Malawi is a land-locked country located in Southern-Central Africa, sharing borders with Tanzania, Zambia, and Mozambique. It has a land area of about 118,484 km2, with a projected population of about 16.4 million. The country is divided into three geographical regions (north, central, and south). There are 28 districts organized into five health zones (Northern Zone, Central Eastern Zone, Central Western Zone, South Eastern Zone, and South Western Zone).
TB remains a major public health problem in Malawi. According to a 2014 WHO report, there were an estimated 16,267 new cases of TB (all forms) in the year 2014, and approximately 54% of these were HIV positive. The prevalence of TB (all forms) in the country was estimated at 334 per 100,000.
The TB CARE II Malawi Project is a coordinated effort led by URC in collaboration with Project HOPE and Partners in Health. The project aims to:
- work with the government of Malawi to reach and sustain global and national targets for case detection and treatment success through DOTS expansion and strengthening;
- scale up universal access to TB diagnosis and treatment, especially in women and vulnerable populations, utilizing community-based approaches;
- improve TB/HIV integration at all levels, particularly at the health facility level, and offer high quality DOTS through a wider range of service delivery outlets, especially for PLHIV;
- increase access to drug-resistant TB prevention and treatment through community-based approaches and improved diagnostic capacity for drug susceptible and drug resistant TB.
The major project interventions are focused on both the national and district levels, in close collaboration with the National Tuberculosis Program (NTP) and the Ministry of Health. At the national level this includes strengthening the laboratory network and improving the Central Reference Laboratory (CRL) capacity, supporting the nascent drug-resistant TB (DRTB) treatment program, piloting novel diagnostics, and strengthening the NTP centrally. Activities in target districts are focused on implementing a comprehensive package that includes: emphasis on DOTS expansion and enhancement, integration of TB/HIV services, improved services for DRTB and health system strengthening through the decentralization of services, improvement of the laboratory network, and involvement of community structures in diagnosis and patient follow-up. TB CARE II works in Machinga, Mangochi, Mulanje, Neno, Ntcheu, Phlalombe, Nsanje, Nkhotakota, Mzimba, Balaka, Zomba, Lilongwe, and Chikwawa.