1.national Strategic Plan Ending AIDS 2016-2030

NATIONAL STRATEGIC PLAN FOR ENDING AIDS
MINISTRY OF HEALTH MALAYSIA |Page

PUTRAJAYA, 2015
Malaysia
Report prepared by:
HIV/STI SECTION
Disease Control Division
Ministry of Health Malaysia
Tel: +60 3 8883 4387
Fax: +60 3 8883 4285
Correspondence:
Dr. Sha’ari Ngadiman
[email protected]
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The National Strategic Plan for Ending AIDS 2016-2030
This document was coordinated and

produced by HIV/STI Section of Ministry of
Health Malaysia. Acknowledgements
The editorial team would like

Editorial Team to express our gratitude to
various government
Dr. Sha’ari Ngadiman (Chief Editor)
ministries and departments,
Consultant Public Health Physician
Deputy Director of Disease Control & Head civil societies, development
HIV/STI Sector, Ministry of Health Malaysia partners and individuals who
have greatly assisted us in
Dr. Anita Suleiman (Principle author & Editor) developing this document.
Public Health Physician
Senior Principal Assistant Director (Technical & The team is highly indebted
Behavioral Research) to the technical staff of
HIV/STI Sector, Ministry of Health Malaysia
HIV/STI Sector and State AIDS
Officer for their tremendous
Dr. Mohd. Nasir Abd Aziz
help in providing related
Consultant Public Health Physician
Senior Principal Assistant Director (Prevention strategic information needed
and Collaboration) and in facilitating the
HIV/STI Sector, Ministry of Health Malaysia workshops.
Dr. Fazidah Yuswan Our heartfelt thanks go to

Public Health Physician UNAIDS Malaysia for funding
Senior Principal Assistant Director (Harm the second workshop and
Reduction)
financing a consultant to
assist in the development of
this document.
Dr. Salina Md. Taib
Senior Principal Assistant Director (M&E)
We greatly admire the
partnership spirit of the
Hairuddin Masnin Malaysia AIDS Council and its
UNAIDS Country Manager partner organizations in
crafting the ending AIDS
Parimelazhagan Ellan responses.
Program Director
Malaysia AIDS Council Our deepest gratitude to all
individuals / agencies /
Shamala Chandrasekaran departments not mentioned
Malaysia AIDS Council here.
Dr. Olavi Elo

UNAIDS Technical Assistance
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National Advisor:
Technical Team
Datuk Dr. Noor Hisham bin Abdullah
Director General of Health, Malaysia
Technical Advisors:
Datuk Dr. Lokman Hakim bin Sulaiman
Deputy Director of Health (Public Health)
Dr. Chong Chee Kheong

Director of Disease Control
Technical Team:
Dr. Sha’ari bin Ngadiman (Head)
Deputy Director of Disease Control and Head HIV/STI Section
Dr. Anita bt Suleiman (Coordinator)

HIV/STI Section, Ministry of Health Malaysia
Dr. Mohd Nasir bin Abd Aziz

Public Health Consultant
Dr. Fazidah bt Yuswan

Dr. Salina bt Md Taib

Senior Principal Assistant Director
Datuk Dr. Christopher Lee

Infectious Disease Consultant
Hospital Sungai Buloh
Dato’ Dr Ghazali bin Ismail

Obstetrics & Gynaecology Consultant
Hospital Sultan Ismail, Johor
Mohd Nazri Mohd Dazali

Pharmaceutical Service Division, Ministry of Health Malaysia
Hairuddin bin Masnin

Country Manager, UNAIDS
Dr. Ilias Yee

Malaysia AIDS Council
Parimelazhagan Ellan
Malaysia AIDS Council
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Table of contents
Acknowledgment …………………………………………………………………………… ii
Technical Team …………………………………………………………………………….. iii
Foreword ……………………………………………………………………………………. v
List of figures ……………………………………………………………………...………… vi
List of tables ……………………………………………………………………………...…. vi
List of Annexes ……………………………………………………………...……………… vii
Acronyms and abbreviations ……………………………………………………………… viii
Terms and definitions ……………………………………………………………………… x
Executive summary ………………………………………………………………………… 1
Chapter 1: Introduction
1.1 The Big Picture....……………………………………………………… 7
1.2 Rationale ………………………………………………………………. 8
1.3 Developing the NSPEA 2016-2030 ……………………………….… 9
Chapter 2: Epidemic Situation, Response and Challenges
2.1 HIV situation …………………………………………………………… 12
2.2 HIV/TB Co-infection ………………………………………………….. 16
2.3 Geographical differences ……………………………………………. 17
2.4 HIV testing, surveillance and surveys ………………………………. 17
2.5 Key populations ……………………………………………………….. 19
2.6 Responses……………………………………………………………… 23
2.7 Challenges ……………………………………………………………... 32
Chapter 3: NSPEA 2016-2030
3.1 Guiding principles ……………………………………………………… 30
3.2 Priorities ………………………………………………………………… 37
3.3 Strategic targets ……………………………………………………….. 39
3.4 Strategies ………………………………………………………………. 40
Chapter 4: Leadership, Coordination and implementation …………………………. 41
Chapter 5: Resources …………………………………………………………………... 44
Chapter 6: Monitoring and Evaluation ………………………………………………… 48
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Foreword
In the past decade, Malaysia has witnessed
unprecedented multi-sectoral commitment in setting and
implementing imperative agenda for halting and reversing
the HIV epidemic. Guided by series of National Strategic
Plan (NSP), the nation has made great strides in
effectively responding to the HIV epidemic.
The resources are deployed in the most effective and

efficient way possible resulting in the achievement of
MDG 6 target of reducing by half the proportion of new
HIV infections. Today, the HIV infection rate has declined
by half, falling from 21.8 per 100,000 population in 2000
to 10.9 per 100,000 population in 2009. The number of
new infections have been stable in the past five years
though it edged up in 2010.
Building on this momentum, the nation has its sight set on the beginning of the end of AIDS in
the country. Our roadmap to ending the epidemic in the country begins with the New National
Strategic Plan for 2016-2030 that places testing and treatment at the heart of national
response, supported by intensified targeted prevention strategies that offer high-impact
interventions.
Developed through a diverse consultative process, the New National Strategic Plan for 2016-
2030 adopts the “Ending AIDS” as the vision for Malaysia getting to the “Three Zeros: Zero
new infections, Zero discrimination and Zero AIDS related deaths”. In line with the Sustainable
Development Goals (SDG), the new NSP adopts the UNAIDS strategic guidance on Fast
Tracking to reach 90-90-90 by 2020 and Ending AIDS by 2030. It recognizes WHO’s new
recommendations on HIV treatment and prevention, adjusted to the country context.
While the goal of Ending AIDS may look ambitious, systemic and well managed coordination
for smart investment and timely acceleration of delivery of key services along with innovative
and cutting edge strategies could well result in averting new infections and AIDS related
deaths by 2030. As we move into the future, we are hopeful that Malaysia will end the epidemic
earlier than 2030. In the spirit of shared responsibility, we shall seize every available
opportunity to fast-track the HIV response and become one of the first few countries in ending
the epidemic.
Last but not least, we would like to acknowledge the key government and non-government
experts and community representatives for the tremendous contribution and effort that went
into the preparation of the NSPEA. We would like to especially thank the HIV/STI Sector for
their relentless effort in coordinating and drafting this important document.
DATUK DR. NOOR HISHAM BIN ABDULLAH

DIRECTOR GENERAL OF HEALTH MALAYSIA
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List of figures:
Figure 1 Reported HIV and AIDS cases and AIDS related Deaths, Malaysia 1986 - 2014
Figure 2 Reported HIV cases by mode of transmission and PWID/sexual transmission
ratio, Malaysia 2000-2014
Figure 3 Distribution of reported new HIV cases by age group, Malaysia 1990-2014
Figure 4 Age-specific HIV prevalence Malaysia 2000-2014
Figure 5 Gender-specific HIV prevalence, Malaysia 1986-2014
Figure 6 New TB and HIV cases and TB-HIV co-infection, Malaysia 2000-2014
Figure 7 Testing of pregnant women, Malaysia 1998-2014
Figure 8 HIV prevalence in selected testing and screening programmes, Malaysia 2000-
2014
Figure 9 Proportion of reported HIV cases by mode of transmission, comparison between
MSM and PWID, Malaysia 2000-2014
Figure 10 AEM baseline projections: Estimated and projected number of case by Mode of
Transmission, Malaysia 1986-2030
Figure 11 Scenarios for new HIV infections for adults, Malaysia 2000-2030
Figure 12 AIDS spending by function, Malaysia 2010-2013
Figure 13 Total resource needs, Malaysia 2014-2050
Figure 14 Total Investment and DALYs saved, Malaysia 2015-2021
Figure 15 M&E reporting flow, Malaysia
List of tables:
Table 1 Percentage of new HIV infections by risk factor, Malaysia 1990-2014
Table 2 Key IBBS findings, Malaysia 2009-2012-2014
Table 3 Approximate total expenditure from domestic (public and private) and
international sources by AIDS spending category, Malaysia 2012-2013
Table 4 Source of approximate AIDS expenditure, Malaysia 2013-2014
Table 5 Summary of total resource needs based on investment scenarios, Malaysia
2015-2021 and 2022-2050
Table 6 Total annual resource needs for “Ending AIDS”, Malaysia 2015-2050
Table 7 Summary of cost-effectiveness by different investment options, Malaysia 2013-
2020
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List of Annexes:
Annex 1: List of participants in the consultations
Annex 2: AEM modelling, estimations and projections
Annex 3: Plans of Action for Fast Tracking
Annex 4: Indicators for monitoring NSPEA 2016-2030
List of annexed AEM figures and tables:
Figure A1 Treatment and prevention coverage, Malaysia 2013

Figure A2 Estimated numbers of new HIV, PLHIV and AIDS-related deaths,
Malaysia1986-2030
Figure A3 Estimated and projected number of cases by mode of transmission,
Malaysia 1986-2030
Figure A4 Total adult ART coverage and need, Malaysia 1986-2030
Figure A5 Current infections (PLHIV) for adults, Malaysia 2000-2030
Figure A6 Scenarios for new HIV infections for adults, Malaysia 2000-2030
Figure A7 Total resource needs, Malaysia 2014-2050
Figure A8 Total investment and DALYs saved, Malaysia 2015-2021
Table A1 ARV treatment at baseline scenario and its impact of the epidemic 2000-
2030
Table A2 Summary estimates of HIV epidemic 2012-2020, Malaysia
Table A3 Summary of targets for each scenario, Malaysia
Table A4 Summary of total resource needs based on investment scenarios, Malaysia
2015-2021 and 2022-2050
Table A5 Total annual resource needs for “Ending AIDS”, Malaysia 2015-2050
Table A6 Summary of cost-effectiveness by different investment options, Malaysia
2013-2020
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Acronyms and Abbreviations

AIDS Acquired Immune Deficiency Syndrome
ART Anti-Retroviral Therapy
ARV Anti-Retroviral drugs
BSS Behavioral Surveillance Survey
CBO Community-based Organization
CCA Cabinet Committee on AIDS
CCAI Coordinating Committee on AIDS Intervention
DIC Drop-In Centre
DRC Drug Rehabilitation Centre
EMTCT Elimination of Mother to Child Transmission
FMS Family Medicine Specialist
FSW Female Sex Worker
GFATM The Global Fund for fight against AIDS, Tuberculosis and Malaria
GARPR Global AIDS Response Progress Report
HAART Highly Active Anti-Retroviral Therapy
HIV Human Immunodeficiency Virus
HPSP Hospital Peer Support Programme
HR Harm Reduction
IBBS Integrated Bio-Behavioural Survey
JAKIM Department of Islamic Development
MAC Malaysian AIDS Council
MDG Millennium Development Goals
MMT Methadone Maintenance Therapy
MoH Ministry of Health
MSM Men having Sex with Men
MTCT Mother-to-child transmission
MWFCD Ministry of Women, Family and Community Development
NADA National Anti-Drug Agency
NAP National AIDS Programme
NAR National AIDS Registry
NATCA National Advisory and Technical Committee on AIDS
NCPI National Commitments and Policy Instrument
NGO Non-Governmental Organization
NPFDB National Population and Family Development Board
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NSEP Needle and Syringe Exchange Programme

NSP National Strategic Plan on HIV and AIDS
NSPEA National Strategic Plan for Ending AIDS
NTR National Treatment Registry
OST Opiate Substitution Therapy
PCR Polymerase Chain Reaction test
PEP Post Exposure Prevention
PrEP Pre Exposure Prevention
PITC Provider Initiated Testing
PLHIV People Living With HIV
PMTCT Prevention of Mother-to-Child Transmission
PWID Person/People who inject drugs
SDG Sustainable Development Goal
SRH Sexual and Reproductive Health
STD Sexually Transmitted Disease
STI Sexually Transmitted Infection
SW Sex Worker
VCT Voluntary Counselling and Testing
TasP Treatment as Prevention
TB Tuberculosis
TG Transgender person
UNAIDS Joint United Nations Programme on HIV and AIDS
UNDP United Nations Development Programme
UNICEF United Nations Children’s Fund
UNFPA United Nations Population Fund
UNGASS United Nations General Assembly Special Session
UNHCR United Nations High Commissioner for Refugees
UNODC United Nations Office on Drugs and Crime
UNTG United Nations Theme Group on HIV
WB World Bank
WHO World Health Organization
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Terms and definitions

Civil society refers to NGOs and informal groups which may include People Living with HIV
(PLHIV), key and vulnerable populations, women’s organisations and faith-based
organisations.
Cost estimates are financial estimations of how much is envisaged to be spent for a particular
programme, usually not be considered as detailed budgets. Detailed budgets are prepared
usually for Annual Work Plans itemising details of the budget.
Coverage is a measure of whether a programme is working in the right places and reaching
its target population.
Ending AIDS refers to elimination of AIDS as public health threat by 2030 through sustained
maintenance of fast tracking results and achieving the targets of 95% of key populations tested
and knowing their results, 95% of those detected as HIV positive placed on ART, and 95% of
these having an undetectable viral load, as well as through reaching 80% coverage of key
populations with effective prevention programmes.
Evaluation is a rigorous, scientifically-based collection of information about programme

activities, characteristics, and outcomes that determine the merit of a specific programme.
Evaluation studies are used to improve programmes and inform decisions about future
resource allocations.
Fast Tracking refers to accelerating the HIV response to reach the 90-90-90 targets by 2020
(90% of key populations tested for HIV and knowing their results, 90% of those detected HIV
positive placed on ART, and 90% of these having undetected viral load. It also includes
reaching 80% of key populations with effective prevention programmes.
Impact evaluation is conducted to assess changes in disease incidence and prevalence as

a function of programme implementation. Evaluation of impact on populations entail rigorous
evaluation design to assess the combined effects of a number of programmes.
Impact indicators are used to evaluate the impact of programmes and interventions on the
overall epidemic, in key populations as well as in general population.
Impact mitigation refers to programmes and activities which work towards reducing the
negative impact and direct consequences of HIV on key and vulnerable populations and
People Living with HIV, such as illness, loss of employment, discrimination and death.
Incidence is defined as new infections per population at risk in a specified time period.
Input indicators are used to monitor the resources available for implementation of the
National Strategic Plan on HIV and AIDS, and to evaluate sustainability of programmes and
interventions.
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Intervention is a set of activities implemented by a project often at the community level.
Men who have Sex with Men (MSM). Many men who have sex with men (MSM) engage in
anal sex and often have multiple sexual partners.
Monitoring is the routine tracking of key elements of a programme or project and its intended
outcomes. It usually includes information from record keeping and surveys – both population
and client-based.
Outcome indicators measure the effectiveness of programmes implemented to change risk

behaviours among key populations, to encourage prevention, treatment, care and support
seeking behaviours.
Output indicators measure the implementation of programmes for key populations, achieved
through behavioural change communication, harm reduction, including access to needles,
syringes and condoms, or utilisation of VCT, treatment, care and support services.
Outreach services take health information and services into the communities where key
populations live, or places where they congregate.
People who inject drugs (PWID) refers to drug users who use injecting equipment.
Prevalence is the total number of HIV infections at a point in time per population.
Programme refers to an overarching national or subnational response to a disease and

generally includes a number of projects.
Project refers to a mix of activities supported by resources, implemented often at the

community level.
Transgender persons refers to persons whose gender identity differs from their sex at birth.
The term “mak nyah” is commonly used in the Malaysian context.
Universal Access refers to access to HIV treatment, prevention, care and support to all,
including key and vulnerable populations, through strengthening of health and community
systems.
Young person or people refers to individuals or group in the age range of 15 – 24 years.
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EXECUTIVE SUMMARY
Since the beginning, HIV epidemic in Malaysia has been driven by injecting drug use,
increasingly in recent years also by sexual transmission among key populations and their
intimate sexual partners, including people who inject drugs, sex workers, men who have sex
with men and transgender persons. The share of new infections through sexual transmission
has increased to close to 80% of the annual total by 2014. The epidemic is still concentrated
in key populations, not spread to general population, as indicated by the low level HIV
detection in routine premarital and antenatal testing.
The recent surveys and surveillance indicate that the steady decline of the reported number
of new HIV infections since the peak of the epidemic in 2002 has stagnated since 2010, and
has even been reversed among men having sex with men, transgender persons, and sex
workers, particularly in geographic locations which may be different for each key population.
These surveys have identified gaps and challenges in the implementation of HIV and AIDS
response under the previous National Strategic Plans (NSP), which will be addressed in the
new National Strategic Plan for Ending AIDS 2016-2030 (NSPEA).
The NSPEA was developed through a comprehensive consultation process, it builds on the
successes of the previous strategies and addresses the challenges identified in the surveys
and surveillance, in the Mid Term Review of the 2011-2015 NSP and in the consequent
consultation process. It places strong emphasis on strengthening the multi-sectoral and civil
society collaboration practiced under the previous strategic plans.
The NSPEA adjusts to the changing international environment and scientific evidence, and
adopts the “Ending AIDS” as the strategy for Malaysia to achieve the Vision of “Zero new
infections, Zero discrimination and Zero AIDS related deaths”. It adjusts to the Sustainable
Development Goals (SDG) endorsed by the UN General Assembly and adopts UNAIDS
strategic guidance on Fast Tracking to Zero and Ending AIDS.
The priorities identified in the extensive consultation process include: 1) Intensifying testing
and treatment; 2) Harm Reduction to considerably increase coverage of the Opiate
Substitution Therapy and Needle and Syringe exchange; 3) Reducing sexual transmission
among key populations (Sex Workers, Men having sex with men, Transgender persons, also
people who use drugs) and their sexual partners, and striving to early elimination of mother to
child transmission; 4) Reducing Stigma and Discrimination, and providing social protection as
a cross-cutting issue for all key populations.
In the NSPEA Malaysia commits to Fast Tracking the HIV and AIDS response. The first fast
tracking phase of the NSPEA, during 2016-2020, aims to reach the 90-90-90 targets: 90% of
key populations tested for HIV and knowing their results, 90% of people infected with HIV
placed on ART, and 90% of these adhering to treatment with suppressed viral load. The fast
tracking phase also aims to reach 80% of key populations with effective prevention.
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Malaysia commits to “Ending AIDS” by 2030 through achieving the 95-95-95 target: 95% of
key populations tested for HIV and knowing their results, 95% of people infected with HIV
placed on ART, and 95% of these adhering to treatment with suppressed viral load. The
commitment includes reaching 90% of the key populations with effective prevention.
The strategies and action plans developed through consultations build on an increasing
collaboration between the government and the civil society organizations, linking the facility-
based health services with community level service provision by lay workers, and ensuring the
quality of these services through extensive training and capacity building of the community-
based organizations and service providers. Ensuring continuum of care between medical and
paramedical health facility-based staff and outreach workers requires extensive training in new
skills for these workers to be able to perform expanded tasks, adequate support by the health
facility staff and smooth referral arrangements.
A few new approaches will be carried out by NGO. This initiative will include treatment
adherence peer support programme (TAPS) and case management by lay person which is
currently piloted by Global Fund grant-supported MSM programme. Another initiative is
community-based HIV screening. This approach will allow NGO to conduct HIV screening
among KPs and those found reactive will be referred to health clinics for confirmation and
further management.
Task Forces will be extended, such as the Harm Reduction Task Force, and new Task Forces
will be established to develop operational plans and to support and guide the development of
prevention programmes, such as programmes for mitigating sexual transmission or
addressing issues specific for young people. Coordination between multiple partners will be
enhanced through establishment of local coordination councils, which will work with support
from State and National levels.
Decentralization of HIV services to primary health facilities, closely linked with the main
hospitals, is gradually taking place and will be quickly expanded during the fast tracking period.
HIV services are integrated in the other services at primary health centres, the network of
which is expanding. Private health facilities and general practitioners are increasingly engaged
and will be accredited for service provision. Treatment adherence, which has been a
challenge, is being addressed, including through peer support groups and ensuring the
continuum of care between health facilities and community level services.
Harm reduction programme, with focus on MMT and NSEP, will continue to be a priority
prevention programme. The advocacy and support to shifting from injection drug use to oral
substitution therapy will be intensified, the trends of people shifting to multi-drug use will be
analysed and addressed. The low condom use, which contributes to sexual transmission
among PWID and their sexual partners, will be addressed.
Sexual transmission among MSM, FSW and TG and their sexual partners has been
increasing. There is a trend for providers of sexual services shifting to use mobile phones and
social media to advertise and connect with clients. Programmes to identify and analyse the
failure of the prevention programmes in these key populations and to intensify the successful
approaches will be developed, including development of social media advocacy and
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information sharing programmes. Mother to child transmission of HIV will be eliminated during
the fast tracking period.
NSPEA will be implemented within the Malaysian Development Plan framework. Given the
mandate by the Government under the NSPEA, the leadership in responding to the epidemic
continues to be shouldered by the Ministry of Health. The engagement from non-health
sectors, NGOs, civil society, private sector, bilateral and international agencies will be
strengthened. Adequate resources and technical support are required to strengthen the
management and human capacity of the health facilities and of civil society organizations, the
crucial partners in the NSPEA implementation.
To maximize the impact of the response, the country will invest adequately and strategically,
prioritising where, for which people and what to invest in to generate best returns. The priorities
are based on what has been identified to work in local context. Sustained domestic funding of
the national response to HIV and AIDS is to be secured. Resources will be allocated aligned
to the priority areas and programmes identified in NSPEA, including strengthening of the
critical enablers, health and community systems capacity and quality of services, and
addressing the prevailing stigma and discrimination.
The Asian Epidemic Modelling (AEM) has provided the projections for the epidemic’s
development and estimated the resource need for Ending AIDS. The total resources needed
to realize the fast tracking targets amount to USD 429.1 million for the period 2015 to 2021.
Annual investment will increase until 2020 and will start gradually decreasing thereafter.
‘Ending AIDS’ scenario shows that intensifying treatment and investing in prevention, even
when the initial costs increase, yields significant savings of costs later, making the programme
affordable in the long term.
Implementation of the NSPEA will be monitored and evaluated through the national HIV
monitoring and evaluation framework, coordinated by the National AIDS Programme
Secretariat. Information gathered from monitoring and evaluation will be used to: a) Ensure
HIV and AIDS response achieves high levels of accountability and efficiency; b) Inform and
help determine whether adjustments are required and to facilitate corrective action; c) Provide
quality information and evidence for future programming; d) Facilitate reporting, such as
reporting for GARPR, Universal Access and the SDGs.
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Vision for Malaysia reaching zero through fast tracking and ending AIDS
VISION:
Zero new infections-Zero discrimination-Zero AIDS related deaths
GOAL:
Ending AIDS by 2030 (90% reduction of new HIV cases from 2010 based on AEM)
TARGETS:
 95% of key populations tested for HIV and know their results
 95% of people with diagnosed HIV+ receive ART
 95% of people on ART achieve viral suppression
 90% of key populations are reached by combination prevention services
INTERIM GOAL:
Fast tracking 2016-2020 towards Ending AIDS
TARGETS:
 90% of key populations tested for HIV and know their results
 90% of people with diagnosed HIV+ receive ART
 90% of people on ART achieve viral suppression
 80% of key populations are reached by combination prevention services
PRIORITY PROGRAMMES:
 Testing and Treatment
a) Intensify and expand testing, including community testing
b) Intensify and expedite introduction to treatment of all PLHIV
c) Ensure adherence through peer support and quality case management
 Harm Reduction
a) Increase PWID shifting from injecting to MMT
b) Increase coverage of NSEP
c) Expedite PWID enrollment in ART
 Reduction of Sexual Transmission

a) Focus and tailor prevention services for MSM, increase condom use
b) Improve access to health and HIV services for TG
c) Improve FSW access to SRH services, develop social media messaging
d) Eliminate mother to child HIV transmission
 Reduction of Stigma and Discrimination

a) Aim to zero discrimination in health services and community
b) Review and remove prohibitive legislation and regulations
c) Provide adequate social protection for PLHIV and affected people
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PROGRAMME INTERVENTION COVERAGE (BASED ON AEM):

