to prove TB/V ntegraton at eat fact eve. 3.3.4.HomeDurng te 2â12/13 fsca ear, a tota of 17ͺ,ââ1 ouseods wt cronca patents, were supported n varous was, aganst a target of 2ââ,âââ Èand a reducton fro 2â2,57ͺ n 2â11/12È. A cuuatve tota of 1,236 count vounteers and eat personne were traned n CBC/paatve care, representng 72% aceveent of te annua target. t te contnued ncrease of PV vng eat ves wt ART, t can be epected tat te nuber of cents on countâbased care w contnue to decrease n te cong ears. 3.3.5.QualitativeAssessmenteffectivenesstreatment,Tere was unanous agreeent aong te staeoders tat te ART prograe as been a great success n ters of ncreased coverage, decentraaton to prar care fact eves and swtcng of an patents fro te d4Tâbased ART frstâne regen to TDFâbased regen. owever, soe respondents fet te need to prove coverage of ART aong cdren and adoescents. Man respondents aso epressed te need to deveop poces and strateges to prove te anageent of oung adoescents on ART. Man staeoders were of te vew tat TB and V actvtes were we ntegrated at eat fact eve and tat te coverage of cotroaoe and sonad propas ad proved. Neverteess, soe respondents epressed concern over te eav dependence of te ART prograe on eterna fnanca support ,wc a affect ts sustanabt. Oters noted a sgnfcant ossâto foowâup of ART patents and te need to ntensf efforts n aderence counseng of patents. Staeoders epressed concerns over te subâopta dever of te oeâbased care servces. Te noted te need for nutrtona support for ART patents wc a prove ter survva. Soe were of te vew tat oeâbased care coud ncude a coponent of aderence counseng and pscosoca support. 3.4.Mitigationn Maaw, pact tgaton actvtes are guded b te Natona Poc for orpans and oter Vunerabe Cdren, te Natona Soca Support Poc and te Natona Acton Pan for Orpans and Oter vunerabe Cdren ÈNPA for OVCÈ and are ed b te Mnstr of ender, Cdren and Soca efare. Te NPA for OVC epred n 2ââÍ» and ts was etended to 2â11. Current te oM and staeoders are deveopng a new NPA for cdren and tere w be no separate Pan for OVC. Ts new Pan w be avaabe b une 2â14. ChildreninstitutionalTe poc of te oM s tat a cdren soud be rased n ter own countes and tat te nsttutonasaton of cdren soud be te ast resort. owever soe cdren a be teporar or peranent deprved of ter fa envronent and ence te w be provded wt aternatve care n an nsttuton. A 2â1â assessent of cdren n nsttutona care found tat tere were 1â4 nsttutons carng for cdren n Maaw and tese ncude orpanages, speca needs centres and reforator centres. Tese nsttutons were tang care of 6,â4â cdren and 71 percent of tese cdren were orpans. n ost of tese nsttutons te needs of cdren suc as food, cotes and scoo fees were beng et. Tese nsttutons are terefore contrbutng towards respondng to te V epdec b addressng te needs of OVC. Tere s no current data on te nuber of suc nsttutons n Maaw as we as te nuber of cdren beng taen care of b tese nsttutons. owever, a 2â13 pact evauaton of te NPA for OVC observed tat tere are no reported actvtes to prevent nsttutonaaton3.4.2.centresTe oM prootes te estabsent and anageent of count based cd care centres ÈCBCCsÈ as one wa of respondng to te needs to OVC n Maaw. Tese CBCCs are owned and run b countes teseves. Suc centres provde opportuntes for cdren to earn, pa and sng and access food. A 2ââ6/7 surve cossoned b UNCEF sowed tat tere were 5,665 CBCCs n Maaw and tat a tota of 41â,âââ cdren were enroed n tese CBCCs. A 2â13 report sows tat tere are 5,6âÍ» CBCCs n Maaw carng for 336,4ͻͻ cdren a drop fro 771,âââ cdren n 2â11. 