Cyclone Freddy's Impact on HIV Services Uptake:
Lessons from MACRO Blantyre Clinics

L. Phiri1*, P. Damiano1, A. Ngambi1*,
A. Elias1, P. Mbulaje1, C. Udedi1
1Malawi AIDS Counselling and Resource Organization (MACRO)
*Corresponding authors

Abstract

Background

Climate change continues to demonstrate catastrophic impacts on community health systems globally. When Tropical Cyclone Freddy struck Malawi in March 2023, it caused unprecedented floods and mudslides across 15 southern districts, directly affecting approximately 2.2 million people (11% of Malawi's population). This study examines the cyclone's impact on HIV service delivery—a critical public health concern—through analysis of service uptake patterns at MACRO Blantyre clinics during the six months surrounding the event.

Objectives

This study had two primary objectives:

  1. To quantitatively assess Cyclone Freddy's impact on HIV service utilization metrics at MACRO Blantyre clinics
  2. To identify effective service delivery adaptations that maintained continuity of care during the disaster period

Methods

We conducted a retrospective cohort analysis using routinely collected program data from clinic registers and reports. The study period encompassed six months (January-June 2023), divided into pre-cyclone (January-March) and post-cyclone (April-June) phases. Primary outcomes included outpatient department (OPD) attendance, antiretroviral therapy (ART) appointment adherence, and treatment interruption rates. Data were analyzed by service type, demographic characteristics, and temporal trends using STATA 17.0, with statistical significance assessed via proportion Z-tests (α=0.05).

Results

OPD attendance decreased modestly by 4.0% (95% CI: 2.1-5.9%) post-cyclone, with gender-stratified reductions of 2.9% (female) and 5.8% (male).

ART appointment non-adherence declined significantly by 39% (378 to 311 cases; p=0.652).

Treatment interruptions decreased by 11% (170 to 151 cases; p=0.507).

Notably, these changes showed no statistically significant variation across age groups or by gender. The maintenance of service continuity was achieved despite substantial infrastructure damage in the surrounding region.

Conclusions

Contrary to expectations, Cyclone Freddy did not produce significant negative effects on HIV service utilization at MACRO clinics. This resilience appears attributable to three key adaptations:

  1. Implementation of mobile HIV service units in displacement camps
  2. Strategic use of multi-month ART prescriptions prior to the cyclone season
  3. Geographic accessibility of MACRO clinic locations

These findings suggest that integrating such adaptations into standard preparedness planning may effectively maintain HIV service continuity during future climate-related disasters in resource-limited settings.

Keywords: HIV service delivery, disaster preparedness, climate change, antiretroviral therapy, Malawi, Cyclone Freddy
Suggested citation: Phiri L, Damiano P, Ngambi A, Elias A, Mbulaje P, Udedi C. Cyclone Freddy's impact on HIV services uptake: Lessons learnt from MACRO Blantyre clinics. Malawi AIDS Counselling and Resource Organization; 2023.