By 2030, the intervention programmes should reach
 95% PWID (80% MMT and 15% NSEP)
 80% FSW
 80% TGSW
 80% MSM
 95% KPS on ART
CRITICAL ENABLERS:
 Health and Community Services Strengthening
a) Ensure health services capacity for expanded case load from fast tracking
b) Intensify support to NGOs/CBOs, build up capacity for community level services
c) Promote integrated health service—community continuum of care and services
 Sustainable Financing
a) Ensure domestic financing for fast tracking and ending AIDS
b) Establish adequate accountability and auditing mechanisms
 Quality information and evidence

a) Ensure and synchronize quality information from multiple information sources
b) Strengthen monitoring and analyzing capacity and information sharing
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CHAPTER 1: INTRODUCTION
1.1 The Big Picture

The HIV epidemic in Malaysia has been driven by injecting drug use, more recently
increasingly also by sexual transmission among key populations and their intimate sexual
partners, including people who inject drugs, sex workers, men who have sex with men and
transgender persons. The share of new infections through sexual transmission has been
increasing to close to 80% of the annual total by 2015, including sexual transmission with the
partners of people who inject drugs. The epidemic is still concentrated in key populations, as
indicated by the low level of HIV detection in routine premarital and antenatal testing.
The response to the epidemic in Malaysia started in 1985—a year before the first case of HIV
infection in the country was detected—when a National Task Force was established for
development of policies, coordination and HIV surveillance. The first National Strategic Plan
on HIV and AIDS was formulated in 1998, the consequent National Strategic Plans, the most
recent for the years 2011 – 2015, have guided the national HIV and AIDS response. The Mid-
Term Review (MTR) of the National Strategic Plan of 2011-2015, conducted in 2013, assessed
the progress, achievements and gaps in the implementation of the NSP, and provided the
starting point for the development of the post-2015 National Strategic Plan aiming at ending
AIDS (NSPEA).
The MTR recognized the significant progress in achieving the NSP 2011-2015 targets across
all priority programmatic areas, in improving the access to HIV services, and in enrolment of
people living with HIV to PMTCT, VCT, ART and Harm Reduction services. MTR identified
challenges in key areas which need to be addressed in NSPEA: Low awareness of HIV, risk
behaviours and HIV transmission among young people and key populations; Increasing trend
of alcohol and substance use affecting risk behaviours; Need for further scaling up HIV testing
and treatment; Mitigating the increasing sexual transmission of HIV; Integration of VCT in all
health services—PMTCT, HIV treatment, TB, SRH; TB detection in PLHIV; Scaling up PMTCT
in private health care; Government-NGO partnerships in eliminating stigma; Male circumcision
among the non-Muslim population; and strengthening of community capacity for Fast Tracking
of HIV response.
The New National Strategic Plan for 2016-2030, developed through a comprehensive
consultation process, builds on the successes of the previous strategies, addresses the
challenges identified in the MTR of the 2011-2015 NSP and in the consequent consultation
process. It continues to place strong emphasis on strengthening the government-non-
government (GONGO) partnership undertaken under the previous strategic plans. It adjusts
to the changing international environment and adopts the “Ending AIDS” as the goal for
Malaysia getting to the vision of “Three Zeros”: Zero new infections, Zero discrimination and
Zero AIDS related deaths. It adjusts to the Sustainable Development Goals (SDG) endorsed
by the UN General Assembly and adopts the UNAIDS strategic guidance on Fast Tracking to
reach 90-90-90 by 2020 and to Ending AIDS by 2030. It recognizes WHO’s new
recommendations on HIV treatment and prevention, adjusted to the country context.
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1.2 Rationale
The Malaysian National Strategic Plan for Ending AIDS 2016-2030 (NSPEA) has been
developed building on the successes in the implementation of the previous strategic plans, to
address the gaps and challenges identified in the MTR in 2013 and in the following
consultation process. NSPEA continues to adhere to the principles established in the previous
strategies, adjusts to the scientific findings and advances in HIV prevention and treatment,
and adopts the most recent global strategic and programmatic recommendations, adjusted to
the country context.
The Strategic Plan has been developed for implementation in the rapidly changing
international political environment. The Millennium Development Goals (MDG), the political
framework for the previous national strategies, are being replaced by the Sustainable
Development Goals (SDG), which extend from 2016 to 2030. SDGs, adopted by the UN
General Assembly in 2015, include a target for “Ending AIDS” embedded in an integrated
health goal. Adjusted to the SDG framework, the UNAIDS strategy for 2016-2021, “Fast-
tracking to Zero”, presented to UNAIDS Programme Coordinating Board for approval in
October 2015, will provide the programmatic guidance for reaching the target.
UNAIDS has introduced ambitious treatment target 90-90-90, adopted in Malaysian country
context: 90% of key populations tested and know their results, 90% of those detected HIV
positive placed on ART, and 90% of these adhering to ART with suppressed viral load. The
aim is to achieve the targets by 2020 through Fast Tracking, which also includes reaching
80% of key populations with effective prevention programmes. The aim is eventually to “End
AIDS” by 2030 by raising the treatment targets to 95-95-95% and the prevention target to 90%.
THE TREATMENT TARGET
90 % 90 % 90 %
Diagnosed On treatment Virally suppressed
On scientific and programmatic fronts, the results of the global studies have convincingly
demonstrated that early treatment reduces HIV and AIDS mortality and morbidity. Several
countries have already adopted the immediate initiation of ART after HIV detection, “Test and
Treat”, as part of their HIV and AIDS strategies. WHO treatment guidelines are being adjusted
accordingly in 2015. WHO also, in the consolidated guidelines on HIV testing services of July
2015, recommends HIV testing by trained lay providers using rapid diagnostic tests, thus
7|Page
promoting further decentralization of testing and HIV case management in the communities
where people live and access the services.
Against this background the Malaysian government conducted the Asian Epidemic Modelling
(AEM) exercise in 2014-2015, to project the epidemic’s path up to 2030 and beyond. The
modelling generated options for epidemic response which strongly support the policy option
“Ending AIDS”, which has been adopted as the basis for the new NSPEA development. The
analysis of the projected investment options demonstrated that this option of investing in
intensified targeted prevention and substantially expanding access to treatment will put
Malaysia on track to ending AIDS.
1.3 Development of the National Strategic Plan on HIV and AIDS 2016-2030
The development of the NSPEA 2016-2030 began in 2013 with the Mid Term Review of the
progress made under the NSP 2011-2015. The process included review of the reports and
other information, and extensive consultations with key government and non-governmental
experts and civil society representatives. Extensive consultations took place from mid-2014
onwards through workshops convened to formulate recommendations to achieve “Ending
AIDS”; to identify challenges, gaps and needs for capacity building and financial inputs; and
to discuss and recommend indicators for “Ending AIDS”.
A technical working group of experts in HIV programming, in behavioural surveys and M&E,
with representatives of civil society and UNAIDS country manager, worked on data
consolidation – collecting, collating, analysing and triangulating data from various
programmatic and survey data sources. Three workshops were held to develop, validate and
analyse a baseline model and a set of scenarios for the response with expert assistance from
East-West Centre Hawaii. The first workshop in October 2014 worked towards the
development of a baseline model; the second workshop in December 2014 validated and
refined the baseline model and began work on scenarios for the epidemic. The final review of
the scenarios was conducted at the third workshop in April 2015. The estimations resulting
from the model were validated against the national surveillance data.
Consultations were held in 2015 with key partners, Ministry of Health (MOH), Malaysian AIDS
Council (MAC), UNAIDS, selected District Health Officers and State AIDS Officers to discuss
the HIV strategic issues and challenges and to suggest changes to policy and priority areas.
List of participants is in annex 1. The first consultation identified priority areas, programmes
and targets for the next 5 years and beyond. The second consultation of selected participants
(annex 1) discussed and developed the National Action Plan and M&E Framework, translating
the inputs from the first consultation into action plans for the fast tracking phase. The final
consultations, involving NSPEA Core Team of key staff from MOH, MAC and UNAIDS,
reviewed the final action plan and estimates of the future financial needs for fast tracking of
response to 2020 and ending AIDS by 2030. The action plans have been incorporated as
integral part of the NSPEA, the costing of the NSPEA is based on the AEM estimates of the
epidemic’s evolution and on the investment analysis.
8|Page
The extensive consultations made recommendations which aim at addressing the identified
challenges through: Establishment of a National task force for mitigation of sexual HIV
transmission that would effectively review current status and develop a national plan with
defined key targets; Establishment of a Technical Working Group to develop the plan for
scaling up testing and treatment, including Treatment as Prevention; Establishment of a
National Task Force for most at risk young people to review the current status and existing
prevention modules and to develop an effective national operational plan; Development of
national policy and guidelines on male circumcision for non-Muslims; Strengthening of the
National M&E unit to include NSPEA monitoring and evaluation; Strengthening Government-
NGO partnership and developing management guidelines and capacity building for costing,
M&E and priority areas of action.
Information sharing, inclusivity and consensus building in the development of the NSPEA
2016-2030 resulted in the experiences in the NSP 2011-2015 implementation now being
reflected in the NSPEA 2016-2030. The setting of prioritized and evidence-based national
priorities, which respond to the evolving dynamics of Malaysian HIV epidemic, was possible
with access to the strategic information and research data, which included data from the work
of civil society and community based organisations working in partnership with Government
agencies and academic institutions. The inputs from government and civil society have been
critical in improving the understanding of the epidemic and its response. The findings indicate
that without substantially expanding the community based HIV response the Ending AIDS will
not become reality.
The NSPEA 2016-2030 is comprised of The National Strategic Plan on HIV and AIDS, the
Action Plans for fast tracking and the Monitoring and Evaluation framework. The first fast
tracking phase of the NSPEA, during 2016-2020, aims to reach the 90-90-90 targets: 90% of
key populations tested and knowing their results, 90% of those detected as HIV positive placed
on ART, and 90% of these adhering to treatment with suppressed viral load. The fast tracking
phase aims to reach 80% of key populations with combination prevention. The second phase
of the NSPEA from 2021 to 2030 aims to end AIDS as public health threat, consolidating the
gains of the fast tracking period and reaching the 95-95-95 targets: 95% of key populations
tested and knowing their results, 95% of those detected as HIV positive placed on ART, and
95% of these adhering to treatment with suppressed viral load, as well as reaching 90% of
key populations with combination prevention. NSPEA identifies the capacity building needs
and resources for implementation of the NSPEA 2016-2030, based on AEM projections and
estimations.
9|Page
CHAPTER 2: HIV EPIDEMIC SITUATION, RESPONSE AND

CHALLENGES
2.1 HIV situation in the country
The Global AIDS Response Progress Reports (GARPR) of 2014 and 2015 provide a
comprehensive overview of Malaysian epidemic situation and response up to 2014. The report
of the Ministry of Health “Ending AIDS in Malaysia. Myth or Reality” updates the information,
including the key IBBS results of 2014, which indicate that the HIV prevalence among people
who inject drug (PWID) continues to decline while the prevalence in the other key population
groups seems to be increasing. It also notes that more than half of the newly diagnosed PLHIV
had the first CD4 count below 200cells/µL, indicating late treatment seeking. The report details
the AEM modelling and estimation exercise which provides the parameters for NSPEA. The
findings of the IBBS surveys in 2009, 2012 and 2014 are presented in table 2.
Malaysia has a concentrated HIV epidemic, the prevalence rates remain elevated among key
populations, which include PWID, female sex workers (FSW), transgender people (TG) and
men having sex with men (MSM). The number of people living with HIV (PLHIV) in 2014 was
estimated at 91,848 (AEM 2015). Based on surveillance data the cumulative number of HIV
infections in Malaysia since the first case of HIV was reported in Malaysia in 1986 had reached
105,189 by the end of 2014, the AIDS cases 21,384, and 17,096 deaths related to AIDS. Thus
the number of PLHIV alive at the end of 2014 was 88,093 according to the surveillance data.
The annual number of reported new HIV cases has been in steady decline from a peak of
6,978 in 2002, however this decline has stalled since 2010 (Figure 1). In 2014, 3,517 new HIV
infections were reported to the Ministry of Health, approximately half of what was reported in
2002, an average 9 new infections each day. The estimated number of all new infections in
2014 was 6,204 (AEM), indicating that the number of all new infections may have been almost
double to those reported. The notification rate of HIV continued to decline from 28.4 per
100,000 population in 2002 to 11.4 in 2013, it edged up slightly to 11.7 cases per 100,000
population in 2014.
Figure 1. Reported HIV and AIDS cases and AIDS-related deaths, Malaysia 1986 – 2014
8000 50
HIV
Notification rate (per 100 000 pop.)
45
AIDS 40
6000
Reported HIV cases
HIV/AIDS related deaths 35

HIV Notification rate 30
4000 25
20
15
2000
10
5
0 0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
10 | P a g e
There has been a steady decline in the number of reported AIDS-related deaths. The reduction
has been attributed to the introduction of affordable and accessible first and second line
antiretroviral (ARV) treatment. At the end of 2014 there were 21,654 PLHIV on treatment, 51%
of the estimated number of 42,408 PLHIV eligible for ARV treatment (CD4 count less than
350), but only 23% of all 89,093 PLHIV.
Injecting drug use has been the main driving factor for the country’s epidemic. However,
sexual transmission has been progressively increasing. Sexual transmission of HIV is
currently responsible for almost 80% of new infections. Share of transmission through injecting
drug use has declined significantly from 60-75% range in 1990s to less than 20% in 2014
(Table 1).
Table 1. Percentage of new HIV infections by Mode of transmission, Malaysia 1990-2014
Mode of
1990 2000 2010 2014
transmission
Injecting drug use 470 (60.4%) 3,815 (74.7%) 1,737 (47.6%) 680 (19.3%)
Sexual transmission 41 (5.3%) 964 (18.9%) 1,773 (48.5%) 2,752 (78.3%)
- Heterosexual 38 (4.9%) 902 (17.7%) 1,472 (40.3%) 1,768 (50.3%)
- Homosexual 3 (0.4%) 62 (1.2%) 301 (8.2%) 984 (28.0%)
PLHIV in Malaysia are predominantly male. However, the trend has changed with increasing
female infections, with male/female ratio declining from 9.6 in 2000 to 4.5 in 2010 and to 4.0
in 2014 (Figure 2). With rigorous implementation of harm reduction programme since 2005
the mode of transmission is progressively shifting from injecting drug use transmission to
sexual transmission, with injecting drug use/sexual transmission ratio of 3.9 in 2000 declining
to 1 in 2010 and to 0.2 in 2014.
Figure 2. Reported HIV cases by mode of transmission and PWID/Sexual transmission ratio,
Malaysia 2000-2014
100 6
PWID/Sexual transmission ratio
80 5
Percentage of HIV cases
4
60
3
40
2
20 1
0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
PWID Sexual Vertical
11 | P a g e
About 35% of reported infections were among young people between 13-29 years of age, and
around 1% among the less than the 13 year olds in 2014 (Figure 3). However, HIV prevalence
has been stabilizing in all age groups (Figure 4).
Males continue to represent the majority of all HIV cases in Malaysia but the prevalence rate
among both sexes seems to have stabilized (Figure 5) for the last five years. In 2014, among
men, 23.7% acquired infection through injecting drug use and 74.6% through sexual mode,
while among women the majority acquired HIV through heterosexual transmission (92.4%).
Figure 3. Distribution of reported new HIV cases by age group, Malaysia 1990 – 2014
100
90
Percentage of cases
80
70
60
50
40
30
20
10
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
<13 years 13-29 years 30-49 years ≥50 years indeterminate
Figure 4. Age-specific HIV Prevalence, Malaysia 2000-2014

80.0
HIV prevalence (per 100,000 population)
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
<13 13-29 30-49 50+
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Figure 5. Gender-specific HIV Prevalence, Malaysia 1986 – 2014
8000 Female 60
Gender-specific Rate (per 100,000

7000 Male
Male Specific Rate 50
Reported HIV cases
6000 Female Specific Rate

40
population)
5000
4000 30
3000
20
2000
10
1000
0 0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Year
2.2 HIV/TB Co-infection

Tuberculosis (TB) remains a public health challenge in Malaysia with around 16,000 – 20,000
new cases reported annually (Figure 6). From 1990 to 2014 the number of TB/HIV co-
infections reported nationwide has increased from six to 1,468 cases. In 2014, 24,711 new TB
cases were registered in Malaysia with reported TB-HIV co-infection of 5.9%. To reduce
morbidity and mortality of TB/HIV co-infection, the government has started Isoniazid
prophylaxis for PLHIV in 2010. As part of its disease control and prevention measures, the
government conducts routine TB-HIV screening for all new inmates in closed settings such as
prisons and drug rehabilitation centres, started in 2001
Figure 6. New TB, HIV and prevalence of TB-HIV Co-infection, Malaysia 2000-2014
30000 12.00%
25000 10.00%
20000 8.00%
15000 6.00%
10000 4.00%
5000 2.00%
0 0.00%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
TB HIV TB/HIV prev.
13 | P a g e
2.3 Geographic differences in HIV prevalence

Knowing the geographic distribution of HIV transmission is essential for planning the response,
these differences point to where the priority of response needs to be directed. In IBBS 2014
the prevalence among PWID, while nationally slowly declining, was highest in Kelantan
(44.7%), Terengganu (30.0), Johor (27.1) and Kuala Lumpur (21.3), and lowest in Penang
(1.6) and Melaka (1.7). Among FSW the prevalence was highest in Kuala Lumpur (17.1) and
Pahang (14.5) and lowest in Perak (0.6), but had been increasing rapidly in Sabah (from 1.1
in 2012 to 6.7 in 2014) and Sarawak (from 0.7 to 6.7). Among MSM and TG the HIV prevalence
was highest in 2014 in Kuala Lumpur for MSM at 22.0 (up from 10.2 in 2012), and for TG at
19.3 (up from 4.8 in 2012), and in Johor for MSM at 15.7 and for TG at 10.6.
Within these geographic areas more detailed mapping will be conducted to identify the
hotspots for transmission where the response will be intensified. As the cities have higher
prevalence rates in a country, but also have the means to fast track the response, a global
movement for cities ending AIDS was initiated in 2014. Melaka was the first city in Malaysia
where the “City Ending AIDS” movement was initiated, by 2015 the participation had been
extended to five other cities in Malaysia. A region-wide movement is ongoing within the
framework of “ASEAN cities against AIDS.
2.4 HIV Testing, Surveillance and Surveys

HIV testing in Malaysia started as early as 1985. Provided for free in all government health
facilities, HIV test can be accessed in 1,039 health clinics and 141 hospitals, inclusive of
private hospitals. The Ministry of Health is promoting both voluntary and confidential HIV
testing (VCT) and Provider Initiated Testing and Counselling (PITC). Ministry of Health has
incorporated behavioural surveillance survey into the existing surveillance system since 2004.
The first round of IBBS survey was conducted in 2009 focusing on three key affected
populations (PWID, FSW and TG). The second and third rounds of IBBS were successfully
carried out countrywide in 2012 and 2014.
The testing and screening programmes include routine HIV screening of all donated blood,
blood products and organs, opt-out antenatal screening, routine testing of inmates in drug
rehabilitation centres and prisons, testing of TB and STI patients, clients of harm reduction
programme, contacts of HIV infected persons, and voluntary premarital testing. Premarital HIV
testing for Muslim couples started in 2001 in one state, programme was expanded country-
wide in 2007 and made accessible to anybody who wishes to undergo premarital HIV testing,
irrespective of faith. As part of the prevention of mother-to-child-transmission (PMTCT)
programme, in 2014 close to 490,000 pregnant women were tested and 324 individuals,
0.06%, were detected with HIV (Figure 7).
14 | P a g e
Figure 7. Testing of pregnant women, Malaysia 1998-2014
Thousands
0.2 600
Total ANC Screened %HIV+

500
Percentage of HIV positive
400
No. of antenatal mother

0.1 300
200
100
0 0
1998 2000 2002 2004 2006 2008 2010 2012 2014
Over the past five years, an average of 1.3 million HIV tests was conducted. In 2014,
1,439,855 men and women aged 15 and above had received HIV test and counselling and
knew the result, out of these 1,321 (0.09%) were HIV positive. Despite strengthening the
surveillance programme and intensified testing the detection rate of HIV is decreasing. This is
compatible with the declining HIV reporting through surveillance system which has validated
the reduction in new HIV infections, in accordance with the estimation and projection exercise.
The surveillance data and routine screening activities demonstrate that HIV is still confined
within the key populations and that the prevalence among relatively low risk population is still
low between 0.02 to 0.11% (Figure 8).
Figure 8. HIV prevalence of selected testing and screening programmes, Malaysia 2000-2014
0.2
HIV detection rate (%)
0.1
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Antenatal Premarital Blood Donor
15 | P a g e
2.5 Key populations
(a) People who inject Drugs (PWID)

It is estimated that there are about 170,000 PWID in the country. The HIV testing among PWID
started as early as 1989 and was further strengthened in 1996. At the beginning of the
epidemic, injecting drug use was the main driver, about 60-75% of all new reported cases.
The prevalence of reported cases among PWID started to decline beginning in 2004, and
reached 19.3% in 2014. Similar pattern has been observed in the three cycles of IBBS in which
the HIV prevalence among PWID declined from 22.1% in 2009 to 18.9% in 2012 to 16.3% in
2014. Reported use of clean needles and syringes for injection has remained above 90%.
Above one third (37.8%) of PWID were tested in the last 12 months and knew the result.
Through the country wide testing programme most of the PWID have come into contact with
HIV test somewhere during their life, either in rehabilitation centre, prison, outpatient clinic or
MMT service outlet. Results of IBBS indicate that most of PWID in Malaysia stay injecting for
median 15 years. There is an increasing trend of young PWID shifting to non-injection drug
use or mixed use of multiple drugs.
(b) Men Who Have Sex with Men (MSM)

Based on the last national survey, it has been estimated that the MSM population is about
170,000 (2% of male adult population). In the National HIV surveillance system, MSM are
grouped as homosexual/bisexual. The new infections reported among MSM indicate an
increasing pattern with significant rise in the last couple of years (figure 10). By the end of
December 2014, cumulative of 4,799 MSM have been reported. The increasing trend of HIV
infection reported by National Surveillance among MSM is supported by the findings of two
IBBS surveys (in 2012 and 2014) that observed an increase of HIV prevalence from 7.1% to
8.9%. This finding is complemented by reducing trend in condom use from 74% in 2012 to
57% in 2014, aggravated by increasing trend of alcohol and narcotics use prior to sex among
MSM.
(c) Sex Workers (SW)

It has been estimated in the last consensus dialogue in 2014 that the sex worker population
size in Malaysia is about 45,000, out which 21,000 are female sex workers and 24,000
transgender sex workers. Sex workers account for approximately 0.6% of total reported HIV
cases, or 658 out of the 105,189 accumulated cases reported by 2014. The number of HIV
cases reported among sex workers may be grossly under reported as they may not identify
themselves as sex worker. These infections are categorized by risk factor, heterosexual,
homosexual or bisexual, in the surveillance system. Preventative behaviour as reflected by
condom use with their last client has improved over years. However, with the trend of narcotics
and alcohol use prior to sex, proper condom use may be impeded. Sex workers’ knowledge
on HIV transmission (39%) remains low, needs to be improved, together with focus on alcohol
and substance use.
16 | P a g e
(d) Transgender persons (TG)