3.4.3.ThesocialcashtransferprogramTe Maaw Soca Cas Transfer Progra ÈSCTPÈ was desgned to aevate povert, reduce anutrton and prove scoo enroent b deverng reguar and reabe cas transfers to utra poor ouseods tat are aso abour constraned. Te progra was poted n Mcn dstrct wt support fro te oba Fund and UNCEF. As of 2â11 te SCTP was beng peented n Mcn, Saa, oa, Ctpa, Mangoc, Macnga and Paobe dstrcts. One of te aor aceveents n 2â13 was tat te progra as been etended to 1Í» dstrcts wc pes tat ore orpans and ter ouseods are beneftng fro te progra. Ts progra s ost funded b deveopent partners. Over te ears te fnanca contrbuton b te oM as been ncreasng; for eape n 2â11/12 oM contrbuted M7â on and n 2â12/13 ts ncreased to M2â6 on and n te current fnanca ear t as ncreased to M45â on. Oter aceveents n 2â13 ncuded te estabsent of an autoated webâbased anageent nforaton sste, te potng of an eâpaent sste for benefcares of te progra, te approva b oM of a structure for peentng te cas transfer progra and an ncrease n transfer eves fro M2,âââ to M2,7ââ per ouseod. Te evauaton of ts progra as sown tat USAD and UNCEF. È2â13È. pact evauaton of te Natona Pan of Acton for Orpand and oter vunerabe cdren 2ââ5â2ââÍ» and 2â1ââ2â11È. ongwe: USAD and UNCEF. USAD and UNCEF. È2â13È. pact evauaton of te Natona Pan of Acton for Orpand and oter vunerabe cdren 2ââ5â2ââÍ» and 2â1ââ2â11È. ongwe: USAD and UNCEF. te prevaence of underâwegt cdren as gone down; food securt proved; and scoo enroent and retenton ncreased aong oter benefts. Te aor caenge wt te progra s tat t s ver epensve and wtout donor support, t s not sustanabe. 3.4.4.SchoolattendanceamongorphansTs ndcator s easured troug te MDS. Te ast MDS was conducted n 2â1â and t found tat te rato of current scoo attendance aong orpans to nonâorpans aong te 1ââ14 ear ods was at â.Í»6. 3.4.5.needsforn te 2â12/13 fsca ear, a range of negatve socoeconoc and atera effects were fet b ouseods, etended faes, negbouroods, and countes affected b V and ADS. Te Caregvers Acton Networ report n une 2â13 dentfed povert as a contnung aor ssue, wt an groups Ç®often unabe to eet veood caenges, to send cdren to scoo and to bu basc necesstes for teseves and ter faesǯ. Food nsecurt, educaton and epoent were aso sgnfcant probes for Peope vng wt V ÈMANET+ Stga nde, anuar 2â13È.Durng 2â12/13 fsca ear, a tota of 12,ââ1 orpans and oter vunerabe cdren were provded wt educaton bursares to attend secondar scoo educaton, representng a 12â% aceveent aganst te set annua target. owever, te panned appng of provders of scoo bursares, to enabe better coordnaton and use of te ted resources was not carred out. n addton te panned revson of te bursar gudenes dd not tae pace. Partners, n partcuar count groups, noted tat tere are nadequate resources for te educaton bursares, gven te nubers n need. Addtona 2,1ͺ1 vunerabe oung peope were traned n vocatona ss durng te reportng perod È45% underaceveent aganst te annua target.È A tota of 1â1,Í»32 orpans and oter vunerabe cdren were provded wt varous fors of support ncudng edca, atera, fnanca and pscosoca support, surpassng te annua target b 13 per cent. 3.4.6.QualitativeAssessmenteffectivenessimpactmitigationsactivitiesTe dever of servces to orpans and oter vunerabe cdren was rated poor b staeoders. Te fet tat pact tgaton nterventons at bot natona and dstrct eves are not we coordnated n te countr. Te aso epressed te need to assess te pact of current pact tgaton nterventons. Te recoended te need for NAC to engage te Mnstr of ender, Cdren and Soca efare to dentf was of provng servces dever. One oter aor caenge was tat we soca cas transfers ave deonstrated tat te ave postve pact n ters of provng access to food, cotes and genera wefare te progra s ver epensve and ence not sustanabe. Tere was aso a ca tat te NPA for cdren soud be fnaed quc so tat t can gude te peentaton of nterventons for OVC and ter