Background: Men remain an important group for testing and treatment interventions in Malawi, as they represent a probable source of HIV transmission in the country. This analysis aimed at describing progress and associated factors in achieving UNAIDS 90-90-90 targets among adult men in Malawi.
Methods: The 2015-16 Malawi Population-Based HIV Impact Assessment (MPHIA) was a two‐stage cluster survey of randomly selected households in Malawi. The survey included home-based HIV counseling and testing using the national rapid testing algorithm, followed by laboratory-based confirmation for positive results using Geenius?. HIV-1 viral load was measured using the Abbott m2000 System; viral load suppression (VLS) was defined as < 1,000 HIV RNA copies/mL. Antiretroviral therapy (ART) was determined by self-report or detection of antiretroviral drugs (ARVs; atazanavir, efavirenz, nevirapine, tenofovir) in blood. All analyses accounted for survey design.
Results: A total of 7,208 men aged 15-64 years were interviewed and tested; HIV prevalence was 8.5% (95% confidence intervals (CI): 7.8-9.2). Seventy-one percent (71.7%, 95%CI: 67.7-75.6) of men were aware of their HIV+ status. Among men who knew their HIV+ status, 88.7% (95%CI: 85.5-92.0) reported being on ART or had detectable ARVs in their blood. Of these, 89.8% (95%CI: 86.2-93.4) had achieved VLS. Among all HIV+ men, irrespective of awareness of HIV and ART status, 60.9% (95%CI: 56.8-65.0) had achieved VLS. Status towards 90-90-90 targets varied by age (Table 1). Younger HIV+ men aged 15-29 years were less likely to be aware of their status and be on treatment. Men in urban areas (65.7%, 95%CI: 59.3-72.1) compared to those in rural areas (73.8%, 95%CI: 69.0-78.6) were also less likely to be aware of their status (p< 0.05). Of men who were unaware of their status, 23.4% (95%CI: 16.3-30.6) reported two or more sexual partners in the last 12 months.
Conclusions: MPHIA results indicate that there is still progress to be made in reaching men for HIV testing and treatment in Malawi; 40% of all HIV+ men in Malawi are not virally suppressed, demonstrating gaps in achieving 90-90-90 targets. Strategies are needed to facilitate access to services for men, especially testing among younger men and those residing in urban areas.

 Aware of HIV-positive statusOn ART among those aware of their HIV-positive statusViral suppression among those on ART
Age Group%(95% CI)%(95% CI)%(95% CI)
15-29 years48.6(37.3-60.0)75.8(61.0-91.6)91.5(81.2-100.0)
30-44 years71.1(65.7-76.4)88.4(83.9-92.8)87.8(82.7-92.9)
45-64 years82.9(77.0-88.8)92.6(87.8-97.5)91.9(86.7-97.1)
[Table 1: 90-90-90 indicators by age among men aged 15-64 years who were tested HIV-positive in MPHIA, 2015-2016]