The latest consensus dialogue in 2014 estimated the number of TG sex workers at about
24,000. TG are often stigmatized and discriminated by society. The number of HIV infections
within this population is not reflected in surveillance system as TG is not identified by the
system. However, based on IBBS studies in 2012 and 2014, the HIV prevalence among TG
population seems to be on the rise, from 4.8% in 2012 to 5.6% in 2014. Condom use among
TG is better (81.2%) than among MSM (56.7%) in 2014. The increasing trend of narcotics and
alcohol use prior to sex is a concern.
Figure 9. Proportion of reported cases by mode of transmission – comparison between MSM and
PWID, 2000-2014
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
%MSM %IDU
(e) Young people, women and girls

Young people among key populations, including street children, are vulnerable and at high
risk of HIV exposure, they may be subjected to sexual exploitation and trafficking, and face
stigma and discrimination. Of the total 105,185 cumulative HIV cases since 1986, some 2,695
(2.6%) have been individuals aged 19 years and below. In 2014, there were 117 cases among
young people out of the 3,517 new reported HIV cases. IBBS findings in 2014 indicate that
47.8% of MSM were in the age group 18-24 years, while the majority of the PWID were 25
years or older. It also indicated that condom use of young FSW and TG was lower than that
of older FSW and TG.
Young people’s awareness on HIV has not improved. The IBBS (2014) revealed that only
40.8% of young people (15-24 years) could correctly identify ways of preventing sexual
transmission of HIV and reject major misconceptions about HIV transmission. As of December
2014, about 11,653 women and girls in Malaysia had acquired HIV since 1986.
The profile of the Malaysian HIV epidemic has progressively shifted from predominantly male
to an increasing share among females, the proportion of female/male has shifted from the ratio
of 1:99 in 1990 to 1:4 in 2013. In 2014, the Ministry of Health recorded 697 new HIV cases
and 183 AIDS cases among females, the numbers seem to be stabilizing the past couple of
years.
17 | P a g e
Table 2. Key IBBS findings
Injecting Drug Users 2009 (n=630) 2012 (n=1906) 2014 (n=1445)

HIV prevalence 22.1% 18.9% 16.3%
Tested in the past 12 months and knew results 60.8% 64.5% 37.8%
Duration of risk behaviour (median year) NA 10 15
Used sterile needle during last injection 83.5% 97.5% 92.8%
Condom use with most recent partner 19 - 58% 26.7% 28.0%
Knowledge on modes of transmission 49.7% 53.8% 58.2%
Received N/S in the past 12 months NA 77.8% 75.3%
Know where to get HIV test NA 86.5% 84.2%
Reached with prevention programme1 NA 68.9% 64.8%
Female sex workers 2009 (n=551) 2012 (n=864) 2014 (n=839)
Condom use with most recent client 60.9% 83.9% 84.5%
Injecting drugs 5.6% 4.2% 7.2%
Used narcotics before sex 38.5% 20.8% 33.8%
Consumed alcohol before sex 35.9% 31.8% 46.2%
Knowledge on modes of transmission 38.5% 35.4% 39%
Received free condom in the last 12 months NA 50.3% 57.5%
Reached with prevention programme2 NA 44.9% 49.9%
Men who have sex with men (MSM) 2009 (n=529) 2012 (n=365) 2014 (n=531)
Tested in the past 12 months and knew results 41% 47.1% 40.9%
Condom use with most recent partner 55-63% 74.2% 56.7%
Injecting drugs 6% 3.6% 2.8%
Consumes alcohol before sex 23.2% 33.8% 45.8%
Knowledge on modes of HIV transmission NA 44.5% 47.8%
Reached with intervention programmes3 NA 43.8% 30.7%
Transgender persons (TG) 2009 (n=540) 2012 (n=870) 2014 (n=1247)
Sex worker 83.7% 83.8% 86.6%
Condom use with most recent client 67 - 95% 72.5% 81.2%
Injecting drugs 3.1% 2.1% 1.0%
Consumed alcohol before sex 35.9% 38.1% 39.5%
Knowledge on mode of HIV transmission 37.2% 40.6% 38.1%
1
‘Reached with intervention programme’ refers to PWID who received free N/S in the last 12 months and know where to go for
HIV test
2
‘Reached with intervention programme’ refers to FSW who received free condom in the last 12 months and know where to go
for HIV test
3
‘Reached with intervention programme’ refers to MSM who received free condom in the last 12 months and know where to go
for HIV test
18 | P a g e
2.6 Response to the AIDS epidemic
(a) National Political Commitment

Strong political commitment and leadership at highest levels have been keys to successful
response to the epidemic. The government initiated the response to HIV epidemic well before
the first case of HIV was reported in 1986. This was marked with formation of National AIDS
Task Force in 1985, an inter-sectoral committee chaired by the Director General of Health.
The Task Force was responsible for formulating policies, strategies and assumed the role of
national HIV/AIDS prevention and control programme coordinator. During the same year, HIV,
AIDS and deaths related to HIV/AIDS were included on the list of notifiable diseases under
the Prevention and Control of Infectious Diseases Act, which led to increasing notification from
screening programmes among high risk populations.
In 1992 the Government established the Inter-Ministerial Committee on HIV/AIDS (CCA) in

order to strengthen the National HIV/AIDS response and its coordination. The Committee was
assisted by the National HIV/AIDS Technical and Coordinating Committees, which took over
the functions of the National Task Force on HIV/AIDS. CCA was entrusted with advising the
Cabinet of Ministers on HIV/AIDS prevention, control and management in Malaysia. The CCA
was in 2009 replaced by National Coordinating Committee on AIDS Intervention (NCCAI)
chaired by the Minister of Health.
Following the restructuring of the Ministry of Health’s Public Health Division in 1993, an
AIDS/STI Section was created under the Disease Control Division. The Section serves as the
secretariat to the Ministerial, Technical and Coordinating committees and coordinates and
streamlines the national response supported by the AIDS Officers in every state. Similar
mechanism, which coordinate actions carried out by NGOs, is being implemented in every
state and district.
Another coordinating body, where also civil society is represented, is the Country Coordinating
Mechanism (CCM), a national consensus body with Deputy Minister of Health as Chair. The
formation of the CCM was mandated in 2009 by the Cabinet to provide governance for
programmes and activities related to the Global Fund for AIDS, Tuberculosis and Malaria
(GFATM) in Malaysia.
Mandated by the Government, the leadership in responding to the epidemic continues to be

shouldered by the Ministry of Health. Multi-sectoral engagement has improved over the
several years. Non-health sectors i.e. Ministry of Women, Family and Community
Development (MWFCD), which leads the Task Force on Women, Girls and HIV/AIDS, National
Anti-Drug Agency (NADA) which implements HIV programmes in the facilities under its
responsibility, Department of Islamic Development (JAKIM), Ministry of Home Affairs, and the
Information Ministry now form part of the key stakeholders in the country involved in the
national HIV prevention and control programmes. Ministry of Human Resources has
developed ‘Code of Practice on Prevention and Management of HIV/AIDS at the Workplace’
as a guideline to employers and employees in managing issues pertaining to HIV at the
workplace.
In the nut shell, all HIV responses in the country were guided by series of strategic plans
started with National Plan of Action 1988, reviewed Plan of Action 1998, National Strategic
Plan 2006-2010 and the currently running National Strategic Plan 2011-2015.
19 | P a g e
(b) Involvement of key populations and civil society

The MOH recognizes the pivotal role of civil society in the national efforts to effectively respond
to the epidemic. To ensure civil society engagement, the government continues to support the
civil society organizations through funding allocated every year for HIV/AIDS response
through Malaysian AIDS Council (MAC). MAC functions as an umbrella organization to
support and coordinate the efforts of Malaysian NGOs, civil society and community based
organizations working on HIV and AIDS response. MAC oversees the implementation of high-
impact HIV prevention programmes of NGOs, which aim to provide 80% service coverage for
key populations, with 60% of those covered practicing safe behaviour consistently. Since
2003, through MAC, the government has extended its funding to more than 30 NGOs every
year, amounting to more than RM 80 million (USD 26.7 million).
Recognizing the varied and vital roles of community health actors in support and promotion of
HIV prevention and care amongst key populations, the MOH extended the CCA membership
to MAC in December 2008, and consequently the membership in CCAI. Inclusion of MAC in
the committee to represent the voice of civil society marked a momentous move in further
strengthening the community systems for an effective response to the epidemic. To ensure
meaningful social impact mitigation, PLHIV and key populations have been involved in
decision making at national level through their participation in NCCAI and CCM. JAKIM has
developed the Manual “Islam and HIV” that provides emotional, religious and spiritual support
to PLHIV and their families.
(c) Treatment and care

Malaysia has witnessed transformation in treatment and care for PLHIV that benefits both the
person and the society. Significant achievements have been accomplished, including the
availability and provision of first line ARV treatment at no cost for those eligible, and the
availability of ARVs for incarcerated populations, specifically for prisoners living with HIV as
well as for inmates in drug rehabilitation centres. Currently, the second line regime is also
heavily subsidised by the government. The policy to provide free first line ARV to all PLHIV in
2006 marked an important milestone in the national response to the HIV epidemic, followed
by a shift in ART initiation from CD4 200 to 350 cells/L in 2010. The latest development in
prevention of transmission to sexual partners has been extending treatment for sero-
discordant couples, introduced in Consensus Guidelines on Antiretroviral Therapy in 2014.
Furthermore, availability of PrEP and PEP for key populations at cost is among the latest
developments.
Services are provided by an extensive network of public and private facilities, an effective rural
health delivery system, specialized care at regional level and successful health promotion and
preventive programmes. Accessible through 355 hospitals (141 government and 214 private),
7,832 clinics with doctors (1,031 public and 6,801 private) and 2,075 community clinics run by
paramedics (Community Clinics and 1Malaysia Clinics), the Malaysian health services have
improved over years with doctor to patient ratio rising to 1:6334. Within the dual public-private
health service system, the Ministry of Health plays the role of funder, provider and regulator.
4 Malaysia Heath Facts 2014
20 | P a g e
The Government continues to support the decentralized approach to health service provision,
which includes community-based and primary health services linked to hospital-based care. It
provides treatment (ART), voluntary counselling and testing (VCT), psychosocial support,
nutritional support and treatment for opportunistic infections. Currently, all government
hospitals and health clinics are providing ART either on site or through referral to those
facilities that are entitled to provide ART. In addition, every year health staff including
Infectious Disease Physicians, Family Medicine Specialists, nurses and medical assistant
counsellors are trained and assigned to various hospitals and clinics to assist in HIV testing,
treatment and counselling.
Integration of services at primary health care level has been practiced since 1960s. Among
the activities that have been integrated into Maternal and Child Health Clinics are screening
of syphilis among antenatal mothers, PMTCT, VCT, TB and HIV care. All government health
facilities have linked HIV to TB services, PLHIV are referred for TB testing and IPT or TB
treatment. Voluntary Counselling and Testing (VCT) is available in all government health
facilities integrated with antenatal care, TB and STI services. However, the uptake of VCT by
key populations, as observed in IBBS was within the range of 32% to 51% only.
Integrating the management of HIV in Primary Health Care makes HIV services accessible,
acceptable and affordable to the whole community, especially to key populations. It is
expected to increase the uptake of HIV testing, care and treatment for PLHIV. The services
are available in almost all primary health clinics which have Family Medicine Specialist (FMS)
in their staff. All these clinics have been equipped with trained health personnel and point of
care testing with rapid HIV test and CD4 testing.
There is a need for better treatment education for PLHIV who are initiating or currently on
treatment to address the low adherence. To ensure treatment adherence, the government has
invested in Treatment Adherence Support Services. Through peer support volunteers, this
service provides psychosocial support for key populations to understand importance of
consistent treatment, and provides a ‘patient navigator’ to help the new patient to navigate and
understand the flow of the hospital services.
(d) Prevention through Harm Reduction

Harm reduction programme was initiated in Malaysia in October 2005 with the Opiate
Substitution Therapy (OST), followed by Needle and Syringe Exchange Programme (NSEP)
in February 2006. These main components of harm reduction programme remain a
cornerstone of the Government’s HIV prevention strategy. OST is currently being implemented
in partnership with NGOs, CBOs and private health practitioners. OST is being provided at
government facilities under the Ministry of Health as well as in facilities under Ministry of
Education. Is also being introduced in the National Anti-Drug Agency (NADA) service centres
and in incarcerated settings, specifically in prisons.
Together, these programmes aim at reaching at least 60% out of estimated population of
170,000 PWIDs by 2015. Provision of harm reduction services is available in 728 NSEP sites
and 811 OST outlets established in government health facilities, NGO sites, private health
facilities, National Anti-Drug Agency (NADA) service outlets and prisons.
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NSEP is mainly provided by the NGOs (78%) and in government health clinics (22%). The
number of NSEP outreach points run by NGO is 540 while the number of NSEP sites in
government clinics is 152. As of 2014, the programme had reached 85,693 PWID with average
distribution of 285 needles and syringes per PWID in a year. In the past two years the
proportion of clients referred to VCT and MMT from NSEP has been increasing, an average
of 21% referred to VCT a year, only 5% of PWID had changed to oral substitution therapy
(OST). This programme is planned to be further strengthened to reduce the harm from
injecting drugs through shifting to OST.
OST programme is currently provided by government hospitals and clinics (44%), private
healthcare practitioners (44%) and has been extended to the National Anti-Drug Agency
(NADA) service centres (7%), and prisons (2%); altogether to 838 OST centres throughout
the country. The programme has reached 74,816 drug users.
NADA has introduced a new way of managing drug users, changing from compulsory
rehabilitation centres to voluntary open access services, Cure and Care Clinics, Cure and
Care Service Centres and Caring Community Houses since 2007. OST has also been
expanded in prison set up, beginning with 1 prison in 2008 and expanded to 18 by 2014.
Methadone is the drug of choice at these facilities. OST at private clinics run by qualified and
trained private practitioners uses widely Buprenorphine and Methadone. 160,509 people who
inject drugs have been reached by this programme since its implementation.
The Harm Reduction programme has been acknowledged worldwide as the country’s success
story in reducing new HIV infections. The programme has benefited 160,509 drug users. With
the expansion of NSEP programme, drug users have better access to clean needles and
syringes, the findings of the latest IBBS 2014 indicated that 97.5% had used clean needles
which was way above target set in the NSP 2011-2015 (60%)
(e) Prevention of Sexual Transmission

To address the rise of sexual transmission of HIV, the NGOs through MAC have amplified
their work to deliver appropriate sexual and reproductive health services and education to key
populations who are vulnerable to sexual transmission of HIV, namely male and female sex
workers (SWs), men who have sex with men (MSM) and transgender persons selling sex
(TGSW). Sexual transmission intervention coverage has improved through: sexually
transmitted infection (STI) prevention services, including education, testing and access to free
condoms; information, education and Behaviour Change Communication; community
sensitisation and provision of sexual and reproductive health (SRH) education and other
essential SRH services; outreach and peer education; encouraging HIV testing through
voluntary testing and counselling; counselling and psychosocial support.
The number of NGOs providing outreach services to key populations that include HIV
Prevention Packages has increased. IBBS 2014 indicated that up to 65% of the key
populations were reached. The IBBS noted a worrying trend of alcohol and substance use
prior to sex among FSW, TG and MSM.
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The IBBS 2014 revealed that understanding on prevention of HIV through sexual transmission
and rejecting major misconceptions about HIV transmission among key affected populations
(FSW, TGSW and MSM) was not satisfactory (38% - 58%). Inversely, the pattern of condom
use with recent partner has shown an increase to a range of 57% - 87%. Although VCT, SRH
and HIV/ STI services were available in all public health facilities, service uptake is low among
key populations, ranging in IBBS 2014 from 41% to 49% only.
To intensify decentralization of services, training in post-basic counselling for paramedics has

been included as one of 6-months in-service training courses offered by the Ministry of Health
and is beginning to show momentum. At the same time, every State Health Department and
National Public Health Institute is currently conducting their own short counselling courses to
equip the Health Clinics with trained personnel.
(f) Prevention of Mother to Child Transmission

Prevention of mother to child HIV transmission became the country’s key programme in 1998
when testing among antenatal mothers was initiated in the whole country. HIV positive
mothers were given free antiretroviral therapy, ART prophylaxis was given to HIV-exposed
infants and routine PCR test was strictly observed. To further prevent transmission through
breast milk, HIV-exposed infants are given free formula feeding. The programme also offers
HIV testing and counselling for spouses. Beginning 2011 the government adopted treatment
option B+ for HIV infected mothers, and the HIV exposed infants are getting free replacement
feeding for extended period of 2 years since 2012.
Moving rapidly towards elimination of mother to child transmission (EMTCT) of HIV and
congenital syphilis the high quality programme is available in all government and in some
private health facilities. Testing coverage in public facilities improved substantially from 49.7%
in 1998 to almost 100% in 2014. In 2014, about 489,993 or 85% of all estimated pregnant
women (575,604) had undergone MTCT programme in 1,039 government health facilities.
The overall prevalence of HIV among pregnant women in 2014 was 0.06 %. To eliminate
vertical transmission MOH has started HIV testing among ‘missed-opportunity’ mothers—
those not tested at ANC services in labour rooms. In 2014, 9651 pregnant women with
unknown HIV status were tested in labour room, HIV prevalence at 0.1% (14 cases) among
them was much higher than among mothers tested in ANC (0.03%).
349 pregnant women received ART in 2014, including 58 pregnant women detected late in
2013, to prevent mother-to-child transmission. All 349 HIV exposed infants born in 2014 were
given ARV prophylaxis resulting in 344 (98.6%) mother-to-child transmission infections
averted. With PMTCT intervention, the HIV transmission rate has been reduced to 1.3%,
compared to 30-40% had there been no intervention. Testing of male partners of pregnant
women at antenatal clinics remains low. In Kedah, Terengganu and Penang where it has been
implemented, about 38% of male partners have agreed to be tested, with HIV prevalence at
0.02%.
(g) Stigma and Discrimination

Stigma and discrimination has been gradually reduced but is still experienced by PLHIV. The
IBBS findings in 2014, along the lines of the MAAG+ stigma index study of 2013, indicated
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that some sixty percent of PLHIV experience self-stigma, and that up to 50% of PLHIV had
experienced verbal abuse and up to 20% had experienced harassment, discrimination and
even physical violence. Creating and maintaining better understanding of HIV transmission
among people living with HIV and among population as well as service providers, to reduce
risk taking, stigma and discrimination is essential for ending AIDS. It is important to establish
and maintain an enabling public policy and environment to reduce HIV stigma and
discrimination, and to respect human dignity.
The involvement of religious leaders, especially Muslim religious leaders has increased over
the past years. Advocacy and investment in programming has facilitated mobilization and
harnessing the support of Islamic religious leaders in HIV prevention and the provision of care
and support. There have been remarkable developments of programmes by JAKIM which
involve a number of religious bodies engaging key populations, such as female SW, TG and
MSM, through the availability of religious classes and programmes. Building on the successes
of the “Islam and HIV/AIDS” project, which was initiated in 2001, Muslim religious leaders have
engaged in not only the implementation of HIV awareness programmes but also proactively
established care and support facilities which extend from financial and welfare assistance to
shelters for Muslim PLHIV. The success of “Islam and HIV/AIDS” programme has also gained
recognition in other Muslim countries worldwide.
There are still gaps in delivery of care and support. Partner Organizations under the
coordination of Malaysian AIDS Council, which are primarily funded by the government, are
addressing the challenge. Treatment and Adherence Support Programme (TAPS)—formerly
Hospital Peer Support Programme (HPSP), has been established to improve coordination,
linkages and referrals from social, health and community level services. TAPS delivers
outreach services to hospital clients who require information and education about antiretroviral
treatment and adherence, emotional management and healthy living with HIV. TAPS
complements the ART provided by the hospitals, ensuring continuum of care and adherence
to ART.
In 2014, 10 Partner Organisations conducted the TAPS in 24 treatment centres, reaching out
to 4924 clients living with HIV, their family and friends. This was achieved through support
group gatherings and peer support counselling sessions. The programme’s standard
operating procedure (SOP) has been drafted by MAC and widely used by the NGOs as
guidance to standardize the operations throughout the country.
In 2014, the Partner Organisations operated 16 shelter homes. These shelter homes were
mainly funded by the government, the Ministry of Women, Family and Community
Development, and complemented through grants from other sources. Services provided by
the shelter homes include basic nursing care, palliative care, medical referrals, distress
counselling, and psychosocial and spiritual support, and also teaching of life skills. In 2014,
625 residents of the shelter homes, 355 of whom were PLHIV, 254 of these on ART, were
served by the shelter homes.
Ministry of Women, Family and Community Development (MWFCD) has established 1Azam
and eKasih Programme that has successfully raised living standards of low income
households of more than 40,000 ‘extremely poor’ families by 2012.
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(h) Availability of quality strategic information

In line with the Three Ones Principle, implementation of the National Strategic Plan is
monitored and evaluated through the national HIV monitoring and evaluation framework,
coordinated by the National AIDS Programme Secretariat, the HIV/STI sector of the MOH,
which has been given the responsibility to monitor and evaluate the implementation of the
national HIV and AIDS response. The NAP Secretariat is also empowered to ensure that all
relevant stakeholders report to the Secretariat on specific indicators and that the results and
achievements of targets are monitored and evaluated periodically.
Poor availability and quality of strategic information and its use by policy makers and
programme planners through monitoring, evaluation and research has been recognized as a
serious gap. Over time, the quality of the case reporting has improved with the use of electronic
and web-based National AIDS Registry (NAR). With the establishment of national Monitoring
and Evaluation (M&E) unit in the HIV/STI Sector of Ministry of Health, HIV programme
monitoring is more systematic and comprehensive. This includes monitoring of programmes
from private sector and NGOs through MAC supervision, and reporting on regular basis.
The analysis and use of M&E data has ensured support from CCA and CCAI in scaling up
interventions. Progress has been made in understanding the HIV epidemic and key
populations’ vulnerability to HIV and STI infection and the need for specific essential services.
Over 25 years a number of surveillance activities have been in place, including: a) Manual
case notification, b) Electronic National AIDS Registry, and c) Behavioural Surveillance,
including now the biological component (HIV test) complementing the surveillance system.
(i) Critical enablers

