Malawi has long struggled with a high prevalence of HIV, and HIV/AIDS remains the most common cause of death, with an estimated 13,000 AIDS-related deaths a year. About 300,000 people live in Nsanje district, in southern Malawi, on the border with Mozambique. According to government estimates 12.5 per cent of them, around 24-25,000 people, are HIV positive.

Despite having taken huge steps to reduce the prevalence of HIV and the numbers of people dying from it, many people in Malawi still get sick and develop advanced HIV. In an effort to improve care for people with advanced HIV in Nsanje district, MSF and the Ministry of Health have established a new operating model called the ‘circle of care’.

The model aims to reduce mortality among HIV patients through early detection and strengthening the referral system within the circle, e.g. the community, health centre and hospital. This is achieved by enabling communities to identify sick patients, ensuring efficient diagnosis and initiation in the health centres, and in-depth assessment and quality care in the district hospital. To make sure all the HIV positive patients being discharged stick to their treatment programmes and don’t fall back in the circle of advanced HIV, MSF have a post-discharged procedure where counsellors will go and visit them.