Modelling health outcomes of a decade of HIV, malaria and tuberculosis initiatives, Malawi

This study assesses the impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria programmes on population health and health system performance in Malawi between 2010 and 2019. Using the Thanzi la Onse integrated epidemiological and health system model, the authors examined the direct and indirect effects of these programmes by comparing observed programme implementation with hypothetical scenarios in which services were removed individually or collectively. The analysis incorporates disease interactions, intervention effects and patterns of health-care utilization across multiple levels of the health system.

The findings indicate that HIV/AIDS, tuberculosis and malaria programmes prevented an estimated 1.08 million deaths and 74.89 million disability-adjusted life years over the study period, while also averting additional mortality from other causes through spill-over effects on related health conditions. The programmes contributed substantially to increases in life expectancy and accounted for a significant proportion of health system interactions, including diagnostic testing, preventive services and treatment delivery. Although implementation required additional outpatient services and health worker time, these investments reduced demand for inpatient and emergency care. The study highlights the broader health and system-wide benefits of disease-specific programmes and demonstrates the value of integrated modelling approaches for evaluating public health investments.