Implementing the National Strategic Plan requires extensive multi-sectoral collaboration
between the government and non-governmental organizations, and engagement of key
populations, including people living with HIV. Other sectors than health sector, including law
enforcement, prison services, education sector, social services are engaged providing the
support to the National AIDS response. Health system and civil society work increasingly
closely together and coordinate their activities. Health facilities and community based
organizations need to have sufficient capacity to provide integrated and quality treatment and
prevention services, to reach the key populations, and to ensure continuum of care and
services at the community level. Led by the government the services which integrate HIV with
other health and social services are being expanded and decentralized throughout the country
through education and training programmes, and assigning qualified staff to primary service
level.
Financing of the NSP is almost totally provided by the government, including financing of the
civil society organizations through MAC. These organizations need appropriate support and
training in management and accountability to qualify for funding. With the expected rapid
expansion of the national response the sustainability of funding is crucial, with front loading
the expenditure during the fast tracking period and keeping in mind the expected large savings
in not too distant future from “Ending AIDS”, as projected by AEM.
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Quality information, collected, analysed and shared between partners is a prerequisite for
efficient implementation of AIDS response. The MOH M&E unit has been strengthened and
will play the central role in monitoring and providing evidence for programme planning and
adjustments as required. Regular surveys and ongoing surveillance provide detailed
information on progress towards targets, reviews and evaluations conducted will guide the
NSP implementation.
Above all, strong political support, appropriate policy in place and active well-coordinated
participation of key players are backbone to the successful HIV response in Malaysia.
2.7 Challenges and lessons to learn
The NSP 2011-2015 Mid Term Review, conducted halfway through the implementation of
the NSP 2011-2015 implementation, assessed gaps and challenges, and made proposals to
improve the HIV/AIDS response and identify next steps to reach the targets. Acknowledging
the considerable successes in the implementation of the national strategies the MTR also
identified challenges to be addressed:
a) The gap in accurate knowledge in the young general population and key populations
about HIV and AIDS is concerning, especially the gap in knowing the risks of
transmission and what they need to do to protect themselves and others.
b) Plans for scaling up testing and treatment will need adequately trained human
resources, appropriate infrastructure and consistent budget allocation for ARV within
the health sector as well as within the community.
c) There is challenge to get PWIDs to change from injecting and adhere to OST. This will
impact on achieving targets to introduce the eligible people on treatment.
d) To reduce sexual transmission of HIV significantly, a special Task Force needs to look
for innovative ways that can have high impact on behaviour change and improve
coverage of comprehensive prevention packages for most at risk populations.
e) To improve coverage and integration of VCT, PMTCT, ART, TB and SRH services at
all levels of the system, including in primary health care facilities, is a challenge. More
investment in health system strengthening is needed, particularly at primary health
care level, to make it happen (staffing, training, infrastructure, accreditation etc.)
f) There is still a large gap in TB/HIV care, notably in early TB screening and awareness,
leading to late TB diagnosis among PLHIV and resulting in high mortality due to TB.
g) Moving towards eliminating MTCT of HIV Malaysia has been implementing high quality
PMTCT since 1998, but its implementation has been limited to government health
facilities.
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h) NGOs’ and multi-sectoral agencies’ engagement in combating HIV and AIDS needs to
be re-energized with new smart partnerships focusing on improving coverage of HIV
related services for key populations, including post-release detainees, and expanding
the role of community support groups.
i) Stigma and discrimination are still experienced in various forms, including among
health staff and population. There is a need to intensify efforts to reduce stigma and
discrimination, and to establish outcome indicators that allow programmes to measure
progress on stigma and discrimination reduction in the workplace and in the
community, as well as to tackle gender based violence and its impact on women’s and
children’s health. A clear operational plan with targets involving all stakeholders needs
to be developed, implemented and reported on.
j) A policy and implementation plan on male circumcision is needed for non-Muslims.
k) The main challenges related to M&E, Research and Surveillance are:

i) Lack of unifying plan for monitoring the National Strategic Plan
ii) Some of the indicators are not measurable and with no clear definitions.
iii) HIV/AIDS research has tended to be dominated by research on bio-medical issues,
with little effort going into the socio-cultural drivers and responses to the HIV
epidemic.
iv) Size estimates for key populations have been outdated, especially for PWID and
MSM populations.
The consultation process leading to NSPEA development after the MTR largely agreed to
the MTR identified challenges, and pointed out some more specific challenges, to be
addressed in the NSPEA:
a) The delays in initiating the PWID on ART after the initial HIV detection if PWID still
inject
b) Decentralization of rapid testing and intensified follow up of treatment and case
management
c) Low adherence to ART in the absence of smooth CBO-health service linkage
d) Insufficient attention to female PWID specific needs, including SRH
e) Recognizing that TGSW need more attention
f) More attention to expand MSM prevention activities
g) Insufficient attention to HIV prevention for young persons in education sector
h) PrEP and PEP promotion and use
i) Adjusting the ART eligibility criteria, and
j) Capacity building to improve NGO/CBO general management and financial
management
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2.4. Projections of HIV epidemic in Malaysia

AEM modelling was used to estimate the projected development of HIV epidemic for the post
2015 period, based on information on programme coverage in 2013 (Figure 10). The model
projected the epidemic’s development if the “business as usual” approach was adopted,
resulting its stagnation with no end of the epidemic in sight.
AEM modelling then designed five scenarios (details in annex 2) for intensified response
aiming to achieve elimination of HIV and AIDS. Comparing all options, ‘Ending AIDS’ will reach
90% reduction of new HIV cases, to less than 800 new HIV cases a year in 2021, eventually
leading to ending AIDS, while the other scenarios would drive the country further away from
ending AIDS, even after 2050 (Figure 11).
Figure 10. Estimated and projected number of cases by Mode of Transmission, Malaysia 1986 – 2030
25 Clients MSM1 TG FSW1 LRM LRF Male PWID

Thousands
20
No. of cases
15
10
0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Figure 11. Scenarios for New HIV Infections for adults, Malaysia 2000-2030
Accelerate treatment only regardless of CD4

15 Scale-up prevention only
Thousands
Scale-up Harm Reduction for PWID and scale-up treatment CD4<350

Ending AIDS (scale-up both prevention and treatment regardless of CD4)
Number of cases
10
0
2004
2015
2026
2000
2001
2002
2003
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2027
2028
2029
2030
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CHAPTER 3: NATIONAL STRATEGIC PLAN FOR ENDING AIDS

2016-2030
3.1 Guiding Principles for National Response
Malaysia’s national response to HIV and AIDS is guided by following principles:
a) The spread of HIV is a challenge to the national development of Malaysia and a

concern to be addressed under the Malaysian Development Plans.
b) HIV and AIDS response is based on evidence, it prioritises interventions among key
and vulnerable populations.
c) HIV and AIDS response focuses on promoting healthy practices and prevention, as
well as on treatment, care and support for People Living with HIV and affected by HIV
and AIDS.
d) The comprehensive response to HIV and AIDS takes into consideration cultural,
religious and societal values.
e) Government, civil society and private sector stakeholders work together in multi-
sectoral partnerships to respond to the spread of HIV. All stakeholders work together
to create a possible, comprehensive and effective intervention in fighting against HIV
and AIDS.
f) Working in consultation and collaboration with relevant stakeholders, the Government
provides policy direction, HIV treatment for those in need, and financial resources in
support of the response.
g) Civil society, including non-governmental organisations, community groups, People
Living with HIV and those affected by HIV and AIDS, complements the Government
in the prevention of HIV, as well as in treatment, care and support for those living with
HIV and for those affected.
h) Active and meaningful participation of key populations, including communities, People
Living with HIV and people affected, is integral to development, implementation,
monitoring and evaluation of all interventions.
3.2 Priorities for ‘Ending AIDS’
To maximize the impact of the response, the country will invest adequately and strategically,
prioritising where, for which people and what to invest in to generate best returns. The priorities
are based on what has been identified to work in local context. The AEM modelling has
provided the projections for the epidemic development and the estimated resource
requirements for Ending AIDS.
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(a) Priority 1. Testing and treatment.

There is overwhelming evidence that early antiretroviral treatment keeps people living with
HIV healthy and reduces the social and economic costs of advanced HIV-related illness, care
of orphaned children and lost productivity. Effective treatment averts death and also prevents
transmission of HIV. The experience indicates that for every 10% increase in the number of
PLHIV getting treatment, the population-level HIV transmission rate drops by 1%.
Malaysia commits to “Ending AIDS” by 2030 through achieving the 95-95-95 target: 95% of
key populations tested for HIV and knowing their results, 95% of people diagnosed with HIV
placed on ARV treatment, and 95% of people on ART achieving HIV suppression, an
undetectable viral load. The commitment includes reaching 90% of the key populations with
effective prevention.
Malaysia commits to Fast Tracking the response during 2016-2020 to achieve 90-90-90 of the
above treatment targets, as well as the 80% prevention target by 2020. The current low
coverage and delayed HIV testing and counselling among key populations is a major
challenge to achieving an early initiation of treatment, and achieving an undetectable viral load
requires strict adherence to treatment.
A technical working group will study the options for intensifying testing and treatment. These
include scaling up testing, making rapid point-of-care testing accessible in community,
performed by health and paramedical professionals working at all health facilities country wide
and through community-based screening, through acceptable testing approaches that
minimize turn-around time for result confirmation and ART initiation.
The working group will also study options to gradually expand initiation of ART immediately
after HIV detection irrespective of CD4 count, as recommended by WHO, and to provide
adequate peer and outreach support and case management to ensure adherence to
treatment, recognizing that treatment resulting in suppressed viral load will also be an effective
means of preventing HIV transmission.
To reach the target of 90-90-90 by 2020, assuming that the eligibility for ART is extended to
all PLHIV irrespective of CD4 count by 2020, will require intensified testing and increasing the
number of PLHIV on ART four fold during the five-year period, from 21,654 PLHIV in 2014, to
cover 90% of the estimated 88,093 PLHIV and newly infected, less those deceased, during
the five-year period. The intensified testing and increased numbers of PLHIV on ART, and the
intensified case management to ensure 90% adherence to ART, will require additional
resources and capacity building both in the health and in the community level services.
(b) Priority 2. Harm Reduction.

Injecting drug use remains a key driving factor for the country’s epidemic. In an effort to control
the transmission of HIV among PWID and their intimate sexual partners, Malaysia is
implementing the Harm Reduction Programme through provision of clean needles and
syringes (NSP) and Methadone Maintenance Therapy (MMT), combined with prevention of
sexual transmission among PWID. The programme has been the cornerstone in government’s
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response to HIV since 2006. The prevalence of HIV among PWID has been steadily declining
over the years. The Task Force for Harm Reduction will study the implications of the trend of
particularly younger PWID to shift from injecting drug use to oral, and to multi-drug use.
Over 81% of estimated 170,000 PWID population have been enrolled in the programme.
However, the proportion of PWID living with HIV initiated on ART is still low. Social support
and adherence to treatment are among crucial factors in initiating and providing ART.
Experience indicates that peer support group is essential to improve the adherence. However,
the majority of PWID who are still injecting have been observed not to be able to adhere to
the treatment, thus provision of ART to these PWID may prove difficult. Persuading them to
change to MMT is one alternative to improve treatment coverage.
(c) Priority 3. Sexual Transmission

A Task Force will be established to review the increasing trends of sexual transmission and to
develop effective messages and methods for HIV prevention in the changing sexual
transmission scenarios. To fast track and eventually end AIDS, the prevention programmes
need to be scaled up to cover at least 80% of key populations. The increasing trend of HIV
transmission through unprotected sexual intercourse, which is still largely confined in the key
populations and their intimate sexual partners, will have to be reversed. While there is a need
to continue the ongoing efforts to map and identify the high risk locations and to intensify the
preventive efforts in those, there is a need to develop innovative and effective ways to address
sexual transmission in the increasing sex trade through mobile phones and social media. This
will include consideration of the newly available PrEP and PEP tools for prevention in specific
key populations and situations.
(d) Priority 4. Stigma and discrimination

Stigma and discrimination faced by key populations and PLHIV are still experiencing will be
addressed in multi-sectoral collaboration, including civil society, and law enforcement
authorities. It will be included as a cross-cutting issue in all prevention programmes, and will
include provision of adequate social and legal protection. It is important to establish and
maintain an enabling public policy and enabling environment which will help to reduce HIV
stigma and discrimination, respect human dignity, gender and sexuality and is supportive to
HIV programmes and interventions.
Stigma is still experienced by key populations in various forms, including in health and social
contexts. The IBBS study of 2014 indicated that up to sixty percent of PLHIV experience self-
stigma, and that up to fifty percent had experienced verbal harassment and twenty percent
had experienced harassment, discrimination and even violence. Creating and maintaining a
better understanding of HIV to reduce risk taking as well as stigma and discrimination are
essential for ending AIDS.
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3.3 Framework for National Strategic Plan for Ending AIDS
3.3.1 National Strategic Plan

The government and key stakeholders have agreed that the new National Strategic Plan
on HIV and AIDS will sustain and upscale the achievements and commitments achieved
under the previous National Strategic Plans, to address concerns and identified gaps, as
well as to respond more effectively to the needs of the stakeholders, especially those of
civil society and key populations. The National Strategic Plan for 2016-2030 aims at
Ending AIDS, and includes the first 5-year Fast Tracking period of 2016-2020 to reach the
intermediate targets established in accordance with the endorsed global and regional
agreements and commitments, followed by consequent 5-year periods. Evaluations of
each 5-year period plan implementation, and the mid-term reviews during these periods,
will be conducted and plans adjusted as necessary.
3.3.2 Leadership and Partnerships

Given the mandate by the Government under the NSPEA, the leadership in responding to
the epidemic continues to be shouldered by the Ministry of Health. The engagement from
non-health sectors, NGOs, civil society, private sector, bilateral and international agencies
will be strengthened.
The Government has always acknowledged the role of civil society in fighting against
HIV/AIDS and this undivided support has been translated into annual funding channelled
to Malaysia AIDS Council (MAC) for implementation of HIV/AIDS programmes in line with
national strategies. NSPEA 2016-2030 acknowledges the increasing role that NGOs
continue to play in HIV response, especially in addressing the needs of key populations.
The Government-NGO co-operation will be based on good partnership and will cover all
issues of national concern, including periodic and systematic evaluation of roles,
performance and impact.
3.3.3 Testing and Treatment

In realizing ‘Three Zeros’ Malaysia has been providing all ART (including first, second and
third line) almost free to PLHIV. Implementing HIV testing in outreach and community
settings will be expanded to ensure services for key populations. CBOs implementing rapid
point-of-care testing services in non-clinical settings are able to reach a large number of
people at high risk for HIV transmission. CBOs will assist in HIV screening; they will be
trained and accredited to provide HIV screening and counselling as well as extend their
support to PLHIV. These services will be linked with the health facilities, to provide
adequate quality of testing, treatment, care and support, to ensure continuum of care and
adherence to treatment, including training and capacity building of health professionals
and lay service providers.
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3.3.4 HIV prevention among key populations
(a) Harm Reduction

Harm Reduction programme will be intensified to ensure the encouraging decline of the
prevalence of HIV among PWID living with HIV will continue. PWID population size will be
re-estimated and its geographical distribution mapped, and programme implementation
adjusted to the priority locations. The Task Force for Harm Reduction will review the policy
of providing ART to PWID still injecting along the lines of international recommendations
in Malaysian context.
(b) Sexual Transmission

The increasing trend of HIV sexual transmission will be addressed. Mapping of the
geographic and local hotspots for HIV transmission will be conducted. A National Task
Force on Mitigation of HIV through Sexual Transmission will look into innovative and
effective ways to mitigate sexual transmission and recommend ways of intensifying the
existing effective sexual transmission prevention programmes and explore innovative
ways of addressing the changing sexual transmission scenarios, particularly the increasing
use of mobile phones and communication through social media for sex trade.
(c) Eliminating Mother to Child Transmission

Malaysia is on the verge to eliminate mother to child transmission with almost 100%
coverage of option B+ in government health facilities. The service will be rapidly expanded
to private health facilities, including adequate training and accreditation of the facilities and
service providers.
(d) Young people

The multi-partner National Task Force on HIV and AIDS for the most-at-risk young people
will be dedicated to prevention of HIV and to care of young persons living with HIV and
AIDS. The Task Force will provide the platform for networking, sharing information as well
as for planning, executing and evaluating promotive, preventive, curative and rehabilitative
HIV/AIDS programmes for young people. These will ensure prevention and reduction of
HIV transmission risk among the most at risk young people, improve the quality of life of
people living with HIV, and reduce the social and economic impact resulting from HIV and
AIDS on the individual, family and society.
(e) Stigma and discrimination

Key populations continue to experience stigma and discrimination. Self-stigma is common
among PLHIV, and requires intensification of psycho-social support. This issue will be
discussed at appropriate forums and will be incorporated as cross cutting issue to all key
population programmes, as well as in the IBBS monitoring.
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3.3.5 Strategic information
(a) National AIDS and Treatment Registries (NAR and NTR)

In view of the gaps in the HIV treatment cascade from HIV testing and detection to
treatment and adherence, as well as the gaps in care and support, measures are being
taken to improve the availability of information for monitoring the situation and progress in
the implementation of strategies and action plans. These include the combined use of
National AIDS Registry (NAR), which was launched in 2010, and registration of the PLHIV
who are on treatment (National Treatment Registry, NTR). NAR is a real time web-based
registration of all notified PLHIVs while NTR is operating as stand-alone registration to be
incorporated into NAR.
(b) Critical enablers:

In order to reach the goal of ending AIDS by 2030 and of fast tracking by 2020, the critical
enablers include: Strengthening health and community services to ensure service capacity
for expanded case load from fast tracking, intensifying support to NGOs/CBOs to build up
capacity for community level services, and promoting integrated health service-community
continuum of care and services. Sustainable domestic financing will be secured for fast
tracking and ending aids, including establishment of adequate accountability and auditing
mechanisms. Quality information will be provided, including synchronizing information
from multiple information sources.
3.4 National Strategies
3.4.1 Strategy 1 - Testing and treatment to End AIDS

The Government continues to support the decentralised approach to health services
which includes community-based and primary health care linked to hospital-based
care. It provides also psychosocial support, nutritional support and treatment for
common opportunistic infections. Malaysia already provides and is committed to
affordable and universal access to care through the public health system, including
free or subsidized access to ART.
Testing and counselling will be intensified through community-based rapid testing,

performed with support by paramedical staff attached to primary health care facilities.
Test and treat immediately after testing HIV positive will be gradually introduced and
guidance and training provided for all staff in the fast tracking of testing and treatment
to reach 90-90-90 by 2020, and in eventually ending AIDS.
The access to testing and treatment of People Living with HIV (PLHIV) in closed
settings and of those living outside the major cities is of concern, and their access will
be ensured under existing programmes. Stronger linkages and referral systems, as
well as integration of HIV in related services, such as VCT, tuberculosis (TB),
opportunistic infections (OIs), PMTCT, SRH, Hepatitis B and C testing, as well as in
OST and NSEP will be instituted. The quality and sustainability of treatment, care and
support services for PLHIV will be ensured. Positive prevention will also be promoted
among people living with HIV.
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Fast tracking in 2016-2020:

a) Intensify testing and treatment, decentralize testing and treatment to accredited
primary health centres and introduce community based point-of-care rapid testing
and case management with support by professional staff to perform testing, link
peripheral services to integrated services in health system.
b) Improve coverage and early access to quality HIV testing, care and treatment,
sexual and reproductive health and STI services for key populations and their
partners. Ensure access to testing and ARVs as well as to commodities at
affordable prices.
c) Improve continuum of care and adherence to treatment and detection of treatment
failure through intensified case management by trained lay service providers and
peer educators.
d) Expand routine PICT for pregnant women, TB and STI patients and strengthen
linkages from prevention to integrated SHR, TB, STI and other services.
e) Adopt single first line treatment and standardize treatment procedures
f) Scale up HIV testing, care and treatment with ARVs, hepatitis and TB screening
and treatment for drug users in prisons and other detention centres, ensure
continuum of treatment and care after their release.
g) Improve TB/HIV detection, including by expanding Gen-expert technology, ensure
early treatment of all TB/HIV patients, as well as IPT for newly detected PLHIV,
improve case management at community level by training and authorizing peer and
outreach workers to perform additional duties
h) Improve availability of strategic information through monitoring, surveillance and
surveys, and the analysis and use of the information
3.4.2 Strategy 2 - Improving the quality and coverage of prevention

programmes among key populations
HIV prevention in 2016 – 2030 will focus on addressing the primary drivers of HIV
transmission in Malaysia, injecting drug use and sexual transmission, through
intensifying the Harm Reduction programme, including NSP and MMT for people
injecting drugs, and preventing sexual transmission amongst key and vulnerable
populations, intensifying advocacy amongst young people, and achieving early
elimination of mother to child transmission. It is recognized that effective ART will also
constitute prevention by drastically reducing sexual transmission to intimate partners
of PLHIV whose viral load is suppressed. The fast tracking activities for 2016-2020,
summarized below each strategy, are priority activities which will provide the basis for
Ending AIDS by 2030.
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(i) Prevention of HIV transmission through injecting drug use

The primary mode of transmission in Malaysia continues to be through injecting
drug use. Sustaining and scaling up of the existing comprehensive prevention
interventions which consist the harm reduction programme, needle and syringe
exchange and methadone maintenance therapy, remains a priority and will be
further intensified.
Fast tracking 2016-2020:

a) Build an enabling environment for HIV prevention amongst people injecting
drugs and their partners by mobilizing key stakeholders, including health offices
at district level, the care providers, community networks and peer support
groups, NGOs, local authorities, and law enforcement, through local
coordination councils, strengthen and regularize the State and National Task
Force on HR.
b) Develop innovative strategies to address challenges in the delivery of HIV
treatment for people who inject drugs, map the high risk locations, provide
access to friendly services, including during extended service hours, improve
linkages between community and health services by locating CBO in health
facilities and assigning paramedical staff to support community services,
review and amend SOP.
c) Establish treatment adherence peer support system to ensure adherence to
treatment, train and accredit the CBOs and outreach workers in case
management and continuum of care to ensure adherence.
d) Intensify and scale up HIV prevention for PWID and their partners and spouses,
including referrals to needle and syringe exchange programmes and opioid
substitution therapy. Review the practices for initiating ART for PWID who are
still injecting drugs and initiate early treatment as appropriate in country
context.
e) Intensify targeted behaviour change initiatives for male and female PWID,
emphasize risk reduction and promote safer sexual behaviours. Develop
innovative approaches to attract women who use drugs or are partners of
people who use drugs to address sexual transmission and sexual health.
f) Review and revise as appropriate the package of services offered to
programme beneficiaries, to include sexual and reproductive health services,
opioid substitution therapy, community-based TB and hepatitis screening.
g) Strengthen management of HIV prevention among drug users in prisons, in
other detention facilities and drug rehabilitation centres, provide access to MMT
and TB/HIV services. Establish training and advocacy for police and other
uniformed services, develop training curricula.
(ii) Prevention of sexual transmission

Strengthening of prevention of sexual transmission will include advocacy and support
activities which apply for all key populations, female sex workers, MSM and TG, as
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well as interventions specific for each of these populations. In view of the increasing
trend of sexual transmission there is a need to establish a Task Force for prevention
of sexual transmission, to develop innovative strategies for prevention of HIV
transmission in the increasingly mobile phone and social media use for sex trade, to
strengthen existing programmes for prevention of sexual transmission in key locations,
to improve coverage and quality of interventions. Introduce case management
approach to ensure adherence to treatment and continuum of services linking health
and community level services, including accompanied referrals, peer groups.

a) Review existing strategies including awareness programmes and activities to
encourage and facilitate behavioural change among key populations. Build an
enabling environment for behavioural change through economic, welfare and
religious aid.
b) Raise awareness and build knowledge and awareness on HIV and other diseases
(TB and STIs), among key populations and youth and their spouses and sexual
partners. Support and promote the use of condoms and lubricants among key
populations and their partners or clients.
c) Improve and strengthen client-friendly VCT, STI and SRH services to all key
populations, including counselling. Develop and scale up services on sexual and
reproductive health, counselling and treatment related to STIs, HIV and AIDS to
ensure universal access to services.
d) Expand and scale up HIV prevention programming incorporating a comprehensive
package of services for men who have sex with men (MSM) and transgender
persons (TG).
e) Study the feasibility and expand introduction of PrEP and PEP for prevention of
sexual transmission.
(iii) Elimination of Mother to Child Transmission

Prevention of Mother to Child Transmission (PMTCT) Programme was piloted in 1997
and implemented countrywide in 1998. Malaysia is on the verge of eliminating the
mother to child transmission of HIV. Building on the successful PMTCT programme,
option B+ which was started in 2012 in government health facilities Malaysia aims at
early elimination of mother to child transmission expanding the services to private
health facilities and general practice. The programme engages also spouses in the
programme. EMTCT will be introduced in accredited private health facilities linking with
existing SRH programmes.

a) Maintain the provision of quality, comprehensive national PMTCT services, in line
with the WHO recommended four pronged strategies, to reach pregnant women,
their partners and their infants, including key populations.
b) Strengthen community awareness of HIV to increase enrolment in the PMTCT
programme and other related antenatal, family planning, sexual and reproductive
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health, voluntary confidential counselling and testing services, particularly among

key populations.
c) Ensure the availability of PMTCT in all ANC facilities, including in private health
care facilities, so that all HIV-infected pregnant women and their HIV-exposed
infants receive ARV treatment, prophylaxis and breastfeeding education and
supplies.
(iv) Young key population

