Data validation on the findings conducted by the Network of Journalists Living with HIV (JONEHA) have revealed widespread concerns around access to viral load testing services across health facilities in Mulanje, Phalombe and Zomba districts.
The findings are part of monitoring activities conducted under the Community Monitoring and Engagement for Transformation (COMET) Project; a two-year initiative being implemented by JONEHA with financial support from the International Treatment Preparedness Coalition (ITPC). Running from July 2025 to July 2027, the project aims at strengthening community monitoring of HIV and Tuberculosis services while documenting the real-time effects of the 2025 United States funding freeze on essential health services. The project seeks to transform community-generated data into actionable evidence that can inform health decision-makers and strengthen accountability in the health system.
Data collected from 997 respondents across the three districts indicated that 489 respondents reported challenges accessing viral load services, highlighting gaps in one of the most critical components of HIV treatment cascade Viral load testing measures the amount of HIV in a person’s blood and helps determine whether treatment is effectively suppressing the virus. It is crucial in informing management of recipients of care on HIV treatment.
The challenges were particularly pronounced in Mulanje and Zomba districts, where a large proportion of respondents indicated difficulties accessing viral load testing services.
In Mulanje, about 66.9 percent of respondents reported viral load access challenges. Some facilities recorded even higher levels of concern. At Kambenje Health Centre, for example, more than 80 percent of respondents indicated problems accessing viral load testing services.
A similar pattern emerged in Zomba district, where nearly 60 percent of respondents reported difficulties accessing viral load services. Facilities such as Chingale Health Centre and Domasi Health Centre recorded some of the highest proportions of recepients of care reporting challenges.
Although Phalombe district reported fewer complaints, with just over 20 percent of respondents indicating challenges, validation meetings conducted in February 2026 revealed that research significant viral load testing disruptions had also occurred in the district.
During the validation process, the ART Coordinator for Phalombe, Harrold Mwaleya explained that viral load services had been affected by equipment failure.
“The main challenge we experienced was a breakdown of the viral load testing machine, which affected our ability to process samples,” explained the ART Coordinator for Phalombe District during the validation meeting. “When the machine is not functioning, samples cannot be processed and that creates delays in recipients of care receiving their results.”
Health experts note that viral load testing is critical in determining whether antiretroviral treatment is working effectively. When recipients of care achieve viral suppression, the virus becomes undetectable there by improving the quality of life and the risk of HIV transmission is significantly reduced.
Interruptions in viral load testing services can therefore delay clinical decisions and make it difficult for health workers to identify recipients of care who may require additional adherence support or treatment adjustments.
Community monitors also reported that some recipients of care were unsure when their viral load tests would be conducted or when results would be available, suggesting possible communication gaps between facilities and recipients of care.
Through the COMET project, community-generated data is also being transformed into evidence for advocacy. The initiative plans to develop a public-facing data visualization dashboard, powered by a Shiny application, that will track health service trends and help advocates communicate community realities to policymakers and health managers.
The project further aims to strengthen the capacity of community advocates and local health structures so that community voices are better represented in health decision-making processes. By documenting service gaps and engaging authorities at both district and national levels, the initiative contributes to broader efforts to achieve the global HIV treatment targets championed by UNAIDS, particularly the 95-95-95 goals, which aim to ensure that most people living with HIV know their status, access treatment and achieve viral suppression.
As Malawi continues working toward ending AIDS as a public health threat, advocates say strengthening laboratory infrastructure, improving equipment maintenance and ensuring reliable viral load testing systems will be critical to maintaining treatment success and protecting the health of people living with HIV.