ouseods. Mer, C.M., M. Tsoa. È2â11È. ARVsandcaringsupportingpeoplewithANDAIDSwiththeMalawiSocialCashTransfer. PRACTICES4.1.PoliticalcommitmentMaaw contnues to deonstrate potca cotent to te fgt aganst V and ADS. er Eceenc te Presdent of te Repubc of Maaw, Dr oce Banda, as deonstrated er cotent troug an was: se s te Mnster responsbe for V/ADS and bot te Departent of Nutrton and V and ADS and te Natona ADS Cosson wc oversee and coordnate te natona response are n er offce. n une 2â13 te Presdent osted te UNADS and ancet Cossoners Conference and se s a oba Abassador for V and ADS. Maaw aso conducted te ega and Poc Envronenta assessent wc as aong oter tngs nfored te draftng of te V B as we as nforng te deveopent of V nterventons. Once te V B s passed, t w assst n protectng and prootng peopesǯ rgts n te contet of V and ADS. 4.2.ProgrammeImplementation4.2.1.ScaleMaaw deonstrated as deonstrated tat g eves coverage of coverage TC and ART for pregnant woen can be aceved even n resource ted settngs troug te adopton of te Opton B+ strateg and effectve use of uan resources. To aceve ts, ART servces were decentraed to prar care factes and ntegrated wt Materna and Cd eat servces. n addton, nstead of cncans prescrbng ART, nurses ave been traned and are now abe to prescrbe ART to patents. A arge nuber of prar eat care fact staff were successfu traned and are now te bacbone of V care dever. ART treatent regen was spfed, b ntroducng one regen for nonâpregnant and pregnant aduts. Ts factated eat worersǯ faart and eperence wt a specfc ART regen and factated te procureent A group of tecnca eperts fro te dstrct, ona and centra eve ontor te peentaton of EMTCT servces at prar care eve. Te quarter vsts obtan g quat data wc can b anaed quc and used to nfor peentaton of actvtes. 4.2.2.TransferTe Soca Cas Transfer Progra ÈSCTPÈ wc was poted n Mcn dstrct as now beng peented n 1Í» dstrcts wt support fro deveopent partners. An evauaton of te Maaw SCTP, as dscussed above, sows tat te progra as ad a postve pact and t s beng scaed up. e acnowedgng tat te progra s epensve and ence sustanabt needs carefu evauaton, t as owever pacted on ouseods especa OVC postve for eape cdren rean n scoo and ave access to food. CHALLENGESACTIONSProgressmadekeychallengesreportedthe2012ProgressA nuber of caenges were dentfed n 2â12 wc apered te peentaton of te natona response to te V and ADS epdec. Soe of te caenges st est and ave not been successfu addressed. Tese caenges ncude wea supp can sstes, nadequate nterventons targetng e popuatons suc as se worers and MSMs, stga and dscrnaton wc nder access to V and ADS servces for PVs, nonâdsburseent of funds fro te oba Fund, te ac of standardsaton of count engageent toos and servce dever protocos and peentaton of soe e nterventons suc as nonâboedca beavoura cange nterventons., n addton to ts te nuber of new nfectons are st qute g. Even toug a ot of nvestents ave been ade n te peentaton of nonâboedca V and ADS preventve nterventons wc are aed at brngng about beavoura cange, tere s st no evdence about te effectveness of tese nterventons. n addton to tese probes te foowng ave been dentfed as affectng peentng of te V and ADS nterventons n 2â13: ted budgetar aocaton especa to nonâboedca preventon nterventons. An overa wea researc and M&E sste especa at dstrct Tere s a genera ac of sarng of data at dstrct and ower eves and te capact to ute data for decson ang s ow. Nonâagnent of soe N Os nterventons and M&E sstes to utâsectora V and ADS strategc pan. A uge fundng gap st ests to enabe staeoders fu peent te Natona V and ADS Strategc Pan. A ted range of servces targetng out and V+ cdren. Tere est soe nconsstences between poces and aws on en avng se wt en and se worers. Tere s soe