Adolescents and young adults are at increased risk for HIV exposure and transmission
due to the many developmental, psychological, social, and structural transitions that
converge in this period of the lifespan. Young key populations (YKPs) also bear
disproportionate burdens of HIV and are the most vulnerable, including young MSM,
transgender youth, young PWID, and adolescent and young adult sex workers. It is
therefore critical to stop new HIV infections and untimely HIV-related deaths through
both primary and secondary prevention and better management approaches. Using an
interwoven prevention and treatment cascade approach, the starting point for all
interventions must be HIV counselling and testing. Subsequent interventions for both
HIV-negative and HIV-positive youth must be “adolescent-centred,” occur within the
socio-ecological context of young people and take advantage of the innovations and
technologies that youth have easily incorporated into their daily lives. In order to
achieve the global goals of zero infections, zero discrimination and zero deaths, a
sustained focus on HIV research, policy and advocacy for YKPs must occur.

a) Enhance delivery of curriculum and co-curriculum related to HIV education &
awareness in school and higher learning institutions.
b) Strengthen awareness programme using interactive and multimedia to reach out
adolescent and young people.
c) Facilitate and support existing programme for young people with drug use
behaviour in school and higher learning institutions.
d) Increase uptake of HIV testing among YKPs.
e) Improve treatment adherence among adolescent living with HIV (ALHIV) and
Young PLHIV with support group
3.4.3 Strategy 3 - Reduction of Stigma and Discrimination
Ending AIDS requires addressing the still experienced stigma and discrimination by
PLHIV through increasing their access to and availability of care and support
programmes, addressing their physical, mental, social, spiritual, religious and
economic needs, and providing social and legal protection. These will be addressed
as cross-cutting issues in each of the priority strategies.
38 | P a g e

a) The required multi-sectoral collaboration and coordination, including with civil
society and private sector, will be strengthened, including establishment of technical
cooperation and regular information exchange and sharing.
b) Ministry of Health will lead consultations with relevant government entities and civil
society, including engagement of private sector, on mainstreaming programmes to
address stigma and discrimination and to ensure social protection.
3.4.4 Strategy 4 - Ensuring quality strategic information and its use by

policy makers and planners through monitoring, evaluation and
research.
Implementation of the National Strategic Plan for Ending AIDS will be structured and
managed to facilitate the participation and involvement of relevant stakeholders from
government, civil society, the private sector and development partners, and to ensure
sharing of the results from the interventions. Strong governance and coordination of
the National AIDS Programme by Ministry of Health will ensure harmonisation and
alignment of all stakeholders involved in AIDS response.
The overarching principle in management of the National Strategic Plan is the Three
Ones Principle of one national multi-sectoral strategy, one national coordination
platform with a multi-sectoral mandate and one monitoring and evaluation framework.
There is a continuous need to improve the availability and quality of research,
surveillance and bio-behavioural data, and analysis of monitoring and evaluation of
HIV response, to guide, adjust and determine the policy and programme directions for
prevention, treatment, care and support.

a) Develop and strengthen partnerships to plan, coordinate and manage the
national monitoring and evaluation, research and surveillance systems.
b) Produce and disseminate timely and high quality data from research, integrated
biological behavioural surveillance (IBBS), population size estimations and other
studies.
c) Promote the production, dissemination and effective use of strategic information
to inform and guide programme and policy decision making.
d) Consolidate and streamline mechanism for data collection from both private and
public health facilities for future planning.
e) Strengthen the capacity of the MOH M&E unit for effective coordination of all
stakeholders, and to analyse and share the information with all partners, and to
prepare reports for programme planning and reporting, including to international
fora.
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CHAPTER 4: LEADERSHIP, COORDINATION AND

IMPLEMENTATION
4.1 Leadership
a) National Coordinating Committee on AIDS Intervention

Leadership of HIV policy and decision making rests with the restructured Cabinet Committee
on AIDS now acting as the National Coordinating Committee on AIDS Intervention (NCCAI)
chaired by the Minister of Health. The NCCAI functions as the highest decision-making body
on HIV and AIDS related policies. Its membership includes all the Secretaries General of the
relevant ministries and agencies as well as civil society representatives, including the
Malaysian AIDS Council.
b) National Advisory and Technical Committee on AIDS

The National Advisory and Technical Committee on AIDS (NATCA), is a merger of two bodies
in the previous framework, namely the National Advisory Committee on AIDS and the
Technical Committee on AIDS. This committee, which is chaired by the Director General of
Health, acts as a high level advisory body to the NCCAI. It provides a forum for discussion of
policy issues relevant to increasing the success of Malaysia’s response to the HIV epidemic
as well as to review progress against the annual work plans and budgets. The membership of
the NATCA is made up of key Ministry officials, subject matter experts, NGO and community
representatives and the Director Generals and HIV Focal Points of the Ministries. It meets and
reports to the NCCAI.
4.2 Coordination
a) National AIDS Programme Secretariat

The responsibility for the overall coordination of Malaysia’s HIV and AIDS response is currently
tasked to the AIDS/STI Sector of the Disease Control Division, Ministry of Health. The
AIDS/STI Sector of the MOH is currently functioning as the National AIDS Programme (NAP)
Secretariat. The Secretariat interacts and engages the other institutions within the Federal
Government and the civil society through HIV Focal Points who are present in each of the
relevant Ministries.
The NAP Secretariat will be strengthened with sufficient resources and capacity to the
implementation of the National Strategy on HIV and AIDS 2016–2030. It will be responsible
for overall coordination, monitoring, evaluation and reporting. This secretariat will continue to
strengthen and maintain linkages with state and district authorities through the respective
State AIDS Officers, build capacity of ministerial AIDS focal points and facilitate information
sharing among the different national level committees.
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The work of the National AIDS Programme Secretariat is supported by the State AIDS Officers
whose tasks are to plan, coordinate, implement and evaluate HIV interventions. The AIDS
Officers and the NAP Secretariat are also instrumental and critical in ensuring that HIV
prevention, care and support programmes carried out by NGOs, who are recipients of public
funds, are harmonised and in line with the identified priorities under the National Strategy on
HIV and AIDS.
b) Country Coordinating Mechanism (CCM)

The Country Coordinating Mechanism, chaired by the Honourable Deputy Minister of Health,
provides governance for all programmes and activities related to the Global Fund for AIDS,
Tuberculosis and Malaria (GFATM) in Malaysia. CCM operates concurrently and
complements the work of the NATCA.
c) Malaysian AIDS Council

The Malaysian AIDS Council (MAC) was established in 1992 by the Ministry of Health as an
umbrella organisation to support and coordinate the efforts of partner organisations working
on HIV and AIDS issues in Malaysia. In partnership with government agencies, private sector
and international organisations, MAC works towards ensuring a committed and effective
response by NGOs to HIV and AIDS response. MAC facilitates the collaboration with civil
society organisations in the implementation of the National Strategy on HIV and AIDS. Most
of the public funds for use by non-governmental organisations working on HIV and AIDS
projects are channelled through MAC.
d) UN Theme Group on HIV

The UNTG composed of the UN agencies in Malaysia, provides coordinated support to
the national authorities and civil society partners.
4.3 Implementing the National Strategic Plan
National Plans of Action

The action plans, developed based on evidence driven national priorities, guide the
implementation of the NSPEA 2016-2030. These broad action plans aim to define the priority
action areas, which will then be translated into actionable and costed annual work plans. The
overall AEM costing, which is based on more detailed cost calculations, serves as the
framework for the action plans. Resources needed to realize the fast tracking action plans
amount to USD 429.1 million for 2015- 2021.
The first action plans, developed through national consultations, have been designed for fast
tracking of the response 2016-2020, to reach the 90-90-90 targets, testing 90% of all key
populations, enrolling 90% of the detected HIV positive cases on ART, and ensuring that 90%
of these will achieve viral load suppression (90-90-90) by 2020, as well as to achieve 80%
41 | P a g e
coverage of the key populations with prevention programmes. These action plans will guide
the activities and the decision making in resource allocations (Annex 4).
After evaluation of the programme achievements towards the end of the fast tracking period
2020, the action plans for the remaining NSPEA up to 2030 will be adjusted as necessary to
reach the goal of “Ending AIDS”, to achieve 95%-95%-95% coverage of testing and treatment,
and 90% prevention coverage of key populations. There will be another evaluation after five
years of implementation, towards the end of 2025, with necessary adjustments for the
remaining 2025-2030 period, and the final evaluation in 2030.
The broad action plans will be complemented by annual work plans which will be clear, action
and results oriented and targeted, to translate strategic priorities and the broad action plans
to operational realities. The adjustments to the action plans and the development of the annual
work plans will be guided by the periodic reviews of the NSPEA, including mid-term reviews
of the fast tracking period and of each consequent five-year period.
Given its role in monitoring and evaluation as well as in resource tracking, the National AIDS
Programme Secretariat will play a central role in advising NCCAI and NATCA in priority setting
and adjustments, facilitating and conducting the reviews and evaluations of the national action
plans, and in the development of the annual work plans. The Secretariat will facilitate these
through regular information sharing and exchange, and through consultations at partnership
and stakeholder forums and through technical working groups and engaging scientific
institutions. The Secretariat will collect and analyse strategic programmatic and financial
information needed to inform priority setting and programme development
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CHAPTER 5: RESOURCES
5.1 Financing HIV and AIDS responses
Information on past programme expenditure has been collected using AIDS spending format
aggregated by category from all key partners, the government and non-governmental
organizations, civil society and bilateral agencies. Total expenditure has increased every year,
in 2014, the total expenditure of HIV and AIDS response was calculated at RM 195,705 million
(Table 3), an increase of 5.5% compared to the previous year, with domestic public funding
from the government covering most of the HIV response expenditure (94%). About 65% of
AIDS spending was for HIV treatment (ART) and care, and 15% for prevention programmes
(Figure 12).
Table 3. Approximate total expenditure from Domestic (Public and Private) and International Sources
by AIDS spending category, Malaysia 2013-2014
AIDS Spending Category 2012 (RM) 2013 (RM) 2014 (RM)
Prevention 26,390,256.14 32,011,097.15 29,939,632.08

Care and treatment 123,026,700.28 118,612,712.05 127,395,654.84
Orphans and vulnerable children 3,550.00 2,688,638.34 2,842,117.00
System strengthening and programme
26,553,621.16 28,210,162.38 30,446,995.42
coordination
Incentives for Human Resources 2,013,434.70 1,826,443.69 1,994,167.68
Social Protection and Social Services
2,394,000.00 2,060,800.00 2,000,000.00
including Orphans and Vulnerable
Enabling Environment 521,219.95 462,134.06 697,914.50
Research 363,300.00 0.00 388,351.50
TOTAL 181,266,082.23 185,871,987.67 195,704,813.03
Regarding sources of financing for HIV response, in 2014 the domestic public funding from
the Government covered most of the AIDS related expenditure, whereas international and
private sector contributions resources contributed 6% of the total funding (Table 4). The
external funding includes a limited Global Fund Grant, of USD 10,742,323 for 01.07.2011-
30.06.2016. No further grants from the Global Fund are expected as Malaysia will no more
qualify for these grants as higher middle income county, approaching high income status.
Some limited resources have been provided by the UN, WB, EU and the International Alliance.
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Table 4: Source of approximate AIDS expenditure, Malaysia 2012-2014
Source of
2012 (RM) % 2013 (RM) % 2014(RM) %
Funding
Domestic Public 173,083,236.10 95 176,705,624.34 95 184,902,731.22 94
Domestic Private 2,853,763.20 2 2,427,169.63 1 1,835,679.81 1
International 5,329,082.93 3 6,739,193.70 4 8,966,402.03 5
Total 181,266,082.23 100 185,871,987.67 100 195,704,813.06 100
Figure 12. AIDS spending by function, Malaysia 2010-2014
2014
Care & Rx
2013
Prevention
Prog Management
2012 OVC
Soc Protection
2011 Human Resource
Enabling environ.
2010
Research
0% 20% 40% 60% 80% 100%
Government funding is channelled from the Ministry of Finance to the Ministry of Health which
disburses the funds to other government ministries and departments. The other Ministries are
also able to provide funding for their own HIV related programmes utilising their individual
budgets. The government is committed to subsidise ARV for PLHIV either in institutionalised
settings or otherwise, including HIV testing and treatment at the Primary Health Care Levels
(VCT, PICT, pre-marital HIV testing, STI) or secondary levels.
In order to support the NGO related programmes, the MOH uses the Malaysian AIDS Council
as a conduit for channelling the necessary public funds to the individual NGOs. Currently,
support to several HIV prevention and control programmes and activities is channelled through
MAC, namely the NSEP for IDUs and intervention programmes for sex workers, MSM and
TG.
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5.2 Financing Fast Tracking and Ending AIDS
The resources required to implement the NSPEA 2016-2030 have been calculated based on
the implementation of “Ending AIDS” scenario by AEM. The coverage to be achieved is
assumed to gradually increase from the baseline levels to the planned targets by 2020 and
further to 2030. The number of people on ART is estimated to increase 3-4 fold from 2014
(21,654) during the fast tracking five-year period to 2020. The unit costs for the services are
based on cost of interventions currently being implemented by the government and non-
governmental partners.
Over the next five to fifteen years, it is important to secure sustained domestic commitment to
fund the national response to HIV and AIDS. Resource allocations will need to be aligned to
the priority areas and programmes identified in NSPEA 2016-2030. Adequate resources and
technical assistance will be needed for the next five to fifteen years to further strengthen
organisational and human capacity for HIV response to be sustained and to build upon the
progress and results obtained from the previous National Strategic Plans.
Table 6. Total annual resource need for ‘Ending AIDS’, Malaysia 2016 – 2030
Prevention (‘000) Treatment (‘000) Total (‘000)

USD RM USD RM USD RM
2016 10,236 37,872 43,111 159,511 53,347 197,383
2017 10,826 40,057 47,745 176,655 58,571 216,713
Fast- 2018 11,383 42,118 51,703 191,300 63,086 233,418
track 2019 11,913 44,079 55,064 203,735 66,977 247,815
2020 12,427 45,980 57,852 214,053 70,279 260,033
Total 56,785 210,106 255,474 945,254 312,260 1,155,361
2021 12,155 44,975 57,365 212,250 69,520 257,225

2022 11,890 43,991 54,215 200,597 66,105 244,588
2023 11,631 43,034 51,262 189,669 62,893 232,703
2024 11,378 42,099 48,479 179,372 59,857 221,471
Ending 2025 11,129 41,179 45,853 169,656 56,982 210,835
AIDS
2026 10,864 40,196 43,381 160,510 54,245 200,706
2027 10,604 39,235 41,052 151,894 51,656 191,129
2028 10,350 38,296 38,857 143,770 49,207 182,065
2029 10,102 37,378 36,785 136,103 46,887 173,481
2030 9,860 36,481 34,828 128,864 44,688 165,346
Total 109,963 406,864 452,077 1,672,684 562,040 2,079,549
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The resources needed to realize the Fast Tracking targets amount to USD 312.3 million
(RM1.1 billion) for period of 2016-2020. The initial investment is undeniably high, but the
annual expenditure needed will start declining within as little as 6 years. The cost of treatment
drives up the total costs incrementally year by year. Prevention is a ‘must have’ component
as it averts substantial costs of providing HIV treatment over medium to long-term. In contrast,
avoiding such investments will merely postpone huge, ever-increasing costs into the distant
future.
If intervention remains as before (business as usual), with no new investment in the response,
the HIV epidemic would continue with serious implications for public health as well as with
major social and economic costs. But focusing all investments on accelerating treatment only
would still lead to a continuous increase in new infections each year. The key to significantly
reducing new HIV infections, therefore, is to scale up the prevention and to accelerate
treatment.
The ‘Ending AIDS’ scenario shows that investing in prevention yields significant savings on
treatment costs later, making the program affordable over the long term (table 8). However, if
ART is scaled up without expanding and optimizing prevention coverage of the most affected
populations, new infections continue to increase, treatment costs will spiral upwards, and the
program becomes unsustainable.
Figure 13. Total Resource Needs, Malaysia 2014-2050

Scale-up prevention only
120 Ending AIDS (scale-up both prevention and treatment regardless of CD4)
Thousands
Baseline -Business as usual

100
Total resource (USD)
80
60
40
20
0
2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050
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CHAPTER 6: The National M&E Framework
6.1 The Purpose

In line with the Three Ones Principle, a comprehensive national HIV and AIDS Monitoring,
Evaluation and Research Framework (M&E Framework) has been developed to coordinate
stakeholders towards one agreed country-level monitoring and evaluation system. The
development of the National M&E Framework (M&E) was participatory involving wider
stakeholders at public, private and community levels and in harmony with the global (Global
Response Progress Report) and country specific indicators.
Information gathered from M&E of HIV and AIDS programmes will be used for tracking the
epidemic trends and the national response to HIV. The goal of National M&E Framework is to
provide timely and accurate strategic information to guide the planning of the national
response to HIV and AIDS in order to achieve the object of NSPEA. Information sources
include among others: a) Mapping of Key Populations; b) Monitoring of overall programme
coverage; b) Monitoring of prevention services; e) Monitoring of treatment services; f)
Monitoring of impact mitigation; g) Operational research conducted to increase the
effectiveness of prevention, treatment, care and support programmes.
Partners involved in the implementation of the National Strategic Plan will continue to operate
their own systems for programme monitoring and evaluation using standard common
indicators. The National M&E Framework (M&E) will consolidate information which is
generated by the government and other key stakeholders. Achievement of expected results
and targets will be monitored and evaluated periodically.
6.2 Indicators and Targets

To monitor the NSPEA Fast Tracking and Ending AIDS, the indicators for measuring
programme coverage targets have been selected to get consistent and accurate information
on programme performance and outcomes, which ensure that key populations will have
access to high quality prevention, treatment, care and support services (Annex 4). The
indicators used in monitoring the past NSPs’ performance have been reviewed and adjusted
to NSPEA Fast Tracking and Ending AIDS targets. These indicators are in line with the AEM
model and UNAIDS global target on ending AIDS. The indicators include:
By 2020:
a) 90% of all key populations will be tested and know their results
b) 90% of detected PLHIV will be placed on ART
c) 90% of PLHIV on ART will have an undetectable viral load.
d) 80% of key populations, including sex workers, MSM and transgender persons will be
47 | P a g e
reached by prevention programmes

e) 95% of people who inject drugs will be reached by the harm reduction programme
(80% referred to MMT and 15% referred to NSEP).
By 2030:
a) Testing and treatment targets will be 95%-95%-95%,
b) Prevention programmes will reach 90% of key populations resulting in Ending AIDS
as public health threat in Malaysia.
6.3 Monitoring and Evaluation Process

Monitoring and evaluation programme will capture and evaluate programme implementation
from input, activities and output to impact level. All stakeholders involved in the response to
HIV are contributors to achieving the targets, measured using the standard common
indicators, and are equally responsible to ensure that their activities are regularly monitored,
reported and utilised to measure progress.
The National AIDS Programme (NAP) Secretariat within the Ministry of Health is given the
responsibility to monitor and evaluate the overall HIV/AIDS framework. The NAP Secretariat
is also empowered to ensure that all relevant stakeholders report to the Secretariat on specific
indicators as necessary. NAP Secretariat will work with Ministries and civil society
organisations to lead the national programme monitoring and evaluation. Utilising strategic
information gained from the M&E, the NAP Secretariat will evaluate the existing response as
well as suggest areas needing improvement or adjustment.
6.4 Surveillance
The responsibility of HIV surveillance is with the HIV/STI Sector of the Ministry of Health. Over
25 years a number of surveillance related activities have been in place:
a) Case notification
All HIV, AIDS and AIDS-related death diagnosed by registered medical practitioners are
reported manually to the Ministry of Health as stipulated in the Prevention and Disease Control
Act 1988. As a nominal case reporting, this surveillance system aims to better characterize
the populations in which HIV have been newly diagnosed and to facilitate the public health
follow up. Sources of notification include health facilities, routine HIV testing among people
who inject drugs in drug rehabilitation centers and prisons, TB and STD patients, pregnant
women attending antenatal clinics and blood donors. The system was upgraded to web-based
notification in 2001.
b) National AIDS Registry

The Ministry of Health established the National AIDS Registry (NAR) in 2009. Intended to
replace the existing surveillance system, the internet-based registry is designed to function as
a streamlined and effective national HIV programme monitoring mechanism able to capture
detailed disaggregated data continuously and systematically. The registry captures data on
each HIV patient relating to their socioeconomic background, risk factor, date of confirmation,
contact information, AIDS-related symptoms etc.
48 | P a g e
c) Behavioural Surveillance
Malaysia began implementing the third generation surveillance system (Behavioural
Surveillance System) among key populations for the first time in 2004 under the auspices of
Ministry of Health Malaysia. Biological component (HIV test) was integrated in the survey in
2012. Currently, integrated bio-behavioural surveillance survey (IBBS) is complementing the
National Surveillance System and is conducted periodically.
Strategic information collected and analysed by surveillance system includes also ARV
resistance surveillance and estimations of key populations and their locations. The information
will be designed, collected and analysed together with the universities, institutions and
international agencies to have meaningful data collection programme planning and for future
projections.
6.5 Guidance and Reporting

Horizontal working relationships between government and non-government agencies at the
state level are critical to ensure that there is appropriate programme monitoring at both
operational and national levels.
National HIV and AIDS Monitoring, Evaluation and Reporting Guidelines will be reviewed and
revised as appropriate, and used to guide monitoring and evaluation of the NSPEA 2016-2030
implementation. These guidelines will be kept as simple and practical as possible to allow
monitoring, evaluation and reporting to be properly carried out. The guidelines will be
disseminated, and training of all service providers conducted so that monitoring, evaluation
and reporting will be optimized.
6.6 Progress Monitoring

Progress monitoring and evaluation are conducted through joint government and civil society
periodic performance reviews which will be conducted at both state and national levels. The
intention of the performance reviews is to evaluate progress based on coverage,
effectiveness, relevance and sustainability of programmes. The frequency of the state level
HIV programme review will be every 6 months with the State AIDS Officers and the State
Health Department taking the lead. The review will be conducted with government and civil
society organisations responding to HIV at the state level.
The Technical Working Group on Monitoring and Evaluation (TWG-M&E), chaired by the
Monitoring and Evaluation Unit of the National AIDS Programme Secretariat will lead the HIV
programme performance reviews conducted at the national level. This includes strengthening
of Secretariat’s own technical capacity and the capacity of the involved Ministries and civil
society organisations
49 | P a g e
6.7 Annual Progress Report

The National AIDS Programme Secretariat will coordinate and facilitate the preparation of
annual progress reports and development of annual work plans through the national HIV
programme performance review, which will be discussed and finalised as part of the annual
joint stakeholder meeting held towards the end of each year. The input to the annual progress
report will also be based on HIV programme performance review conducted at the State level.
The annual progress report will provide information on the progress made in implementing the
work plans. Based on programme monitoring data which is routinely collected by the National
AIDS Programme Secretariat and the Malaysian AIDS Council, an assessment is made
whether planned activities have been implemented and whether planned outputs and
expected results have been achieved, and whether corrective adjustments need to be made.
The annual progress report will be based on the indicators and targets agreed in the M&E
framework, which includes core indicators (Annex 1). Based on data collected by the National
AIDS Programme Secretariat and the Malaysian AIDS Council and stored in a centralised
database an analysis will be made concerning the progress made in achieving the agreed
targets for these core indicators. The annual progress report will include an analysis of most
recent surveillance data as well as data from other recent surveys in order to assess changing
and emerging epidemiological trends. Based on the results and findings of the assessments
presented in the annual progress report, the National AIDS Programme Secretariat, in close
consultation with its partners, will prepare or revise the work plan for each coming year.
6.8 Mid Term Reviews

A mid-term review of the implementation of the first fast tracking period 2016-2020 is planned
to take place in 2018. After the interim fast tracking evaluation in 2020, and the evaluation of
the second 5-year period 2025, the mid-term reviews will be conducted every 2-3 years, until
the final evaluation in 2030. The reviews on the progress made in the implementation of the
national response will be discussed in joint stakeholder meetings and will suggest adjustments
and direction and scope of future implementation of the response.
6.9 Impact Evaluation

