In 2023, 10,800 people in Malawi died from HIV-related conditions, with tuberculosis (TB) being the leading cause of death. Integrating TB and HIV services is critical to reaching underserved populations and saving lives. Lighthouse Trust, a World Health Organization (WHO)-recognized Centre of Excellence in HIV management, is leading this change with its specialized expertise and advanced equipment.
"HIV Doesn't Happen in Isolation"
Malawi, known as the "warm heart of Africa," is a land of breathtaking beauty. Yet, behind its scenic vistas, the country once faced a devastating HIV epidemic. An estimated 980,000 Malawians were living with HIV. Thanks to a robust national response, Malawi has reduced new HIV infections by 76%, from 56,000 annually in 2010 to 13,500 in 2023.
Dr Ethel
Medical Director of Lighthouse Trust
We are coming from the era where we were on a fight response when the epidemic was up there. But now Malawi achieved epidemic control in 2020, the new infections have declined and the number of deaths has also declined. So they are like at an equilibrium.
Lighthouse Trust
A World Health Organization-recognized Centre of Excellence in HIV management, operates referral-level HIV care in all tertiary hospitals in Malawi.
The institution has been in operation for over 22 years providing specialised, high impact and high quality services across the cascade of HIV services. Part of its unique services include screening and diagnosis of advanced HIV disease.
However, despite progress in controlling HIV, HIV-associated diseases like TB remain a leading cause of death. "HIV doesn’t happen in isolation. TB is often part of the picture," explains Dr Ethel.
HIV/TB Combination: A Lethal Combination
According to World Health Organization (WHO), HIV and TB form a lethal combination, each speeding the other's progress. In 2023, about 161,000 people died of HIV-associated TB. The percentage of notified TB patients who had a documented HIV test result in 2023 was 80%. The WHO African Region has the highest burden of HIV-associated TB.
A lack of ultrasound scanning has hindered timely diagnosis and treatment. Kelvin Njoka, a 35-year-old HIV/TB patient, was misdiagnosed with cancer before an ultrasound at Lighthouse revealed he needed TB treatment. Like Kelvin, many patients with advanced HIV disease (AHD) remain unaware of their condition, risking severe outcomes without prompt intervention.
Equipment Matters - "The machines do not reduce the workload, they increase it"
- But that's for better diagnosis.
At Lighthouse, 30% of admitted patients are HIV-positive, many with AHD. For these patients, quick ultrasound scanning is lifesaving. Through a partnership with Mindray, Lighthouse has become a hub for training medical students, residents, and doctors, offering prompt management of HIV-related conditions.
Dr Tom Heller, a German clinician and experienced trainer who has been working with the Lighthouse in Malawi for more than 7 years, has developed two protocols for the quick diagnosis and training of clinicians across Africa:
FASH Protocol
A protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH), which can be used by physicians who are relatively inexperienced in ultrasound was developed.
PUSH Protocol
Point-of-care ultrasound: A protocol to detect cirrhosis and liver cancer in chronic hepatitis B patients.
Partnership for Progress: New Donation Allowed for Advanced Diagnosis
In 2024, Mindray donated two ultrasound machines — Consona N8 and MX7 — to Lighthouse. These devices enable liver elastography, a breakthrough for integrating hepatitis B into Malawi’s AHD program. "With these machines, we can identify patients needing hepatitis B treatment earlier," says Dr Tom.
According to Dr Lilian Chunda, Chief of Health Services in the Ministry of Health in Malawi, this allows for the elastography in liver scan, a big step forward to include hepatitis B into the national AHD program. As Dr Tom put it, with the new machines they were able to identify the patients who need hepatitis B treatment earlier.
A Ray of Hope
This partnership brings hope to Malawi, offering safer, healthier lives to those battling stigmatized diseases. On this World TB Day, we celebrate the progress made in the warm heart of Africa and look forward to Mindray’s impact spreading across the continent.
From Malawi to the edges of Africa, and to the world, Mindray’s mission for accessible healthcare continues, shining a light of hope for all.
References:
https://malawi.un.org/en/286174-journey-hope-malawi%E2%80%99s-fight-end-aids
https://www.who.int/news-room/fact-sheets/detail/tuberculosis
https://www.unaids.org/en/regionscountries/countries/malawi
