One clinic, many solutions: The future of HIV care in Malawi’s villages

Receiving antiretroviral (ARV) medication and being attended to within a short period has enabled Esther Mambele of Neno district to do income generation activities.  

When Esther Mambele of Neno district gets her ARVs refilled, her absence from her fish bench at the marketplace is hardly noticed. She collects her six-month refill quickly and gets back to her ​​business.

Esther Mambele, a fish seller from Neno district, doesn’t let anything slow her down, not even a clinic visit. Thanks to quick service and a six month supply of antiretroviral (ARV) medication, she’s back at her market bench in no time, serving customers as if she never left. 

Esther collects her ARVs swiftly and gets straight back to business. Her regulars barely notice she’s been away. With more time on her hands, she’s able to focus on earning a living and supporting her family. 

When it’s her turn for ARV refill, her absence from her marketplace fish bench is hardly noticed. She silently collects her six-month medication refill and heads back to her business. 

This speedy service, known as Integrated Chronic Care Clinic (IC3) model is courtesy of Partners In Health (PIH). It’s locally known as Abwenzi Pa Za Umoyo. The IC3 model does more than providing ARV therapy. It combines HIV treatment with Sexual and Reproductive Health and Rights (SRHR) services, chronic care for Non-Communicable Diseases (NCDs), and social support.  

“ART is provided every Thursday and Friday. It’s however hard for people to differentiate who is living with HIV or not. As all services are provided simultaneously,” explains Mambele.  

Unlike in the past, Mambele recollects, ART clinic had its own day. Other ailments like hypertension, heart disease and diabetes among other NCDs were handled on different days. This increased stigma among communities. People could easily connect those on a particular day to HIV treatment.  

“Getting combined medical attention in one visit saves time for us to do income generating activities and participate in development,” states the widowed mother of three. 

Emotional burden scars: A new model changing lives 

Nineteen years ago, things were different. Mambele, now 50 years old, recalls the anxiety and stress she felt on every medication refill day.  

She would arrive at the clinic by 7a.m. but often left after 4p.m.. There was no fixed time for the arrival of the ambulance carrying the ARVs and health workers from Mwanza hospital.   

Located in southern Malawi, Neno became a standalone district in 2003, after being separated from Mwanza district. Even before the split, it lagged behind in many things, including provision of quality health care. 

“Our health facility didn’t provide ARVs then. Mwanza hospital staff had to bring them,” recalls Mambele. 

“Sometimes they couldn’t come due to logistical challenges and poor roads, especially during the rainy season. This put our lives at risk. Others even defaulted treatment along the way.” 

Another IC3 beneficiary, 34-year old Rose Likoswe joined the ART program in 2012, after PIH had already introduced the model.  

“I found out my HIV status when I was pregnant with my second child. Since then, I’ve stayed healthy. I get all I need in one hospital visit,” says Likoswe.  

Since she joined the IC3 program in 2012, it has continued to improve, “In 2012, I would get one month treatment supply only. Then it changed to three months. Now, I only go twice a year for refills,” she explains proudly. 

Likoswe speaks highly of the IC3 model, “Everything is done in one visit.  I attend under five clinic, family planning, cervical cancer screening (done once a year) and hypertension screening.”  

She  also received counselling support and small scale business management skills through IC3. 

 Integrated care that ends stigma  

 “My only challenge is a lack of sustainable business. I sell tangerines, but they’re seasonal,” Likoswe says. 

PIH came to Malawi in 2007 to support ​G​overnment health care in Neno.  At the time, only six patients were in HIV care. By 2015, the programme had expanded to all 12 primary health care facilities under Neno district hospital.  

According to the Malawi National AIDS Commission (NAC),  by December 2023,  991,600 people were living with HIV  with 927,310 of them  on ARVs . 

Dr. Brown Khongo, PIH’s NCD and Mental Health Director, says at inception, the organization noted other conditions besides HIV care, but developing a parallel program would have been costly.   

“Patients used to make three different hospital visits per month for various conditions. This is all currently happening in one visit through IC3,” he said. 

“Reducing visits also reduced stigma. There was lots of stigma in the community. People could come to the health facility on ART clinic day pretending to be sick just to see who comes to receive ARVs,” he recalls. 

With IC3 it’s not easy to know why someone is visiting a health facility because patients are handled the same way. Their privacy is protected.  

IC3 also has outreach clinics. PIH has 100 community based health workers distributed in the district.  They assist in these clinics, remind the clients on their medication refill day and trace those who have defaulted. 

IC3 approach is embedded within PIH’s mission of providing care to the poor and serving as an antidote to despair.  A mission that goes beyond medicine. 

Apart from providing trained staff, equipment, supplies, medications, providing leadership, governance, information and financing, the organisation uses a social support approach in providing basic necessities and resources needed to ensure effective care. 

This social support aims at empowering clients through addressing their social determinants of health and supporting them to live with greater dignity, security, and independence.  

Through its Programme on Social and Economic Rights (POSER), PIH reduces the financial burden of healthcare by helping vulnerable clients access essential services and resources.   

Both Mambele and Likoswe are POSER beneficiaries. Mambele has also benefited from the ​​goats pass on program.  

“We know that most conditions are related to poverty, gender and inequality issues. This programme includes livelihood improvement programmes, which are provided to both patients enrolled in the chronic care system and others outside the system,” Dr. Khongo further explains. 

 So far, 13,000 people are enrolled in IC3.  About 60 percent of that are patients living with HIV, and 40% are patients with NCDs.  Outreach clinics have helped grow these numbers by providing services alongside support systems. 

“We have also been tackling mental health, focusing on depression screening and care. At the moment, we have enrolled 500 patients that have been in care for depression,” Dr Khongo said. 

 Local solution with global possibilities 

Christopher Kamoto, ART Coordinator at Neno district hospital says the IC3 model has been a lifeline for hard-to-reach areas. 

“IC3 model has been like an answer to Neno communities. Clients who would have defaulted treatment have been sustained on ART. The model has provided care to bed-ridden patients on palliative care,” he observes. 

Neno currently has 8,000 people living with HIV, 95% of them are linked to care and on ART. However, he notes that some defaulters remain untraceable. They are believed to be from neighbouring Mozambique, which borders the district.   

Health and Rights Education Program (HREP), a local Non-Governmental Organisation says IC3 comes at an opportune time when Malawi is promoting the “one health” approach to health services delivery.  The approach promotes one plan, one budget and one monitoring and evaluation of health services. 

“There's been a lot of inequities in terms of social allocation for rural marginalised communities. So I think, the integrated approach would help to ensure that allocated resources are utilised as some programmes are better funded than others,” says HREP Executive Director, Maziko Matemba.  

In February, 2025, 11 countries; Malawi, Tanzania, Kenya, South Africa, Zambia, Uganda, Zimbabwe, Lesotho, Eswatini, Nigeria and  Ghana agreed to consider integration of HIV prevention into routine health service delivery considering the prevailing funding landscape.   

As the world moves towards sustainable and equitable health systems, Neno district’s  IC3 model stands as a promising design for the future of chronic care. Particularly in rural and underserved communities where Mambela and Likoswe live. With integration at its core, IC3 is not only demystifying HIV care but also normalizing access to a broad spectrum of essential health services in a dignified, stigma free environment. 

HIV in focus 

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them. 

About the writer 

Josephine Chinele is a multi-award-winning investigative journalist who has worked for newspapers, radio, and television platforms in Malawi, Tanzania, and South Africa, and as a fellow for the Los Angeles Times in the USA amid other international journalism fellowships. She is passionate about sexual reproductive health and rights issues, having reported on the topics for over 15 years.