An interim evaluation of the fast tracking period will take place in 2020, to evaluate the
implementation of fast tracking phase. It will recommend corrective action and adjustments to
the NSPEA if necessary. The second evaluation will take place in 2025. The final evaluation
of the National Strategic Plan will take place in the second half of 2030. These evaluations will
assess the results in the achievement of targets, analysing the available data to verify outcome
and impact in comparison with baseline values for core indicators. These evaluations will not
only assess effectiveness of individual programmes and of the overall national response, but
will take into consideration the quality and efficiency of programmes and interventions.
50 | P a g e
6.10 HIV and AIDS Research

Monitoring and evaluation of the National Strategic Plan will also require data collected
through research, including regular surveys. Research compliments monitoring and evaluation
by building a knowledge base which will guide the national response. Thematic research will
be conducted to better understand underlying causes, dynamics and impacts of the epidemic,
such as epidemiological trends, new and emerging areas of concern and a better
understanding of vulnerability and long-term consequences of the epidemic.
51 | P a g e
Annex 1
List of participants attended 1st consultation meeting (9 – 11 June 2015)
NO. NAME ORGANIZATION

1 Dr. Sha’ari Ngadiman MOH (HIV/STI)
2 Dr. Anita Suleiman MOH (HIV/STI)
3 Dr. Salina Md Taib MOH (HIV/STI)
4 Dr. Fazidah Yuswan MOH (HIV/STI)
5 Dr. Mohd. Nasir Abd. Aziz MOH (HIV/STI)
6 Azman Mohamed MOH (HIV/STI)
7 Dr. Jiloris Donny MOH (TB/Leprosy)
8 Dr. Gunenthira Rao MOH (Family Health)
9 Mohd Nazri Mohd Dazali MOH (Pharmaceutical Service)
10 Dr. Zahariyah Yaacob AIDS Officer, State Health Department, Kedah
11 Dr. Khamisah Awang Lukman AIDS Officer, State Health Department, Sabah
12 Dr. Ruziana Miss AIDS Officer, State Health Department, Sarawak
13 Dr. Norhayati Md. Amin AIDS Officer, State Health Department, Melaka
14 Dr. Masitah Mohamed AIDS Officer, State Health Department, Selangor
15 Dr. Janizah Ghani* AIDS Officer, State Health Department, Pulau Pinang
16 Dr. Hazura Mat Zubir AIDS Officer, State Health Department, Kelantan
17 Dr. Mahani Nordin AIDS Officer, State Health Department, Terengganu
18 Dr. Surinah Asan AIDS Officer, State Health Department, Johor
19 Dr. Norliza Ibrahim AIDS Officer, State Health Department, N. Sembilan
20 Datuk Dr. Christopher ID Physician, Hospital Sungai Buloh
21 Dr. Suresh Chidambaran ID Physician, Hospital Sungai Buloh
22 Dr. Norliza Che Mi Psychiatrist, Hospital Kuala Lumpur
23 Dr. Masliza Zaid ID Physician, Hospital Tun Aminah, Johor
24 Dr. Wan Fazilah Wan Ismail Family Medicine Specialist, KK Mahmoodiah
25 Dr. Sheela Family Medicine Specialist, KK Cheras
26 Dr. Narul Aida Family Medicine Specialist, KK Tanglin
27 Dr. Sally Ahip Family Medicine Specialist, KK Kota Sentosa
28 Hammed Noor Norddin Health Edu. Officer, Hospital Tanah Merah
29 Dr. Rahimi Hassan District Health Office, Cameron Highland
30 Dr. Norzakiah Tahir District Health Office, Melaka Tengah
31 Kumar a/l K.M. Perumal Royal Malaysia Police (Johor)
32 VM Asok Kumar A/L Marathiah Anti-Drug Agency (Johor)
33 Mohd. Zulhelmy B. Abd Jalil Prison, Simpang Renggam
34 Jeremy Jahir Prison, Kluang
35 Ust. Khairil Isma Hafiz b. Mahathir Dept. Islamic Development (JAKIM)
36 Ustaz Zakuan Sawai Dept. Islamic Development (JAKIM)
37 Nik Azlan Nik Man Dept. Islamic Development (JAKIM)
38 Ustaz Sulaiman Dumang Islamic Religious Department, Johor
39 En. Abd Majid bin Mat Min. of Women, Family and Community Development
40 Abd Majid Mat Min. of Women, Family and Community Development
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41 Norehan Yusof District Edu. Office., Larut, Matang & Selama
42 Hairuddin Masnin Country Manager, UNAIDS
43 Stefan Stojanovik GFATM
44 Datuk Dr. Raj Karim President, MAC
45 Jasmin Jalil Executive Director, MAC
46 Parimelazhagan Ellan Progam Director, MAC
47 Joselyn Pang Program Director (GF), MAC
48 Assoc. Prof. Dr. Azlinda Azman MAC
49 Hisham Hussein MAC
50 Dr. Ilias Yee MAC
51 Tamayanty Kurusamy MAC
52 Azahari Said MAC
53 Abdul Muizz Che Zaini MAC
54 Malini Sivapragasam MAC
55 Mazlimi Ramthan MAC
56 Shamala Chandrasekaran MAC
57 Jane Kasim MAC
58 Chung Han Yang MAC
59 Manohara Subramaniam MAC
60 Ridzuan Kamaruddin MAC
61 Khalid Hashim NGO, Komited Malaysia
62 Zulkifli Zamri NGO, Pertubuhan Ikhlas
63 Ust. Bukhari Mat Akhir NGO, Yayasan Ihtimam
64 Rueben Kiew NGO, KLASS
65 Berlin Elvis Lee NGO, KLASS
66 Ng Bertlin NGO, Intan Life Zone
67 Raymond Tai Fook Then NGO, PT Foundation
68 Frederick Pour NGO, PT Foundation
69 Julia Atan NGO, Harapan Kasih
70 Fatimah Abdullah @ Selvi NGO, PAMT
71 Christine Low Bee Cheng NGO, FHDA
72 Rahmah Nicholls NGO, SACS
73 Danisha Monish NGO, Komited Malaysia
74 Mohd. Nor Azlie Roslan NGO, SAGA
75 Jessy Lim Wah Leng NGO, SEED
76 Sulastri Ariffin NGO, SEED
77 Nor Hasni Fazlinda Binti Mat Yunus NGO, ReHAK
78 Elisha Kor Krishnan NGO, PKKUM
79 Hafiz Afendi NGO, Sahabat
80 Low Cheap Foh @ Edward NGO, MTAAG+
81 Rasasooran Kannian NGO, Harapan Kasih
53 | P a g e
List of participants for the 2nd consultation meeting (9-11 August, 2015)

1 Dr. Sha’ari Ngadiman MOH (HIV/STI)
2 Dr. Anita Suleiman MOH (HIV/STI)
3 Dr. Mohd. Nasir Abd. Aziz MOH (HIV/STI)
4 Dr. Salina Md Taib MOH (HIV/STI)
5 Dr. Fazidah Yuswan MOH (HIV/STI)
6 Azman Mohamed MOH (HIV/STI)
7 Dr. Fatanah Ismail MOH (Family Health)
8 Dr. Jiloris Dony MOH (TB/Leprosy)
9 Dr. Khamisah Awang Lukman AIDS Officer, State Health Department, Sabah
10 Dr. Ruziana Miss AIDS Officer, State Health Department, Sarawak
11 Dr. Zahariyah Yaacob AIDS Officer, State Health Department, Kedah
12 Dr. Norliza Ibrahim AIDS Officer, State Health Department, Negeri Sembilan
13 Dr. Masitah Mohamed AIDS Officer, State Health Department, Selangor
14 Dr. Nur Aishah Buang AIDS Officer, State Health Department, Melaka
15 Dr. Hazura Mat Zubir AIDS Officer, State Health Department, Kelantan
16 Dr. Mahani Nordin AIDS Officer, State Health Department, Terengganu
17 Dr. Surinah Asan AIDS Officer, State Health Department, Johor
18 Dr. Rohemi bin Abu Bakar AIDS Officer, State Health Department, Perlis
19 Dr. Hafeez Intiaz AIDS Officer, State Health Department, Pahang
20 Dr. Hj. Amirullah Mohd Arshad Deputy Director, State Health Department, Melaka
21 Dr. Suresh Chidambaran ID Physician, Hospital Sungai Buloh
22 Dato’ Dr Ghazali Bin Ismail O&G Specialist, Hospital Sultan Ismail
23 Prof. Dr. Raja Iskandar ID Physician, UMMC
24 Dr. Salmiah Sharif Family Medicine Specialist, KK AU2 Keramat
25 Dr. Narul Aida Family Medicine Specialist, KK Tanglin
26 Dr. Rohaya Rahman Director, Hospital Port Dickson
27 Dr. Sahrol Azmi bin Termizi State Health Department, Pahang
28 Cheok Yoon Wah Royal Malaysia Police
29 Dr. Ravi Ramadah Anti-Drug Agency
30 Ust. Bukhari Mat Akhir Dept. Islamic Development (JAKIM)
31 Ust. Saiful Azhar Saadon Dept. Islamic Development (JAKIM)
32 Ustazah Mastura Mohamed Tahir Dept. Islamic Development (JAKIM)
33 Dr. Srii Puvaneswari A/P Selvaraj Occupational Safety and Health Department
34 Dr. Hammed Noor Norddin Health Edu. Officer, Hospital Tanah Merah
35 Hairuddin Masnin UNAIDS
36 Parimelazhagan Ellan Program Director, MAC
37 Dr. Ilias Yee Executive Director, MAC
38 Joselyn Pang Program Director (GF), MAC
39 Hisham Hussein MAC
40 Assoc. Prof. Dr. Azlinda Azman MAC
41 Abdul Muizz Che Zaini MAC
42 Mazlimi Ramthan MAC
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43 Malini Sivapragasam MAC
44 Jane Kasim MAC
45 Chung Han Yang MAC
46 Shamala Chandrasekaran MAC
47 Tamayanty Kurusamy MAC
48 Manohara Subramaniam MAC
49 Amran Ismail NGO, CAKNA
50 Zulkifli Zamri NGO, Pertubuhan Ikhlas
51 Clayton Koh NGO, KLASS
52 Andrew NGO, KLASS
53 Raymond Tai Fook Then NGO, PT Foundation
54 Christine Low Bee Cheng NGO, FHDA
55 Rahmah Nicholls NGO, SACS
56 Danisha Monish NGO, Komited Malaysia
55 | P a g e
Annex 2
AEM Projections of HIV epidemic in Malaysia
Baseline scenario
AEM modelling was used to estimate the projected development of HIV epidemic for the post
2015 period. Based on information on programme coverage in 2013, the current prevention
interventions for key populations were reaching 52% of PWID, 52% of FSW, 49% of TGSW
and 38% of MSM (Figure A1). Treatment coverage was reaching only 44% of eligible PLHIV
(CD4 count under 350 cells). Majority of PLHIV in Malaysia who either did not know their HIV
status or had not been initiated on ART was PWID, not initiated for fear that they may not be
able to adhere to the regime.
Using these baseline levels and assuming that the interventions continue at the present level,
the AEM predicted that the new HIV cases will decline and stabilize from 2014 onwards (Figure
A2). This could be due to declining new cases among PWID as they change substance use
from injecting to oral drugs. At the same time HIV cases among other risk groups would
increase as more get tested and treated early. This projection indicates that the HIV
transmission would be ongoing in 2021 and beyond, AIDS-related deaths and HIV prevalence
gradually declining. It projected that ART coverage barely would reach half of those in need if
interventions remain the same as 2013. The summary of baseline scenario projected by the
model is as below.
1. New HIV infections showed a smooth decline at the beginning but reached plateau from
2014 onwards. This means that the epidemic will continue, thus ending AIDS would be
far from reality.
2. AIDS-related deaths would be declining but only gradually.
3. Epidemic would be largest in PWID with increasing proportions reaching 62% of all by
2030 (Figure A3).
4. The infections among MSM would continue to climb slowly in the range of less than 10%.
In opposite, infections among LRM, LRF, clients of FSW and TG would be declining
(Figure A3).
5. This model showed that more than 50% PLHIV still would not get ART; this explains the
slow decline of AIDS-related deaths (Figure A4).
56 | P a g e
Figure A1. Treatment and prevention coverage, Malaysia 2013
MMT (31%) Target : 80%
NSEP (21%) Target : 15%
FSW (52%) Target : 80%
TGSW (49%) Target : 80%
MSM (38%) Target : 80%
Treatment ALL (44%) Target : 95%
Figure A2. Estimated numbers of new HIV, PLHIV and AIDS-related death in Malaysia,
1986 - 2030
120 30
Thousands
Thousands
100 25
80 20
60 15
40 10
20 5
0 0
Est. PLHIV (15+) Est. New infections (15+) Est. Death (15+)
Table A1. ARV treatment at baseline scenario and its impact on the epidemic
Sub-epidemic model 2000 2010 2013 2020 2030
PLHIV 99,175 103,319 94,399 78,480 67,277
New HIV infection 12,853 7,936 6,118 5,780 5,781
Annual AIDS related death 9,809 9,838 9,366 7,748 6,373
Number of PLHIV on ART 82 12,148 15,615 16,826 14,236
PLHIV in need for ART (CD4 < 350 counts) 14,487 43,842 42,764 38,350 32,305
57 | P a g e
Figure A3. Estimated and projected number of cases by Mode of Transmission, Malaysia 1986-2030
25
No. of cases Thousands
20 Clients MSM1 TG FSW1 LRM LRF Male PWID
15
10
Figure A4. Total adult ART coverage and need, Malaysia 1986-2030
50 Total adults on ART Total adults ART need

Thousands
45
40
Number on/in need of ART
35
30
25
20
15
10
5
0
1990
2018
2021
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2019
2020
2022
2023
2024
2025
2026
2027
2028
2029
2030
Designing Investment Options for Ending AIDS
Using AEM, six (6) best investment scenarios were projected that focus on ending AIDS.
The summary findings are as follow:
a) Scenario 1: Business as usual

This scenario shows how the epidemic would progress over the years if the present
prevention intervention and treatment coverage remain as in 2013. The average annual
resource need from 2015 to 2021 would be around USD 25.2 million (RM 93.2 million).
58 | P a g e
b) Scenario 2: Accelerate treatment only

This scenario looks at the impact of a rapid scale-up of universal access to ART by
adopting the ‘test and treat’ model (treating 90% of PLHIV regardless of CD4 count), while
sustaining prevention coverage at current levels for all KPs. This scenario would require
an average annual investment of USD 71 million (RM 262.7 million) from 2015 to 2021.
c) Scenario 3: Scale-up Prevention only

In this scenario, the prevention coverage was scaled up for the KPs with the greatest need
- 80% coverage for opioid substitution therapy and 15% for needle exchange programme,
80% coverage for female sex workers, 80% coverage for MSM and 80% coverage for
transgender. This scenario would require an average annual investment of USD 28.7
million (RM 106.2 million) from 2015 to 2021.
d) Scenario 4: Scale-up Harm Reduction for PWID and treatment at CD4<350 cells/L
This scenario was designed to scale-up access to 80% coverage for opioid substitution
therapy and 15% coverage for needle exchange programme and 80% treatment coverage
for PLHIV at CD4<350 cells/L. This scenario would require an average annual investment
of USD 38 million (RM 140.6 million) from 2015 to 2021.
e) Scenario 5: Scale-up Harm Reduction for PWID and treatment at CD4 <500 cells/L
This scenario was designed to scale-up access to 80% coverage for opioid substitution
therapy and 15% coverage for needle exchange programme and 80% treatment coverage
for PLHIV at CD4<500 cells/L. This scenario would require an average annual investment
of USD 46.7 million (RM 172.8 million) from 2015 to 2021.
f) Scenario 6: Ending AIDS

This scenario was designed to scale-up Harm Reduction coverage for PWID - 80% for
MMT and 15% for NSEP and simultaneously increase to 80% prevention coverage for
other KPs (FSW, TG and MSM). This scenario also adds in 95% treatment coverage for
all key populations irrespective of CD4 counts. To end AIDS, the country would require an
average annual investment of USD 69.6 million (RM 257.5 million) from 2015 to 2021.
Table A3. Summary of targets for each investment scenario, Malaysia
Options MMT NSEP FSW MSM TG CD4 ART
Scenario 1: Business as usual (Base-line) 31% 21% 52% 38% 49% 350 37%
Scenario 2: Accelerate treatment only 31% 21% 52% 38% 49% ALL 95%
Scenario 3: Scale-up prevention only 80% 15% 80% 80% 80% 350 37%
Scenario 4: Scale-up Harm Reduction and 80% 15% 52% 38% 49% 350 80%
treatment CD4<350
Scenario 5: Scale-up Harm Reduction and 80% 15% 52% 38% 49% 500 80%
treatment CD4<500
Scenario 6: Ending AIDS 80% 15% 80% 80% 80% ALL 95%
59 | P a g e
Investment Impact
a) Impact on the epidemic

The estimated number of new infections has already started to decline. The interventions,
starting from 2015, would result in the biggest reduction in the number of PLHIV in scenario
‘Scale-up prevention only’. However, in the absence of treatment intervention, more PLHIV
would progress to AIDS and end up with premature death, thus bringing down the number of
current infections year by year. Focusing solely on treatment, on the other hand, would
stagnate the epidemic but the country would end up having to constantly increase resources
for ART (Figure A5).
The graph in figure A6 shows that the number of new infections has started to decline
beginning in 2002 but this decline would stall from 2014 onwards in baseline scenario.
Investing in treatment only is not a good choice as this would eventually result in another cycle
of epidemic after 2021, and to spiraling treatment cost. A good investment needs to balance
between prevention and treatment interventions. AEM has modeled several options that would
lead to a decline of new infections. Comparing all options, ‘Ending AIDS’ will reach 90%
reduction of new HIV cases to less than 800 new HIV cases a year in 2021, eventually leading
to ending AIDS, while the other scenarios would drive the country further away from ending
AIDS, even after 2050.
Figure A5. Current infections (PLHIV) for Adults, Malaysia 2000 - 2030

FigureBaseline
A6. Scenarios forusual
-Business as New HIV Infections for adults, Malaysia 2000-2030
120
Thousands
100
80
Number of cases
60
40
20
0
2007
2008
2009
2000
2001
2002
2003
2004
2005
2006
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
60 | P a g e
Figure A6. New HIV Infections for total adult, Malaysia 2000-2030

14
Number of cases Thousands

12
10
2015
2026
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2027
2028
2029
2030
b) Impact on resource needs
Based on projected annual new HIV infections the country would reach 90% reduction of new
cases in 2021 through ‘Ending AIDS’ scenario. The total resources needed to realize this
target will amount to USD 429.1 million for period of 2015 to 2021. The initial investment is
undeniably high, but the annual expenditure needed would start declining within as little as 7
years (Figure A7). Summary of total resource needs is narrated in table A4. Under all
scenarios, the treatment cost of ongoing infections drives up the costs incrementally year by
year. Looking at all scenarios, prevention would be a ‘must have’ component in any
investment option as it averts substantial costs of providing HIV treatment over medium to
long-term. In contrast, avoiding such investments will merely postpone huge, ever-increasing
costs into the distant future.
If intervention remains as before (business as usual), with no new investment in the response,
the HIV epidemic would continue with serious implications for public health as well as with
major social and economic costs. But focusing all investments on accelerating treatment only
would still lead to a continuous increase in new infections each year. The key to significantly
reducing new HIV infections, therefore, is to scale up the prevention and to accelerate
treatment.
The ‘Ending AIDS’ scenario shows that investing in prevention yields significant savings on
treatment costs later, making the program affordable over the long term (Table A5). However,
if ART is scaled up without expanding and optimizing prevention coverage of the most
affected populations, new infections continue to increase, treatment costs will spiral upwards,
and the program becomes unsustainable.
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Figure A7. Total Resource Needs, Malaysia 2014-2050

120 Scale-up Harm Reduction for PWID and scale-up treatment CD4<500
Thousands

100
80
Total resource (USD)
60
40
20
0
2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050
Table A4. Summary of total resource needs based on investment scenarios,

Malaysia 2015-2021 and 2022-2050
SCENARIO INVESTMENT OPTION TOTAL RESOURCE NEED (USD)

2015-2021 2022-2050
Baseline Business as usual 157.1 million 434.4 million
Scenario 1 Accelerate treatment only 436.9 million 1.8 billion
Scenario 2 Scale-up prevention only 178.7 million 470.3 million
Scenario 3 Scale-up HR for PWID and treatment 234.1 million 820.5 million
CD4<350
Scenario 4 Scale-up HR for PWID and treatment 287.9 million 987.7 million
CD4<500
Scenario 5 Ending AIDS 429.1 million 1.3 billion
62 | P a g e
Table A5. Total annual resource need for ‘Ending AIDS’, Malaysia 2015 – 2050
Prevention Treatment Total (thousands,

(thousands, USD) (thousands, USD) USD)
2015 9,603.01 37,712.80 47,315.81
2016 10,235.63 43,111.03 53,346.67
2017 10,826.34 47,744.67 58,571.00
Invest now 2018 11,383.30 51,702.61 63,085.91
2019 11,913.32 55,063.60 66,976.92
2020 12,426.93 57,852.18 70,279.11
2021 12,155.47 57,364.74 69,520.21
Ending AIDS (2015-2021) 78,544.00 350,551.63 429,095.63
2030 9,859.81 34,828.19 44,687.99

Future savings 2040 7,464.09 20,219.52 27,683.60
2050 5,540.05 11,706.14 17,246.19
c) Return of investment
The return on investing in AIDS can be measured in several different ways. Among others are
annual reduction of new cases, treatment cost saved if fewer people become infected and
number of disability-adjusted life years (DALY) saved. AEM permits calculation of DALYs and
comparison between scenarios. A DALY is equal to one year of healthy (and productive) life
which translates into one year of earned per capita GDP, currently USD 10,500 (World Bank).
Every HIV infection averted in Malaysia saves an average of 27 DALYs, amounting to USD
285,580 GDP earned.
Table A6 shows the impact and resource needs for each investment option. The analysis of
the six different scenarios shows that the highest impact can be attained through ‘Ending
AIDS’ scenario that is combination of prevention (coverage of FSW, MSM and TG at 80%,
and PWID at 80% with reference to MMT 80%, NSEP 15%) and scaling up effective testing of
key populations to 95%, treatment of those detected with HIV to 95%, and achieving
adherence of those in ART to 95%. This investment option will save more lives and yield the
greatest cost-benefits in terms of DALYs, income and treatment cost saved. Saving DALYs is
good for productivity and economic growth and reduces the impact of AIDS on individuals,
families and society in general. The impact on the longer term is even more striking. Figure
A8 compare number of DALYs that could be saved under each scenario between 2015 and
2021. ‘Ending AIDS’ save over 640,000 DALYs compared to just about 300,000 if only
treatment is accelerated.
From the model, it can be concluded that through an investment of approximately USD 429
million over short period of 7 years (2015-2021) or an average of USD 61 million a year,
Malaysia will be able to avert close to 27,000 HIV infections and save over 640,000 DALYs
potentially ending AIDS by 2021. The financial returns are also substantial. ‘Ending AIDS’ will
save USD 6.8 billion in future income.
63 | P a g e
Table A6. Summary of cost-effectiveness by different investment options, Malaysia 2013-2021

Base- Business Accelerate Scale-up Scale-up Scale-up Ending
line as usual treatment prevention PWID + PWID + AIDS
only only treatment treatment
CD4<350 CD4<500
2013 2021 2021 2021 2021 2021 2021
New infections 6,118 5,773 2,912 1,622 2,227 1,974 751
HIV averted - - 2,861 4,151 3,546 3,799 5,022
Death averted - - 4,318 902 3,717 4,135 4,676
PLHIV on ART 15,614 16,477 86,142 14,641 35,739 46,341 73,358
DALYs saved - - 76,000 110,000 94,000 100,000 133,000
GDP earned (million) - - 798 1,155 987 1,050 1,396
Resource Need (thousand) $24,418 $91,417 $29,031 $47,794 $57,991 $85,501

