• Service: Advisory
  • Type: KPMG information
  • Date: 1/23/2014

Government approves improved drugs for treatment of 450,000 people living with HIV 

In Malawi, campaigning targeted at policy makers led to the phasing out of the first line treatment “Triomune” containing D4T for People Living with HIV (PLHIV). As a result, 450,000 PLHIV on Antiretroviral Therapy will benefit from better new treatment which has fewer side effects.
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Context and Theory of Change


Key elements of context


  • Malawi is one of the countries with the highest HIV prevalence rates in the world (10% in 2010)
  • Nearly one in four women aged 34 to 39 was HIV positive in 2010
  • Out of the 950,000 People Living with HIV (PLHIV), 450,000 are on ART in 2013, up from 350,000 in 2011/12
  • ART “Triomune” contains d4T, responsible for at times severe side effects
  • Government is aware of those side effects. In 2010 the World Health Organisation (WHO) recommended the phasing out of the drug due to its long-term irreversible side effects.
  • Although CSOs were confident to engage with Government/Parliament, the Government was slow to prioritize and respond to the calls for change
  • Policy makers were indifferent to calls for change by CSOs because they believed that Government was already doing enough for PLHIV by ensuring that there was treatment available, regardless of its side effects
  • Lack of evidence to campaign for greater involvement of PLHIV


Theory of change


A three-pronged approach was envisaged to tackle the delays in phasing-out “Triomune” containing D4T: 1) Tackling Government complacency; 2) Strengthening of the PLHIV network; 3) Use of the media.


Although the WHO had recommended the phase out of “Triomune”, the Government did not see the urgency for action. Prior to the Leadership through Accountability (LTA) programme, Civil Society was not united with regard to the topic. The PLHIV network faced challenges in terms of financial management, resource mobilization and planning, managing and undertaking research, including the analysis and dissemination of results.


A strong PLHIV network, enhanced by applying research to international standards, was needed to engage policy makers with the challenge to identify and target the relevant issues. Media coverage during these discussions was to further increase the pressure on policy makers.