eergng concern tat te use of condos n soe areas of te countr s droppng because of te beef tat VMMC s protectve. Coverage for VMMC s st ver ow. And te eat sector acs capact to eet te deand for VMMC. Ear nfant dagnoss s st a aor caenge. Te nuber of OVC and ter ouseods beng reaced wt dfferent nterventons s st sa. ea coordnaton ecanss for OVC progras and te ac of te NPA for OVC to gude peentaton of nterventons. V B s et to be enacted. ted capact of peentng partners for beavoura cangnterventons. Sustanabt of te soca cas transfer progra s beng questoned. FROMTHECOUNTRYSDEVELOPMENTPARTNERSsupportdevelopmentpartnersn 2â13, deveopent partners contrbuted over Í»â% of te fnanca resources for te peentaton of te natona response to te V and ADS epdec. Tese ncude te oba Fund, PEPFAR, ord Ban, DFD, CDA, Norwa and te UN agences. Most of te deveopent partners ave agned ter V and ADS actvtes to te Natona V and ADS Strategc Pan and te drect support nterventons as detaed n te NSP. Deveopent partners contnue beng ebers of te Maaw V and ADS Partnersp Foru ÈMPFÈ and te Maaw oba Fund Coordnatng Cottee ÈM FCCÈ. Te MPF s an advsor bod to te NAC Board supportng te eadersp and coordnaton ecanss of te NAC and servesecans tat nes wastefu dupcaton of efforts n scang up te natona response to V and ADS. Te M FCC s a cottee setâup to provde oversgt and governance of oba Fund grants n Maaw. Te are aso ebers of te V and ADS Deveopent roup ÈA DÈ wose obectves are to aronse and coordnate deveopent partnersǯ support to te peentaton of te NSP and to agn deveopent partnersǯ support to te ntegrated annua wor pan. A nuber of Tecnca orng roups ave been fored as part of te natona response to te V and ADS epdec and deveopent partners are ebers of tese T s. n 2â12/2â13 deveopent partners an provded tecnca assstance as we as fnanca resources to te Natona ADS Cosson, te M FCC and te peentng partners n Maaw. UN agences ave supported te natona response b supportng te conduct of severa studes wc were aed at generatng evdence to nfor te deveopent of nterventons as we as poces. For eape UNADS supported te conduct of te NASA n 2â13, te Dznow our Epdec and Response and Modes of Transssondz stud and te Boogca and Beavoura Surveance Surve ÈBBSSÈ. Oter UN agences aso provded tecnca assstance n supp can anageent for V coodtes, te deveopent of te Natona V/ADS Poc, te Capact Deveopent Pan and te revew of te Natona V/ADS Strategc Pan. UNADS aso provded tecnca assstance to support te nter fundng appcaton tat Maaw subtted to te oba Fund for fundng. n 2â13 UNADS aso supported te frst ancet Cosson Conference tat tooTe UN as aso been nstruenta n te provson of tecnca assstance n te revew of egsaton, ncudng te draftng of te V B, eporng sustanabe fnancng ecanss and as provded support n te deveopent of strategc docuents. O n partcuar provded tecnca assstance on te new treatent gudenes and on TB/V ntegraton we UNCEF as been nstruenta n addressng ED caenges tat Maaw s eperencng troug tranng and transportaton of sapes. UNFPA as aso been qute nstruenta n supportng wor wt e popuatons suc as se worers, MSMs especa focusng on creatng awareness about ter rgts. Maaw s now peentng VMMC as one of te nterventons for preventng V nfecton. n 2â13, ts nterventon was ost supported b te US overnent, troug PEPFAR. n addton to ts, te US overnent s aso supportng a Tecnca Assstant n nd M&E, as we as BC nterventons. developmentpartnersachievementn order to ensure tat Maaw aceves te targets as set n te 2â11 Potca Decaraton on V and ADS, deveopent partners w need to do te foocontnue supportng te NAC and peentng partners and cose te fundng gap tat as been dentfed. contnue supportng operatons researc ncudng surveance n order to nfor prograng and