AIDS 2026: Closing the Last-Mile Gap: Bringing HIV Care From Malawi’s Clinics Into Children’s Homes

Malawi has made remarkable progress toward controlling HIV among adults, but achieving the same success among children requires reaching beyond hospitals and clinics and into the communities where vulnerable families live. A community-based approach is helping close that gap by finding HIV-exposed infants and children who have missed critical testing or follow-up milestones and reconnecting them with care.

The program operates across both the health and social service systems, collaborating with Malawi’s Ministry of Health and the Ministry of Gender, Children, Disability, and Social Welfare. When clinical partners identify an HIV-exposed infant who has missed testing or follow-up at 12 or 24 months, community health and child protection workers use those records to locate the child and family.

“We bridge in between the facility and the community,” Endale Tilahun, MD, MPH, chief of party in Malawi for Project HOPE Namibia, explained to Infection Control Today^®. “That connection is especially important when families face barriers such as transportation, illness, or other circumstances that prevent them from returning to a health facility. When necessary, the program can help facilitate transportation and reconnect children with clinical services.

The intervention also continues to support children who are diagnosed with HIV. Of 12 children discussed during the interview who were found to be HIV positive, all were placed on treatment. They subsequently moved from the HIV-exposed infant population into services specifically designed for children living with HIV.

“Treatment is so powerful,” the interviewee said. “They can lead a healthier life with the support of their parents and the household support.” Community health workers remain closely involved with households and caregivers to help children stay connected to care.

The strategy addresses an important disparity in Malawi’s HIV response. According to the interviewee, the country has achieved the UNAIDS 95-95-95 targets among adults, meaning 95% know their HIV status, 95% of those diagnosed receive treatment, and 95% of those receiving treatment achieve viral suppression. Children, however, continue to lag behind, with viral load suppression reported at approximately 84%.

Closing that difference requires finding children who may be nearly invisible to a facility-based system.

“These children...are important to be traced and fill the epidemic control gap,” the interviewee said. “It’s like the best way to describe it is a last-mile intervention for the epidemic.”

For infection prevention and public health professionals, the program offers a broader lesson: Prevention does not end at the doors of a health care facility. Sometimes, the final and most difficult step in disease control is finding the people that the traditional system cannot reach.