AIDS 2026: Malawi Targets the “Last Mile” of HIV Epidemic Control Through Community Care

Malawi’s progress toward HIV epidemic control demonstrates what sustained testing and treatment can achieve, but important disparities remain between adults and children. Community-based interventions that identify HIV-exposed infants who have missed testing or follow-up may be essential to closing that remaining gap.

During an interview with Infection Control Today^®, Endale Tilahun, MD, MPH, chief of party in Malawi for Project HOPE Namibia, described how community health workers help connect vulnerable children and their families with clinical and social services when traditional facility-based care is not enough.

Among 12 children identified as HIV positive through the program, all were placed on treatment and transitioned from services for HIV-exposed infants into programs specifically supporting children living with HIV.

“Treatment is so powerful. HIV treatment is so powerful,” Tilahun said. “They can lead a healthier life with the support of the parents and the household support.”

That household support is central to the program. Community health workers remain closely involved with caregivers, while the initiative works with both the Ministry of Health and the Ministry of Gender, Children, Disability, and Social Welfare.

When health facilities identify children who have missed important HIV testing milestones, community teams can use that information to locate families, determine what prevented follow-up, and reconnect them with care.

“We bridge in between the facility and the community,” Tilahun said.

Transportation can be a major obstacle. When necessary, teams help families reach health facilities, including children who require evaluation for opportunistic infections or other health concerns. The approach reflects an understanding that successful HIV care requires addressing both medical and social barriers.

The remaining pediatric gap is significant. Tilahun said Malawi has achieved the 95-95-95 targets among adults: 95% know their HIV status, 95% of those diagnosed are receiving treatment, and 95% of those receiving treatment have achieved viral suppression. Among children, however, he cited viral suppression of approximately 84%.

For infection prevention and public health professionals, that difference demonstrates why facility-based strategies alone may not reach every vulnerable patient.

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

The lesson extends beyond HIV. Effective disease prevention may require health systems to identify who is missing from care, understand why, and build bridges capable of reaching them where they live.