poc foruaton. ensure tat Maaw overnent taes te ead n decdng te aocaton of fnanca resources for V and ADS, based on oca researc evdence n ne wt te Pars Decaraton, support nterventons as defned n te NSP and wn parae peentng ecanng cdren and adoescents wsupport te ntroducton and peentaton of effectve nterventons targetng e popuatons suc as MSMs, se worers and prsoners, we apprecatng te need to adere to acceptabe deocratc processes for cangng te ega envronent. support te budng of tecnca and anageent capact of Maawan ndvduas, nsttutons and nonâgovernenta organaton. MONITORINGANDoverviewthecurrentmonitoringevaluationsystemMaaw subscrbes to te Dztree onesdz prncpe wc cas for one natona strategc pan, one natona coordnatng bod and one natona M&E sste. Te natona M&E sste s coordnated and anaged b te Natona ADS Cosson wt oversgt fro te Departent of V/ADS and Nutrton n te Offce of te Presdent and Cabnet. Te Departent of Pannng, Montorng, Evauaton and Researc at te Natona ADS Cosson s responsbe for M&E actvtes ncudng te producton of quarter and annua M&E reports. Maaw as a Montorng and Evauaton Pan for te perod 2â12â2â16 and s agned to te Natona V/ADS Strategc Pan 2â12â2â16. Te M&E pan provdes gudance to a V/ADS peentng partners n Maaw on ow te can report ter M&E actvtes to te Natona ADS Cosson. A Montorng, Evauaton and Researc T as been fored and ts functon s to oversee V ontorng and evauaton ssues wtn te natona response and t s supposed to eet quarter. peentng partners for V and ADS nterventons are supposed to report to te oca councs usng te oca Autort V and ADS Reportng Sste ÈAARSÈ wc coects bot boedca and nonâboedca data. Te oca counc, n turn, report to te Natona ADS Cosson on a quarter bass. Based on tese reports te Cosson copes quarter and annua reports. Routne M&E data s terefore coected and reported to te Cosson. Te Mo aso peents te MS wcoects routne data on V and ADS. Te Departent of V n te Mo as aso deveoped a parae sste wc s beng used for coectng data on boedca nterventons nae TC, PMTCT and ART on a quarter bass. n addton to te routne M&E prograe data, tere are severa popuaton based surves tat aso for part of te natona V and ADS M&E sste. Tese surves, snce te are conducted after ever few ears, are used for tracng bot te outcoe and pact ndcators. Suc surves ncude te Maaw Deograpc and eat Surve, te utpe ndcators custer surves ÈMCSÈ and te Boogca and Beavoura Surveance Surves conducted b te Natona Statstca Offce; and te V Sentne Surveance Surves conducted b te Mnstr of eat. n addton to ts tere are aso soe geograpca specfc surves tat are carred out b peentng partners to nforaton progra desgn. implementationsystemTe peentaton of te M&E sste n Maaw as been decentrased and oca councs are supposed to generate data and cope reports wc are sent to te centra eve. owever, one of te aor caenges beng eperenced at oca counc eve s tat tere s crtca sortage of staff to effectve generate datof te staff as we ac te requste M&E ss. Dstrct ADS Coordnators ÈDACsÈ pa an portant roe n ters of obsng varous sectors to subt reports wc can subsequent be sent te Natona ADS Cosson. ere DACs are avaabe copance wt natona V and ADS reportng requreents are adered to. owever n a nuber of dstrcts n Maaw tese DACs are not avaabe ence affectng reportng to te Natona ADS Cosson. Te sortage of staff s not on at oca counc eve but aso n te Departent of Pannng, Montorng, Evauaton and Researc at te Natona ADS Cosson: tere are supposed to be 5 offcers but for te past 2 ears tere ave been 3 operatons of te Departent. UNADS cas for one M&E sste. n Maaw, atoug tere s an M&E Pan, te caenge s tat tere are a nuber of peentng partners bot at natona as we as oca counc eve wose M7E sste as not been agned wt