---
title: "Strategies to improve access to pediatric HIV services in Malawi: study protocol"
id: "pubmed-42691038"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42691038"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42691038/"
doi: "10.1371/journal.pone.0357408"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Strategies to improve access to pediatric HIV services in Malawi: study protocol
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42691038
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42691038/)
- **DOI:** [10.1371/journal.pone.0357408](https://doi.org/10.1371%2Fjournal.pone.0357408)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This protocol describes a multi-method study designed to identify and develop strategies to improve access to **HIV** services for **children** in **Malawi**. - The study is motivated by persistent gaps in pediatric HIV outcomes: Malawi has progressed toward UNAIDS **95-95-95** targets overall, but only 55% of children living with HIV are virally suppressed compared with 87% of adults. - Conceptual frameworks guiding the work are the **Socio-Ecological Model** and the **HIV care cascade**; these will structure analysis and intervention design across individual, community, health-system and policy domains. - The research comprises four linked sub-studies: (1) secondary analysis of national HIV program data and Spectrum estimates from 2012–2023 to assess trends and progress toward 95-95-95; (2) a scoping review (2015–2025) of health system interventions that improve pediatric HIV service access in sub-Saharan Africa; (3) a modified e-Delphi with 15–30 experts to develop a context-appropriate intervention package; and (4) feasibility and acceptability testing of the package at Kabudula Community Hospital, Lilongwe, involving healthcare workers, community health workers, and caregivers via questionnaires and qualitative interviews. - The feasibility assessment will collect both quantitative and qualitative data to evaluate acceptability and practicability at the selected site. - Ethical approvals will be obtained from Stellenbosch University Health Research Ethics Committee and the Malawi National Health Sciences Research Ethics Committee; written informed consent and confidentiality protections will be ensured. - The study aims to identify gaps in pediatric HIV care access, synthesize evidence on effective interventions, and produce a feasible, context-specific intervention package to strengthen children’s access to HIV services and accelerate Malawi’s progress toward UNAIDS targets. - No competing interests were declared by the authors in the source article.
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Affiliations Expand ### Affiliations * 1 Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. * 2 Department of HIV, STIs and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi. * 3 AFRIQUIP, Health Systems Strengthening, Johannesburg, South Africa. * 4 Burden of Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa. * PMID: **42691038** * DOI: [ 10.1371/journal.pone.0357408 ](https://doi.org/10.1371/journal.pone.0357408) Item in Clipboard # Investigating strategies to enhance access to HIV services among children in Malawi: A multifaceted research approach, study protocol Bilaal Wilson Matola et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42691038/) . 2026 Sep 3;21(9):e0357408. doi: 10.1371/journal.pone.0357408. eCollection 2026. ### Authors [Bilaal Wilson Matola](https://pubmed.ncbi.nlm.nih.gov/?term=Matola+BW&cauthor_id=42691038)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-1 "Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-2 "Department of HIV, STIs and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi."), [Juliet Charity Yauka Nyasulu](https://pubmed.ncbi.nlm.nih.gov/?term=Nyasulu+JCY&cauthor_id=42691038)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-1 "Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-3 "AFRIQUIP, Health Systems Strengthening, Johannesburg, South Africa."), [Edward Nicol](https://pubmed.ncbi.nlm.nih.gov/?term=Nicol+E&cauthor_id=42691038)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-1 "Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691038/#short-view-affiliation-4 "Burden of Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa.") ### Affiliations * 1 Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. * 2 Department of HIV, STIs and Viral Hepatitis, Ministry of Health, Lilongwe, Malawi. * 3 AFRIQUIP, Health Systems Strengthening, Johannesburg, South Africa. * 4 Burden of Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa. * PMID: **42691038** * DOI: [ 10.1371/journal.pone.0357408 ](https://doi.org/10.1371/journal.pone.0357408) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Despite major progress in HIV epidemic control, children in sub-Saharan Africa, particularly in Malawi, continue to experience poorer HIV outcomes than adults. While Malawi has made substantial progress toward the UNAIDS 95-95-95 targets, only 55% of children living with HIV are virally suppressed compared with 87% of adults. This study aims to identify and develop strategies to improve children`s access to HIV services in Malawi. **Methods:** Guided by the Socio-Ecological Model and the HIV care cascade framework, this multi-method study comprises four sub-studies: (1) secondary analysis of national HIV program data and spectrum estimates (2012-2023) to assess trends and progress toward the 95-95-95 targets; (2) a scoping review of health system interventions that improve paediatric HIV service access in sub-Saharan Africa (2015-2025). (3) a modified e-Delphi process with 15-30 experts to develop a context-appropriate intervention package and (4) a feasibility and acceptability assessment of the package at Kabudula Community Hospital, Lilongwe, Malawi, involving healthcare workers, community health workers, and caregivers using questionnaires and qualitative interviews. **Ethical considerations:** Ethical approval will be obtained from Stellenbosch University Health Research Ethics Committee (HREC) and the Malawi National Health Sciences Research Ethics Committee. Written informed consent and confidentiality will be ensured. **Conclusion:** This study will identify gaps in HIV care access among children, synthesize evidence on effective interventions, and develop a feasible, context-specific intervention package to strengthern children`s access to HIV services and accelerate Malawi`s progress toward achieving UNAIDS 95-95-95 targets. Copyright: © 2026 Matola et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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