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. 2006 Apr;82 Suppl 1(Suppl 1):i9-13.
doi: 10.1136/sti.2005.016030.

Assessment of trends in biological and behavioural surveillance data: is there any evidence of declining HIV prevalence or incidence in Malawi?

G A Bello  1 , J Chipeta, J Aberle-Grasse
Affiliations

Assessment of trends in biological and behavioural surveillance data: is there any evidence of declining HIV prevalence or incidence in Malawi?

G A Bello et al. Sex Transm Infect. 2006 Apr.

Abstract

Objectives: In 2003 an estimated 87 000 AIDS deaths and approximately 110 000 new infections occurred in Malawi. This paper aimed to analyse and review HIV prevalence trends in conjunction with other second generation surveillance data including behavioural data and, therefore, to describe trends in HIV prevalence and behaviours related to HIV transmission.

Methods: In order to determine the extent of the problem, HIV prevalence in Malawi has been monitored through testing women attending antenatal clinics in 19 sentinel sites consistently since 1994. These sites are classified as urban, semi-urban, and rural.

Results: The overall HIV prevalence for all 19 ANC sentinel sites in 2003 was 19.8% (95% CI 19.0% to 20.7%). The central region urban/semi-urban sites showed a decline in prevalence from 1999 to 2003. Since 1997, overall national incidence estimates remained stable. This stable incidence estimate is supported by the proxy of fairly stable prevalence in ANC attendees aged 15-24 years. HIV sentinel surveillance data for Lilongwe city showed a significant linear decline in prevalence (p<0.00001) over the last seven years for both all ANC attendees and those aged 15-24 years suggesting that incidence has declined over the time period.

Conclusion: The available epidemiological and behavioural surveillance data show that HIV prevalence has declined in several urban and semi-urban areas, specifically in the central region with Lilongwe (capital of Malawi) showing exceptionally strong evidence of decline. In some rural areas, particularly in the northern region there is some evidence of an increasing trend in HIV prevalence.

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Conflict of interest statement

Competing interests: none declared

References

    1. National AIDS Commission Malawi national HIV/AIDS estimates 2003; Technical report. Malawi: NAC, January, 2004
    1. National AIDS Commission HIV sentinel surveillance report 2003. Malawi: NAC, 2003
    1. National Tuberculosis Control Program Report of a country‐wide survey of HIV/AIDS services in Malawi for year 2004. Malawi: NTP, MOH, 2005
    1. MEASURE Evaluation AIDS in Africa during the Nineties: Malawi. A review and analysis of survey and research results. Chapel Hill, NC: Carolina Population Center, University of North Carolina at Chapel Hill, 2004
    1. Joint United Nations Programme on AIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance Guidelines for conducting HIV sentinel serosurveys among pregnant women and other groups. Geneva: WHO, 2003