te natona M&E sste beng used b te Natona ADS Cosson. Soe partners are peentng ter own M&E sste and ts s especa te case f tese partners are not beng funded b te Natona ADS Cosson. Te nterest for ost of tese organsatons wose M&E sstes are not agned to te natona M&E sste s to fuf te M&E requreents of ter fundng agences. A sgnfcant proporton of te staeoders do not report to te Natona ADS Cosson and even were te report te reports are ncopete and unte. Fnanca resources are requred n order to peent a copreensve M&E sste. owever on about 5% of te V progra budget s for M&E peentaton. Te resources aocated to te M&E pan wtn te Natona ADS Cosson s nadequate to effectve eet M&E resource requreents. Oter peentng partners aso fa to report because of te ac of fnanca resources. ast anoter caenges affectng te M&E fraewor n Maaw s tat tere s ted use of data especa at oca eve for decson ang. Te M&E pan outnes a nuber of data sources for te M&E sste suc as te Maaw Deograpc and eat Surve and te Boogca and Beavoura Surveance Surves. For soe of tese surves te Natona ADS Cosson does not ave te powers to ensure tat te are done te to nfor te natona V and ADS cts te overa M&E sste as RemedialactionsplannedM&Eexperiencedn order to address te sortage of staff at te oca counc eve, te Natona ADS Cosson s provdng fnanca resources for te recrutent of DACs n dstrcts were tese are not avaabe. Te fng of tese postons at oca counc eve w ensure tat DACs are avaabe wo can wor wt CBOs and oter peentng partners to provde data/reports for te natona response. tn te Departent of Pannng, Montorng, Evauaton and Researc, we awatng for te fng of te 2 vacances, two nterns w be recruted to wor wtn te Departent. n order to address te probe of nonâagnent to reportng sstes, pans are beng pursued for peentng partners recevng fundng outsde te Natona ADS Cosson to sgn a Meorandu of Understandng for te to use te M&E sste. Tere ave aso been attepts to provde resources for tranng or orentng DACs, data entr cers and M&E offcers on ow to use te AARC. Ts ntatve w contnue. n addton to tese nterventons tere s a need for staeoders to advocate for ore funds beng aocated to M&E at a eves. ast tere s contnued need for budng capact of users n utsaton of M&E and researc data for poc and progra deveopent.needM&EtechnicalassistanceandbuildingTe Natona ADS Cosson sas tat t needs tecnca assstance to address soe of te M&E caenges tat are beng eperenced. Te M&E sste as been decentraed and te one at oca counc eve s not ned to te natona eve sste. Tese two soud be ned. Te Natona ADS Cosson s terefore oong for tecnca assstance n ters of deveopng a webâbased sste suc tat once te data s entered at oca counc eve ten t soud edate be avaabe and accessed at natona eve. Te V and ADS sector s aso caractered b parae M&E sstes wc are not ned. Tere s terefore a need for tecnca assstance to ensure tat tese parae sstes spea to eac oter. ANNEXESANNEXConsultation/preparationprocesscountryreportProvded separate ANNEXNationalCommitmentsandPolicyInstrumentProvded separate ANNEXListthevalidationORGANISATIONDESIGNATION 1. Mac Ban Mandawre ONECOâobaEecutve Drector 2. Auree Andrason UNADSCMNA 3. Erca Noc UNADSR & ender 4. Ae Seds CAV Fnancng 5. Troube Coo UNADSSA 6. upres Suba UNFPANPOâV 7. Dave aoba NACPMER ͺ. Marra Mangoc DNA âOPCDA Í». Dr. Rosear uwenda UNDPV Poc Advsor 1â. Moses Cow NACM & E Offcer 11. ev wanda NACM & E Offcer 12. engan Crwa V/ADS MOT/A Care & Treaten 13. Macene Cguua Maaw PoceServceV & ADS 14. Saoe Cbwana MANET+PO, M & E 15. Brenda aangaPS MaawV Progra Manager 16. usao Munenebe MRCPrncpa uan Rgts Offcer 17. ness . Soo MBCACouncatons 1ͺ. Ace Cenga DNAM & E Offcer 1Í». Vctor ane DNAV & ADS Offcer 2â. Vctor B aa CEDEPResearc Offcer