Malaysia GDP per capita – $10,500 (World Bank 2015)
Figure A8. Total investment and DALY saved, Malaysia 2015-2021
700
Thousands
Ending AIDS
600 Scale-up
Scale-up HR (PWID) +
500 prevention only
treatment CD4<500
Total DALY saved
400
Scale-up HR (PWID) + Scale-up
300 treatment CD4<350 treatment only
200 Business as usual
100
0
0 200 400 600
Total investment (USD) Millions
For a total investment of USD 429 million in 7 years beginning 2015, ‘Ending AIDS’ will:
a) Reduce new HIV infection by 90% from 2010 (7,936) to 2021 (751)
b) Each HIV infection averted saves an average of 27 DALYs; resulting in $283,500 GDP
earned
c) Save total of 644,000 DALYs, or healthy, productive life years
‘Ending AIDS’ scenario will reverse the epidemic and achieve the three Zeros.
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Annex 3
NATIONAL PLAN OF ACTIONS FOR FAST-TRACKING 2016-2020

NO KEY ACTIVITIES KEY PROGRAMMATIC TARGET REMARKS
STAKEHOLDERS
STRATEGY 1: TESTING AND TREATMENT TO END AIDS

1.1 Increase testing in key affected population and PLHIV-indicator conditions (STI, Herpes Zoster, Hepatitis B, IDU on MMT)
 Training of health care providers, including MOH, General Implementation of services by end of
health care providers within institutionalized Practitioners, Prison, 2017
setting (such as prisons) and other government CBOs
health care (such as LPPKN) on providing
STI/HIV awareness and test screening during
family planning counselling
1.2 Normalizes HIV testing in all Health Care Services

 Revision and reform current SOP / Module MOH Guideline to be revised by 2016
Counselling Guidelines that normalizes HIV
testing in all Health Care Services (Government
& Private) and enhance Provider Initiated
Testing and Counselling (PITC) services
1.3 Enhance and implement Community-based HIV / STI screening

 Revise policy and guideline to allow community MOH, NGO Policy and guideline to be revised by end PTF CHCC: In 2014, total clients (all
based HIV screening 2016 clients) screened was 1,635 clients. All
 Accreditation the CBOs / NGOs to be screening reactive clients referred for medical
centers follow-ups. From Oct 2014-Jul 2015, PTF
CHCC screened 650 clients for STIs
 Credential of CBOs/NGOs to be HIV para (Syphilis= 589; HCV= 31; HBV=30)
counsellors
Private GPs (10 clinics)
Community Based Testing (CBT)
- CBO based (model FHDA, Penang)
- HC based using Beserah model
(Kuantan), Pekan model (Kota
Kinabalu) and Cheras model (KL)
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1.4 Improve and ensure linkage to care after diagnosis

 Enhance the utilization of National AIDS MOH, NGO/CBO,
Registry (NAR) Private labs
 Linking NGO/CBOs/Private labs to Treatment
Centers (KK) for case management
1.5 Increase coverage of PLHIV on ART

 Increase number of Integrated HIV Treatment MOH One Integrated Treatment Centre per
Centres5 district by 2017
 Increase number of private clinics providing HIV MOH, GPs Provision for providing testing and
services treatment at cost through public-private
partnership
1.6 Adopt a single first line regime for all adults and adolescents with HIV – Tenofovir + Lamivudine or Emtricitabine + Efavirenz as a fixed dose combination
 Fixed dose combination becomes a preferred MOH 80% of all new patients by 2017
First Line regime in all facilities
1.7 Decentralization treatment center to increase access to HIV treatment and improved rate of retention to care for those already on ART
 Increase the number of HIV Post Basic Training MOH Increase from 1 to all Allied
Center Professionals training centers by end
2018
 Strengthen & increase the number of shelters / NGO/CBO, MWFCD, At least one shelter home in each Region
halfway house services (job placement and life JAKIM / State
skills building) for PLHIV
 Scale up treatment peer support programmes in MOH, NGO/CBO Peer support programmes available in all
all and to include outreach services Integrated HIV Treatment Centres
(IHTC)
5 Component of integrated HIV clinic includes:

(i) FMS who has undergone attachment at ID clinic; (ii) Paramedic HIV counsellors / trained in HIV management; (iii) RVD MTAC Pharmacist; (iv) Peer support / outreach
worker from CBO; (v) X-Ray facilities to detect TB; (vi) Lab facilities- Basic investigations for STI , TB, CD4 / Viral Load POCT, Basic bio-chemistry / haematology test- RP,
LFT, FBC; (vii) Methadone clinic; (viii) Medications- 1st line ARV, Anti TB, Penicillin injection, Ceftriaxone ; (ix) Key Affected Population (TG, MSM, FSW, MSW) friendly
environment
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1.8 Improve retention and viral suppression through better case management
 Opening Integrated services for PLHIV after MOH By end 2016 one clinic per district Currently offered only in Sg. Buloh
office hours to improve retention Hospital (Saturdays)
 Expand the services to all institutions and MOH
continuation of ART, anti TB, MMT on entry into
the institution
 Sustain & Expansion of ‘Teman’ pilot project6 to MoH, NGO/CBO Expansion of Teman Project in all States
all incarcerated settings with incarcerated settings
 Shelter home for post release care for TB-HIV NGO/CBO, MWFCD At least one shelter available per region As more PLHIV are on TB treatment,
patients (halfway house) shelter care to adhere to treatment is
needed
1.9 Increase/ upscale coverage of PLHIV on treatment
 Task shifting to Paramedics MOH Allow paramedics to prescribe ARV As more testing and improved linkage to
drugs for patients stable on ART care is done, health facilities is needed &
need to be equipped to cater to the
increased number of PLHIV
1.10 Improve TB diagnosis and case management

 Upscale case detection activities and prevention MOH, CBO/NGO Training completed by end of 2016 Currently TB sputum collection being
of TB infection piloted in Terengganu.
a) Train and equip CBO/NGO with right IPT implemented in all integrated health
information on TB screening and clinics by 2016
prevention
b) Sputum collection by CBO/NGO
c) Strictly implement IPT program for all
newly diagnosed HIV
 Improve availability of point of care test (Gene MOH To procure point of care equipment by Currently 4 available
expert) end 2016
6 Teman is Buddy Project in incarcerated settings currently implemented in Pahang, Kelantan, Johor, Negeri Sembilan and Penang
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 Prevent TB transmission among PLHIV in close MOH, Prison By end of 2018 In all prisons in Malaysia, currently none
setting Department available. Training is currently conducted
a) To procure Gene Xpert unit state-based
b) Standardize training curriculum for Prison
Officers creating awareness, sensitization
of HIV / TB / MMT integrated into the
current training and daily work of Parole
Officers to ensure TB-HIV parolees are
linked to Health Care Facilities during
parole period
STRATEGY 2 - IMPROVING THE QUALITY AND COVERAGE OF PREVENTION PROGRAMMES AMONG KEY POPULATIONS
2.1 Prevention of HIV transmission through injecting drug use
2.11 Increase effort toward client’s behavioural change
 Organize training / seminar on capacity building NGO, MOH, MOE, Min 80% ORW will be trained annually 30% ORW trained in 2014.
for ORW to improve and update ORW’s NADA, RPM, Prison  District level: at least 2 sessions
knowledge on treatment cascade (HIV and co- Department, Head of per year (District Health Office’s
Community With these knowledge, ORWs are
infection (Hep/TB), SRH, OST, testing, Initiative) expected to be able to provide accurate
treatment)
information on HIV and co-infection
 National level: at least 2 sessions (Hep/TB), SRH, OST, testing, ARV
per year (MOH and MAC initiative) treatment and condom usage to NSEP’s
clients
 Provide accurate information on HIV and co- NGO, MOH at least 3 sessions per client per year  Referral NSEP for OST: 5.4% in 2014
infection (Hep/TB), SRH, OST, testing, ARV (targeted 30%),
treatment and condom usage to NSEP’s clients  Referral NSEP for VCT: 29%
(targeted 50%)
 Condom use: still very low (25%)
 Increase number of referral to testing and NGO, MOH, NADA  Min 30% of active NSEP client  Referral NSEP for OST: 5.4% in 2014
treatment (OST/ARV/SRH/Hep/TB) (opiate users) referred to OST (targeted 30%),
services per year  Referral NSEP for VCT: 29%
(targeted 50%)
 At least 80% of active NSEP client  Condom use: still very low (25%)
referred to VCT services per year
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 Organizing VCT session with health clinic at NGO, MOH  At least 2 VCT sessions organized VCT session with NGO has been carried
NGO office or appropriate community site per year out at certain site such IKHLAS, CAKNA
and AARG.
 Appoint person in charge at health clinic/NADA NGO, NADA, MOH  To appoint one Assistant Medical The OST services were headed by FMS
facilities as liaison officer to improve or facilitate Officer / NADA’s key person in each at health clinic or head of NADA
referral from NGOs OST center to be liaison officer for institutions.
NGO
2.12 Expand OST Programme
 Increase OST center at health care centre MOH, NGO, MOE Min 45% of health clinics provide OST by 33% (316/954) health centres provide
2020; 55% by 2025; 65% by 2030 (20 OST services in 2014.
clinics/year)
 Increase OST/HTC/ARV uptake at existing MOH, MOE, NADA, Sustain OST services at the existing 39% (55) hospitals, 58% (18) prison,
facilities Prison Department, center in hospital, prison institution and 16% (30) NADA facilities, 5.3% (366) GP
NGO NADA facilities. provided OST service in 2014
 Expand Methadone dispensing hours MOH, MOE, NADA, Methadone dispensing hours at health  63.9% (76 out of 119 health clinics
Prison Department, clinic to be conducted throughout office surveyed) assign 1-2 hours
NGO hours including public holiday and methadone dispensing services;
weekends  10.9% (13 out of 119 health clinics
surveyed) assign 7-9 hours
methadone dispensing services;
 4.2% (5 out of 119 health clinics
surveyed) assign two (2) times / day
(methadone dispensing services)
with total various hours from 2.5 to 4
hours.
 Enable other healthcare providers (MA/ Nurses) MOH Amend Poisons (Psychotropic Regulation 11 (1) (e) in Poisons
to dispense methadone and other substitution (Pharmaceutical Substances) Regulations 1989 by (Psychotropic Substances) Regulations
medications. service) 2016/2017 1989 permits pharmacists to dispense
methadone or other substitution
medication.
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STAKEHOLDERS
 Increase number of accredited assistant MOH a) Percentage of assistant pharmacist  30% (556 / 1806) assistant pharmacist
pharmacist on dispensing methadone at health clinic accredited; at health clinics accredited on
 45% by 2020 methadone dispensing as of Dec 2014
 60% by 2025
 75% by 2030  121 assistant pharmacist in hospital
accredited on methadone dispensing
b) 100% assistant pharmacist at health as of Dec 2014
clinic without pharmacist will be
accredited by 2020.
 Number of health clinic with assistant
pharmacy (but no pharmacist) 2014 :
125
 Expand the use of Methadone 1Malaysia card MOH Methadone 1 Malaysia services will be 14% (130 / 954) health clinics provide
available at; Methadone 1 Malaysia card services in
 60% health clinic by 2020 2014
 100% health clinic by 2025
 Review and update SOP / Guideline of OST, MOH, MOE, NADA, SOP / Guideline reviewed every five SOP OST last reviewed was in 2010 but
NADA, NSEP, Prison, Police for standardization Prison Department, years no updated done since no much of
changes agreed. Lasted up: Revised
SOP OST will be ready by beginning of
2016
 Accelerate the administration of Methadone / MOH, MOE, NADA, Newly registered OST client will be Currently patient / client has to be 2
OST medication to new clients Prison Department, prescribed with minimum dose (20mg) of weeks or more for blood result before
Methadone / other OST medication once starting OST, thus losing the patient
passed physical examination and without
waiting for Liver Function Test (LFT)
result.
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 Ensure the continuation of OST & ARV in MoH, RMP, Prison Number of detainees examined for OST  RMP Guideline
custody (lockup and prison & detention centre) Department, NADA and ARV in lock up, remand and - Guideline on methadone dispensing
by conducting regular visit and health services detention center to ensure continuum of in lock up was implemented on 22
at lockup and remand and provide basic health care & treatment July 2014 with approval by MOH and
assessment and treatment for clients in the RMP (RMP Letter KPN 10/3/7 dated
initial custody 8 August 2014). Lock up was
gazetted for methadone dispensing
on 5 November 2012 (Director
General of Health letter, Bil (46) dlm.
KKM-171/BKP/ 07/32/ 0475Jld.2).
- Guideline Pemeriksaan Perubatan
Untuk Orang Kena Tahan (OKT) in
RMP’s lock up will be finalized by
end of October 2015 for
implementation.
- These two guidelines will
complement each other
 Gap in continuum of care & treatment
in rehab center & remand prison
 Organize support group for OST/ARV patient at MOH, NGO Support group session: minimum 1 Only selected sites in Kuala Lumpur
Healthcare Clinic session/ 2 wk/ health clinic implementing Peer Support
 Adopt “Klinik Kesihatan Angkat Project” in which MOH, NGO At least 40 clinics by year 2020  Pilot project currently being carried out
NGOs will be located in health clinic and assist in Kuala Sg Baru, Melaka
in running harm reduction services at the clinic.  Currently – 316 health clinic with OST
service with 40 NGOs running NSEP.
 Monitoring of Methadone diversion Pharmacy, MOH At least once a year (report) No mechanism to monitor diversion
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2.13 Sustain and Consolidate Needle Syringe Exchange Programme
 Increase active NSEP registered client by: NGO, MOH Min 35% active NSEP client by 2020; Less than 30% registered NSEP clients
a) Stress on the need of regular NSEP service 40% by 2025 and 50% by 2030 were active in 2014.
to client Definition of active NSEP client:
b) Establish ‘to increase rate of active clients' Registered NSEP client came for
as indicator that need to be achieved NSEP services at least 9 times per
c) Conduct activities/event to attract back year
client into NSEP once every quarter (4
times a year)
 Improve outreach services MAC, NGO, MOH  All Harm Reduction Prevention Demand from client & also attracts client
a) Provide sterile water in NSEP kit Programme to join NSEP
b) Educate client on the important of using  Increase return rate of used needle &
sterile water while injecting syringe
c) Provide first aids kits to be taken along by
ORW during outreach activities
d) Include tong in NSEP outreach programme
for safe disposal
2.14 Increase adherence of ARV treatment among PWID
 Retain number of PWID on ARV treatment MOH Percentage of eligible PWID with HIV 23.8% of eligible PWID with HIV received
receiving ARV: ARV treatment in 2014.
 2020=50%
 2025=70%
 2030=90%
 Provide post release support to inmates who are NGO, MOH, Prison a) Briefing in Prison every quarterly by Project TEMAN was implemented in
on ARV & OST Department, NADA NGO on Harm Reduction 2014.
Programme upon release
b) Receive clients upon release
(focusing inmates on treatment)
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 Establish drop in center (DIC) at NGO office to Ministry Women, At least three DICs established by 2030
improve PWID’s adherence to ARV treatment. Family &Community
Development, MAC,
NGO, MOH
2.2 Mitigating Sexual Transmission
 Revive the Sexual Transmission Task Force that MOH, NGO (MAC to a) In 2017, gap analysis on sexual
leads the development of SOP guiding inter- facilitate and co-chair transmission reported will be
agencies collaboration to upscale prevention the formation of the conducted on transmission of HIV in
efforts in line with NSPEA. task force), MWFCD, Malaysia
UN, Government b) A working group or Task Force to be
stakeholders formed by 2016 to be coordinated by
MAC and the Ministry of Health
c) Terms of reference on this Task
Force will be jointly be done by MAC
and the Ministry of Health
 Capacity building for ORWs and healthcare MOH, NGO a) 80% of ORWs trained annually 20% of ORWs trained
workers: b) 30% of health care workers trained
a) Prevention, treatment and care cascade of annually
HIV and STI c) Frequency of training: 2/year
b) Sexual Reproductive Health
c) Behaviour Change Communication
2.2 Mitigating Sexual Transmission among Men having Sex with Men
2.21 Increase awareness on HIV and STI testing among the youth
 Reviving the SRH education, prevention HIV and MOE, KPWKM, One awareness campaigns in university Reviving SRH education is important,
STI in schools/colleges JAKIM, KBS, NGOs or Colleges per year per Pejabat however, due to cultural sensitivity, MSM
Kesihatan Daerah target SRH is not feasible to be
 Internet-based targeted messages/intervention implemented
for high risk young population (peer created
content) Social media strategy
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2.22 Increased HIV and STI awareness in high risk behaviours

 Provision of comprehensive package of Ministry of Housing a) 100 MSM reached/NGO
services, i.e. condoms, lubricants, IEC (PBT), MOH, NGOs, b) 1 safer sex kits distributed/MSM
materials, testing, linkage to care, as indicated venue operators, reached
by WHO 2014 Guideline for key affected PDRM, SKMM
(multimedia) c) 50% MSM tested for HIV per session
populations in high risk venues (etc. saunas,
pubs and public gyms such as Celebrity Fitness d) 100% of MSM tested for HIV will be
gyms). reviewed every 6 months
e) Pilot new intervention method at
public gyms (1 fitness chain, 6
branches in Klang Valley)
 Strengthening Access and Usage of condoms NGO Conduct an assessment on condom and
and Lubricants through Condom and Lubricants lubricants usage and attitude among
Social Marketing and Promotion Strategy MSMs (social marketing)—2016—TA
support
 Targeted Awareness Programme NGO a) One assessment project on condom

a) To have awareness poster to encourage and lubricants usage and attitude
the community to look at positive ways on among MSMs (social marketing) will
the usage of condoms in online, facebook, be done in 2016.
website, private clinics b) One report will be distributed to the
b) Condom negotiation skill as part of the Ministry of Health and other key
outreach programme stakeholders
c) Attitudes about condom
d) Knowledge, attitude and practice
e) Usage of chem sex
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 Awareness campaign7 using social media NGO a) By the end of each year, 5,000
respondents will be using the social
media to test HIV & STIs via social
media campaigns done by
Malaysian AIDS Council.
b) 25,000 MSMs will be tested for HIV
& STI by the end of 2020 using the
social media campaigns as
advertised by MAC
 Behaviour Change8 to minimize risk of acquiring JAKIM, MOH, a) I session of Mukhayyam per state
HIV & STIs infection through spiritual support Muslim-based NGOs per year
and guidance b) 50% MSM reached tested for HIV &
STI
c) A registry of MSM joining the
session will be kept by JAKIM and
the respective state to take note of
changing behavior of Muslim MSMs
 50 Muslim MSM reached per
session
 Reduction of number of partners
 Abstinence behavior from MSM to
heterosexual
 Increase knowledge on the issue
of HIV / AIDS and reduce the risk
of new HIV infections
7Integrated social media awareness campaign on gay apps with banner advertising that is linked to safer sex videos, referrals to Whatsapp and telephone counselling,
web based resource center, appointments for community based testing and case management approach to health clinic testing
8 The objective is to expose and 1) guide Muslim MSMs to perform religious demands, 2) provide knowledge and awareness of the health especially HIV and other
infectious diseases, 3) provide guidance and motivation to improve the skills of identifying, guiding and giving spiritual awareness through religious approach (tauhid) to
face the challenges of life and abandon the practice of unnatural sex, 4) and eliminate stigma and discrimination among religious groups and communities with the
surrounding communities. Classes are held in the form of camping for 3 days 2 nights (i.e. Mukhayyam). Completion of a spiritual awareness, knowledge about health,
outdoor activities / sports
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2.23 Increase uptake of HIV test & and proactive/asymptomatic STI testing
 Use of mobile HIV and STI test MOH (Sabah), NGO 1 Pilot project in Kota Kinabalu (Sabah) Based on AFA’s mobile testing in
to conduct HIV & STI testing among Singapore.
MSMs and transgenders See AFA 2013 Performance Report
http://www.afa.org.sg/wordpress/wp-
content/uploads/mts/afa-mts-report-
2013.pdf
 Exploring the feasibility of integrating self-testing NGO By the end of 2017, MAC will conduct an
HIV test kits as part of prevention (rapid assessment study/ survey on the
assessment +pilot project) feasibility of “self HIV testing”
 Accompanied referrals by integrating case MOH, NGO a) By the end of 2017, MAC will present Global Fund Pilot MSM project conducted
management approach/ client-centered an evaluation report of Integrated in KL and JB
approach (case workers facilitate clients to Case Management Report to the Progress Update: January-June 2015:
come forward for testing at health clinics or Ministry of Health regarding the study 228 clients reached, 148 MSM clients (65
drop-in-centers) done in KK Kelana Jaya, Cheras, % of total clients) were screened for HIV,
Sentul Kuala Lumpur (Global Fund and of those screened, 34 MSM clients
project). are tested HIV positive (23%), and 2
b) By the end of 2018, at least 1 health MSM clients (6% of HIV positive clients)
clinic per state in Malaysia will run this started on ART.
project. Among the key screenings to
be done include the following:
i. HIV testing
ii. STI screening
iii. Nucleic acid amplication tests
(NAT)
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 Awareness campaign to private hospitals, GPs MOH, NGO, Private Malaysian AIDS Council will facilitate at
and labs on possibility of doing mas HIV Practitioner least 2 sessions per year together with
screening among community9 Association, MMA the Ministry of Health on the possibility of
expanding HIV screening among the
public together with the Private
Hospitals, Private Laboratories and
General Practitioners
 Opportunistic PITC (Provider initiated testing a) Malaysian AIDS Council will initiate
and counselling) a session with the Ministry of Health
and other key stakeholders on this
topic.
b) By the end of 2017, Malaysian AIDS
Council will produce a report on the
possibility of doing this project will
involve private practitioners and
health clinic
 Screening of minors (address policy issues MOH (Family Policy brief on screening of HIV and STI UNICEF’s study on young key population
pertaining to Child Act under the purview of Health), NGO, for minors (reinterpret policy of testing for (minors. Policy brief on screening of HIV
MWCFD) JAKIM minors and STI for minors (reinterpret policy of
testing for minors)
2.24 Pre and post exposure prophylaxis (ARV as a method of prevention)
 Pre Exposure Prophylaxis (PrEP) NGO Latest research supports early ART
a) Positioning Paper on PrEP’s feasibility in treatment. Ref : The Strategic Timing of
Malaysia Anti-retroviral Treatment (START)
Study: Results and Their
b) Research data for PrEP among selected
pilot sites (implementation science) by MAC/ Implications, UNAIDS
UNAIDS/ CERIA.research (PrEP cost-borne
by clients)
9
Expanding HIV and STI testing in private hospitals/GPs and robust data surveillance, ensure the confidentiality of clients when engaged in services, revisit HIV testing policy
in government community health clinic setting, ensuring paramedics at health clinic/hospitals are trained to conduct pre-post HIV counseling, prevention in HIV and STI,
treatment and support counselling
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 Post Exposure Prophylaxis (PEP) MOH, MGO, a) By 2016: forum on PEP/PreP by WHO consolidated guideline for Key
a) Agreement or buy-in from key stakeholders MASHM, MMA, MAC and agreement from key Population 2014
to implement a pilot PEP Malaysian Primary stakeholders by June 2016, including
Care Association of the Corporate Bodies and private
b) Setting up of Pilot KKs, CBOs, Private GPs, Malaysia (MPCAM) sector in Malaysia. This forum will
and hospitals for PEP (PEP cost borne by include Medical Development Div. of
clients) MoH
c) Development of guideline for healthcare b) By mid-2016: MAC will initiate a pilot
workers in administrating PEP (MASHM) study on PreP/PEP at 1 Health Clinic
d) Revise the PEP policy and key population (Cheras), 1 CBO, 1 GP, 1 Hospital
(MSM) eligibility for PEP—based on (HSB)
feedback of pilot programme c) Revision on the guidelines on PrEP
e) Central sourcing of PEP to reduce the price and PEP by the Malaysian AIDS
of PEP Council and Medical Development
Div. of MoH. It is envisaged that there
will be a new guideline on PEP / PrEP
by mid-2017
d) MAC and CERIA of UM will conduct a
feasibility study (of usage PrEP and
PEP by PLHIVs in Malaysia) by mid-
2017.
 Training on PrEP and PEP NGO, MOH a) Yearly training workshops on PrEP Refer to the latest research supports
a) Training workshops for NGOs, and health and PEP by MAC early ART treatment. Ref : The Strategic
providers on PrEP and PEP b) By 2017, 100 healthcare workers will Timing of Anti-Retroviral Treatment
be trained by MAC on PrEP and PEP (START) Study: Results and Their
b) Development of IEC and awareness Implications, UNAIDS
programme on PrEP and PEP yearly
2.25 Managing drug dependency in MSM community
 Identify MSM using polysubstance/ice in existing MOH, NGO a) By 2017, MAC will produce a report
prevention and treatment programme on challenges of MSM using
polysubstance abuse based on a
 Design a pilot intervention for MSM with drug study (KL, Selangor, Penang, Johor,
use (peer support, psychosocial support, harm Sabah).
reduction paradigm using case management
approach)
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 Training for FMS, other health providers, NGOs b) MAC will produce yearly IEC/BCC
on management of substance use development of materials on
polysubstance abuse and the risk of
 Collaboration with psychiatrists in referral and
acquiring HIV infection by 2017.
management of MSM with drug use
c) By 2017, MAC will conduct yearly
 Development of IEC/BCC materials for workshops on polysubstance abuse
management of drug use (harm reduction and the risk of acquiring HIV
based) infection among the CBOs
2.26 Expand Care and Support
 Setting up of self-help peer support (including MOH, NGO, JAKIM 1. By 2020, a minimum of 2 Health MSM Poz, KLASS, FHDA,
HIV negative) Clinics will have peer support groups --Module for Health Care Workers
a) Inclusive of adherence support and for HIV+ patients in KL, Selangor, (HCW)— The Time Has Come - Training
counseling (developing of treatment literary Melaka, Negeri Sembilan, Penang, Package for Healthcare Providers, UNDP
module for community) Pahang, Sabah, Sarawak, Johor (by 2013. In Mar 2014 – Feb 2015, MSM
5th year—18 sites). This project will POZ total case management = 347 MSM
b) Counselling and treatment for be initiated by the CBOs (expansion
serodiscordant couples clients (incld 213 new MSM clients)
of peer support groups like - Yayasan
Ihtimam Malaysia, MSM Poz)
 Managing discrimination (at work, college, 2. Training sessions will be done by MSMPOZ workshop module in 2012-
community) CBOs at least once a year based on 2013 adapted from Australia ACON
the “Module for Healthcare Worker by module has demonstrated results in
MAC” in 5 regions (Central Region, adherence to treatment.
Southern region, Northern region,
Eastern Region, Sabah, Sarawak).
Each region conduct 4 modules per
year.
2.3 Mitigating Sexual Transmission among Female Sex Workers
2.31 Upscaling coverage of prevention services
 Retaining client in the programme through NGO, MOH a) Min 50% clients are retained in the 10% clients are retained as of 2014
support group sessions coupled with other programme (6x/year)
activities/ services such HIV info session, legal b) Frequency of support group session:
aid, HIV/STI screening, SRH info and services10 One session/month
10Other activities such as beauty course, opening of bank account, getting admission in the school for children, living skills (baking, sewing) could be organised on a regular
basis to attract the clients
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 Expand programme outreach sites: MOH,NGO a) By 2020, 60% of the FSW are 14 programme sites as of 2014
Current outreach programme is focused more reached Estimated FSW: 20,000
on street and venue based FSWs. To include b) By 2030, 95% of the FSW are Unique client as of 2014: 8584 clients
FSWs operating through social media and apps: reached (40%)
a) Maintain the existing peer to peer approach
b) Social media e.g. FB, TAGGED, WECHAT
c) To expand on VOICE POWER (Closed group
on FB specifically for FSW – currently there
are 138 active members in KL only)
 Forging smart and connected partnership to MOH, NGO a) To identify and place outreach Terengganu – 0 programme
reach out to FSWs in states that has limited workers in government clinics in Sarawak – 1 CBO
NGOs/CBOs implementing HIV prevention states without NGO/CBOs
services: b) Pilot states (4 outreach
workers/site):
c) 2016 – 2020: 5 states: Terengganu,
Sarawak, Kedah, TBC1 & TBC2.
Expansion of programmes in all states by
2030
 Increase uptake of VCT and STI among FSW: MGO, MOH a) By 2020 – 90% of reached FSW are Current target - 50% for VCT and 30%
a) Community-based testing sessions tested and know result STI and achievement – 28% for VCT and
organised in partnership with JKN in b) By 2030 – 95% of reached FSW are 57% for STI
locations preferred by the FSW e.g. salon, tested and know result
brothel, entertainment outlets, FSW’s
house. When this is not possible, NGOs to
Frequency of testing session: 1/month
engage independent registered health care
personnel for on-site testing.
b) Community-based testing paired with
interesting activities11 to attract FSW
c) To promote HTC in social network - VOICE
POWER and social apps such as
11
Activities such as Make-up , hair-styling, cooking, baking, tailoring
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WhatsApp, Tagged, Wechat in addition to
the existing approach (peer to peer).
d) Rapid kit for STI
 Increase uptake of SRH services among FSW: NGO, MOH, a) By 2020 – 30% clients receive SRH SRH is not actively promoted to clients
Outreach workers to actively promote SRH FRHAM, LPPKN services though SRH services are offered in all
services offered in healthcare settings as an b) By 2030 – 80% clients receive SRH government health clinic.
entry point to VCT and STI screenings through services
referrals in identified clinics. The outreach
workers are to accompany the clients to the
clinics – at least for the first visit12
2.32 Condom and lubricant programming
 Increase number of FSW practicing safe sex NGO, MOH By 2020 - 90% of reached FSW using IBBS 2012: 84%
consistently with regular and non-regular condom IBBS 2014: 84%
partners13 By 2030 - 95% of reached FSW using
condom
 BCC intervention – to reduce alcohol or drug NGO, MOH, AADK & All FSW reached to be educated on no Drugs
use prior to sexual act JAKIM drugs and alcohol prior to sex. IBBS 2009: 38.5%
IBBS 2012: 20.8%
<10% of FSW consume alcohol or take Alcohol
drugs before sex
2009: 35.9%
2012: 40.0%
 Empower FSW that condom is not an evidence NGO, MOH, Bar a) Frequency of training: 2/year
for sex work: Council & RMP b) 80% of outreach workers trained.
a) Paralegal training for ORW and community c) Activation of all legal aid centers by
leaders end 2016
b) Involvement of legal aid centre at state d) % of clients assisted through this
level service
12 Training as part of capacity building is proposed in the next section to enhance knowledge of ORW in SRH.
13 Education focused on positive behaviour change combined with condom use negotiation skills.
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2.33 Linkage to Treatment, Care and Support
 To link FSW with HIV to treatment: NGO, MOH a) 100% of FSW tested positive and Case management approach to be
a) Outreach worker are trained to facilitate require treatment are linked to considered.
referral to TAPs. treatment.
b) Peers are engaged as navigators in b) To identify and train case workers if
hospital and clinics (ID @ KK) to case management approach is
strengthen adherence and retention. used.
 Refer FSW to agencies that provide NGO, MOH, JAKIM, Number of clients referred
psychosocial support including spiritual and Interfaith
religious support that could facilitate positive organisations
behavior change leading to better adherence
and retention in treatment.
2.34 Risk Elimination through Job Rehabilitation
 Provide training and job opportunities as an KPKWM, JPN, Majlis a) % FSW referred and assisted
alternative to sex work. Sessions could be Agama Islam Negeri- b) % FSW change job
organised for the FSW to introduce these negeri (MAIN), GIAT
MARA, Amanah Frequency: 1 session/quarter
opportunities.
Ikhtiar Malaysia,
MOHR, ZAKAT,
KEMAS, Jabatan
Pertanian
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2.4 Mitigating Sexual Transmission among Transgender
2.41 Upscaling of HIV / STI Testing uptake
 Community mobilization and mapping MOH, NGO a) Estimation of TG population size - Very limited capacity building has been
a) Mapping of population of Mak Nyah (MN/TG) b) Coverage of all states (relative to conducted or planned
in localized areas overall population density) - ISEAN HIVOS (myISEAN) capacity
b) Identify community led local TG groups c) Min 80% Identified focal group trained building initiatives can be leveraged
(using social media such as Facebook and on specific issues related to TG upon
Whatsapp) with potential to be trained to - 42.8% tested for HIV and know result –
provide HIV/STI education/services to TG IBBS 2014
community
c) Training of those identified focal groups on
specific issues related to TG (Capacity
building on full cascade of HIV/STI services)
 Community led HIV/STI services MOH, NGO a) Min 1 CBO/HC per year provide CBT At present 1 NGO (FHDA) in Penang and
b) 80% high risk TG tested for HIV Kedah providing CBT and 3 HC providing
special testing facilities for the
community.
 Case Management approach for continuum of MOH, NGO Min 80% of Case Management Modelled on currently ongoing MSM pilot
care and to ensure comprehensive and quality conducted by peers from CBO. project by GF (Global Fund)
services to TG.
 Ensuring community friendly services at Health MOH, NGO Coverage of areas not reached by Complement community led services
Care Providers (HCPs) Community Based Testing (CBT) especially where it is not
a) Sensitization of health care workers (HCW) feasible/available
to provide more effectively full HIV/STI
cascade of services to TG community
b) Trained Peer educators from the TG
community stationed at HCPs
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2.42 Upscale awareness and education on safer sex

 Condom Marketing to increase the use of MOH, NGO a) Incorporate with IBBS activities every - Currently not all states were involved
condoms with all partners 2 years in all states Prevention - To overcome limitation of venue based
a) Assessment of needs, willingness & programs to cover all states outreach
feasibility b) 1 Focal Point per district in Year1 in - Condom use with recent partner 69.2%
b) Increase coverage of existing prevention district with TG. (2014)
program c) Min 2 peer education session per - TG are less likely to use condoms with
c) Expansion of outreach activities using Focal district per year. their regular partners (unlike with
Points who will conduct peer education d) Increased condom usage among TG customers)
sessions with most recent partners
d) Expansion of prevention programme for - 2016– 75%
partners of TG - 2018 - 80 %
e) Condom negotiation skills (role play or - 2020– 85%
simulation)
e) 2 TOT workshops for focal points on
Condom Negotiation Skill per
state/year (to be incorporated into
above mentioned district peer
educations sessions.
2.43 Upscale behaviour change communication
 Training of Peer educators from the TG MOH, NGO a) Peer educators trained for every state Currently BCC are available however
community themselves b) Min 2 BCC Material per year. need to be improved using ICT and
delivery should be by peers from the
c) Min 2 Workshop / FGD / state / year. community
 On site FGD with hands on experiences by peer MOH, NGO
educators in cooperation with Health Clinics ISEAN HIVOS (myISEAN) capacity
building initiatives can be leveraged upon
 Interactive education material/application (video/ MOH, NGO,
ICT) with FAQ / social media/apps MWFCD (LPPKN)
a) Strengthening SRH activity - focusing on HRT
management related on HIV prevention –
providing information on HRT and use as an
Entry Point for HIV and STI program.
b) Platform for advocacy
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 TG representative in related committees –at all MOH, NGO, JAKIM Number of committees with
levels of Prevention, Treatment, Care and representative from TG
Support for HIV
2.44 Improve service delivery and treatment compliance
 Training to empower TG-specific PLHIV support MOH, NGO Min 1 Training or Workshop / state
groups (Mentor mentee training)
 Create Buddy system (Treatment buddy) within “Buddys” must be properly trained to
TG-specific PLHIV support group provide the support needed.
 Increase Drop In Centers NGO, MOH, JAIN, Min 1 Drop In Center in each states No Drop In Centre in except for Komited
Local authorities within 5 years Malaysia & SEED currently
 Establishment of treatment modality based on NGO, MOH 80% of TG PLHIV treated at Health Existing Beserah (Kuantan), Pekan (Kota
existing best practices models Clinics Kinabalu) and Cheras health clinic
models
2.45 Development of supportive systems
 Address non-injecting substance abuse: MOH, NGO, AADK 2 workshop per year per states Estimated 80% of TG SW abusing
a) Awareness program on substance abuse At least 60% who need substances substances particularly ATS and alcohol
b) Referral to relevant agencies abuse referred to the relevant agency
 Psychosocial support TEKUN, a) Number of TG being referred to Need to break out of stereotypical job
a) Job Substitution &Income generation, Skills MARA, related agencies initiatives for TG
training and career related training KEMAS, b) At least 2 legal Aid sessions per Can we use legal aids instead of legal
b) Legal Aid Sessions - to increase awareness state per year rights
Jobs Malaysia,
of legal aids** c) Number of TG CBO participation in Program Mukhayyam is a program under
NGO, Private sector, local engagement JAKIM mainly conducted for Muslim TG
c) Family Reconciliation - Engage JAKIM,
communities at local level to raise d) 1 TOT at Federal level (for officers groups in Malaysia. The activities are
SUKAGUAM, focusing on voluntarily participation,
awareness and encourage acceptance of Yayasan Bantuan at the State Religious Departments
TG to overcome rejection of TG by their (JAIN) using the training manual for empowerment, self-motivation and
Guaman spiritual well-being that help to reduce
families Kebangsaan, Mak Nyah.
internal stigmatization.
d) Upscale Program ‘Mukhayyam’ community leaders e) Min 1 activity/ state
e) General Peer support groups for TG (CBO f) Min 1 CBO support group per state
based)
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2.5 Prevention of HIV Transmission and Care Among Children, Adolescent & Young People
2.51 Enhance delivery of curriculum and co-curriculum related to HIV education & awareness in school
 Ongoing capacity building among teachers who MOH, MOE, NGO a) Min 2 state level training per year, Already had existing curriculum in school3
teach subject related HIV education with District Health Office (DHO)  Primary school: Personal and Family
echo training to schools in districts. Health
Coverage at least 70% of schools in
the states trained  Secondary school: Family Health and
Sexuality Module
b) Pocket information for trained
teachers on Comprehensive Sexual *Teachers trained are those involved in
Reproductive Health (SRH) subject matters and Doctor Muda
Education
 Ongoing capacity building among teachers who MOH, MOE, NGO Coverage 100% of schools with “Kelab Not all secondary school currently having
are in charge for co-curriculum activity related to Doktor Muda” dan “Kelab Doctor the programme but is in the process of
HIV Remaja” (Young Doctor Club) trained in expanding to all school
implementing HIV module Focus on primary school students as
main prevention direction
 Task Force for HIV, Drug & Reproductive Health KBS, MOE, AADK, No. of meetings: JKN with existing Task force may
PDRM, MOH, a) National: 2 times/year continue with the present committee
MWFCD, JAKIM,
RPM, NGO/MAC b) State: 2 times/year
 Weekly School Program/ Social Ethics Program MOH, MOE a) 100% school implementing the These two existing programmes are
(Etika Pergaulan) – reading health education programme – 2 times/year HIV already ongoing.
material during school assembly education topics
b) 100% schools received standard
education materials from MOH
2.52 Interactive and Multimedia Campaign to reach out adolescent and young people
 Social media campaign to reach out to younger MAMPU, MOH, NGO One apps / one webpage created, There are two apps available (Info Sihat
online users & developing social network updated and maintain on monthly basis, & myHealth) currently, but not enough
among users with target of 20% of the young focus on HIV.
population in Malaysia. Yearly increment of 5% visit flow into the
webpage
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 Multimedia campaign to reach out children4 on MOH, MOE, KKMM HIV slot for popular TV programme Example of popular cartoon with high
HIV messages airtime – Upin & Ipin
 Interactive game/awareness message in school MOH (HECC) a) One material per school Snake & Ladder game
to increase interest in HIV awareness b) (primary schools) developed and Used during school health festival
utilized (School Health Week) /Young Doctor’s
c) One human standby in school to Club activities
have HIV messages
 Multimedia campaign to reach out adolescent MOH, KKMM TV Programme Reality Show/Prime time “Run” Programme TV reality show to take
and young people on HIV message show to take on HIV theme as part of the on awareness campaign in one of their
awareness campaign episode
2.53 Rehabilitation & Care of young people with drug use behavior
 Facilitate and Support existing programme on MOH, MOE, AADK Collaboration of MoH with MOE & AADK Existing DARIH/SHIELD programme
managing drug use issue in secondary school for the HIV Prevention programme, twice DARIH: Dadah (Drug), Alkohol (alcohol),
per year Rokok (cigarette), Inhalant, HIV
SHIELD (Sayangi Hidup Elak Derita
Selamanya)
2.54 Provide safe space for young MSM/TG/SW (Male & Female) to discuss about health behaviours and HIV
 Training for school counsellors in HIV/STIs & MOH, MOE a) MOH identified technical expert to
Sexuality for them to increase skills in providing be trainer (Psychology Officer,
counselling support to students whom belong to Family Medicine Specialist,
Key Populations Psychiatrist)
b) One national ToT organized by
MOH
c) Echo training at state level – JKN or
PKD (minimum one or two a year)
d) To create one Hotline number as a
link to support group
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 Need assessment in school to Identify key MOE One survey per year for all forms of MOE currently having the survey in
population, and follow up with confidential students5 and smart partnership with place5
counselling programme in school JKN
 A compulsory slots of HIV/STIs sexual MOH, MOE, One education activity/university/year Focus on creating awareness on early
education programme in Orientation programme Universities’ Student STIs/HIV testing for KAPs
of IPTA/IPTS or PROSIS Affair Dept.
2.55 Provide treatment support to Adolescent Living with HIV (ALHIV) and Young PLHIV
 Improve treatment adherence among MOH, NGO/MAC a) 1 adolescent support group/ state * Pending on verification of disease
Adolescent Living with HIV (ALHIV) and Young b) 50 % of patient linked to the burden amongst the adolescent
PLHIV with support group6 CBOs/NGOs/ Adolescent Support
Group
 Enhancing paramedic adolescent counsellors’ MOH 90% of ALHIV/PLHIV retained in care

skill on treatment adherence for ALHIV/PLHIV
2.56 Access to HIV & STI testing for young key populations
 Increase uptake of HIV testing among young NGO, MOH a) At least one smart partnership of RTK reten as baseline
people (key populations) NGO screening site and government *To increase uptake to 90% testing
health clinic –
*To counter self-stigma of key population
b) Empower community to conduct HIV
screening
c) 100% screened reactive will be
referred to health clinic
 Review HIV/STI testing barrier for adolescent MOH Community feedback reflects needs to
have doctor test minor on HIV/STI
2.57 Need Assessment for at risk young people (school MOH, MOE, NGO Regular need assessment conducted on Include into IBBS
drop-out/street kids/young people with sexual the at risk young people (once in every 2
exposure before marriage) years)
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2.6 Elimination of Mother to Child Transmission
2.61 Increase testing among women of reproductive age
High Risk Group

a) Contact tracing through NSEP/MMT program NGO 100% among partner MMT program All reproductive age group women should
(Screening for spouse/partner) clients know their status
b) Community-based screening (eg: home visit for MOH 50% among partner NSEP program
screening) clients
Low Risk Group

a) Incorporate into BSKK (Borang saringan klinik MOH a) 50% of reproductive aged group
kesihatan) screening-offer for screening (>18 women involved in BSKK screening
years) b) Module to be reviewed every 5
b) To review pre-marital course/module every 5 years
years- Collaborate with MOH (To emphasize JAKIM, Islamic
more on HIV and STI) Religious Dept.,
MOH
c) To train appropriate medical personnel to deliver
talk
d) Refreshment course for the pre-marital facilitator Islamic Religious
and certificate valid for 5 years Dept., MOH
e) To increase uptake of pre-marital HIV testing MOH, Registration
among non-muslim couple Dept.
-Collaboration with registrar of marriage
-Create Awareness (Forum, IEC materials)
2.62 Reduce the failure rate in locating partners of HIV positive prisoners
 Incorporate contact tracing through Project NGO, Prison 50% of partners among clients in a) Wrong/incomplete address
TEMAN Department TEMAN program did HIV testing b) Mobile
c) Failure to identify partners
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2.63 Reduce loss to follow up among HIV Positive women at PPHIV clinic
a) Appoint dedicated staffs at clinics as trained MOH <5% defaulter rate a) no family support
counsellors/assistant counsellors to look after b) logistics
the well-being of HIV positive mothers.
(Personalised Care) c) poor knowledge
b) Clinic Peer Support Program at point of care NGO d) no partner support
(Klinik Kesihatan) e) poor defaulter tracing
f) stigma (self/public)
2.64 Reduce new HIV infections among women

a) Initiation of ART treatment in all HIV positive MOH 100% a) Early initiation of ART(regardless of
partners among sero-discordant couple CD4 count) among HIV positive
regardless of CD4 level. partner in sero-discordant couple is
b) Appoint dedicated staffs at clinics as trained not widely practiced in Malaysia
counsellors/assistant counsellors to look after b) Failure to regularly monitor HIV
the well-being of sero-discordant couple status of the partner
2.65 Reduce late booking among pregnant women

a) Strengthen pre pregnancy counselling in PPHIV NGO 95% of HIV Positive mothers under a) poor knowledge
b) Establish “Rakan Ibu Mengandung” support MOH follow up to come for early booking b) denial
group lead by HIV positive mothers (e.g. (<12w POA) c) stigma
CAKNA and PFHDA)
d) logistics
c) Strengthening tracing system for defaulters
e) background problem
f) no family/partner support
g) defaulter tracing
2.66 Strengthen partners screening
Partner’s screening as an “opt out” MOH 2016- 20% of partner’s antenatal women a) unknown status of husband/Partner
screened. b) unknown risk behavior of
2017- 30% husband/partner
2018- 40%
2019-50%
2020-75%
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2.67 Promote adherence among HIV positive pregnant women
a) Establish peer support group “Rakan Ibu MOH, NGO 100% of HIV Positive mothers adhere to 1.non compliance
Mengandung” treatment 2. lack of knowledge
b) Dedicated team from health clinics to do regular 3. no proper counselling
home visits to check on medication and
compliance of the treatment.
c) Treatment literacy and patient education at point
of care by dedicated staff.
d) Strengthen HIV MTAC (Medication Therapy
Adherence Clinic)
 Titer monitoring of VDRL to be done regularly in MOH 100% of patient receiving treatment Failure to adhere to the SOP
accordance to the SOP should be performed regular VDRL titer
2.68 Improve repeat test among HIV negative pregnant women during ANC
 Repeat HIV test to all pregnant women at 28w MOH 100% of High risk pregnant women are Failure to adhere to the SOP and failure
screened in according to SOP to appreciate the risk
2.69 Expand HIV test among pregnant women at private hospitals and clinics
 Credentialing of private hospitals / clinics MOH, UKAPS 100% for GP providing antenatal care
providing antenatal care to do HIV test Private Practise are credentialed
Practitioners
2.610 Ensure locational suppression therapy for HIV positive mothers with 24 hours after delivery
a) Lactation Suppression Therapy given to all MOH 100% mothers been given Lactation Lactation suppression therapy not
mothers with HIV Suppression Therapy within 24 hours universally practiced to prevent mixed
b) Peer support group by HIV positive mothers feeding
NGO, MOH
2.611 Provision of Zidovudine for HIV positive new born baby after discharge from ward
a) New born babies are provided with Zidovudine MOH, NGO a) 100% of baby are provided with Lack of awareness regarding the
and mothers are counselled Zidovudine before discharge and importance of compliance to medication
b) Linkage of care between paediatrics clinics and 100% of mothers counselled before
health clinics discharge
b) 100% of HIV positive babies come
for follow up
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2.612 Provision of Option B+ for HIV positive pregnant women
 Optimise Option B+ART for HIV positive MOH At least 90% given option B+ ART
mothers
STRATEGY 3 - REDUCTION OF STIGMA AND DISCRIMINATION
3.1 Reduce Stigma and discrimination through: MOH, NGO, Module ‘Managing Stigma among KP’ by Workshops on Manual Islam and
a) Development of specific module and training Government 2016 HIV/AIDS have been conducted by
among KPs to overcome self-stigma agencies, private Module ‘Effective communication & HIV JAKIM since 2009 to Imams, Bilals,
sectors Counselling for HCW’ by 2016 officers at the State Religious
b) Development of module for effective
Departments and community leaders.
communication and HIV counselling for HCW Training for HCW – 2/state/year
c) Service Providers sensitization (HCW and staff Training for KPs – 2/year
of related agency) based on ‘Manual Islam and
HIV/AIDS’
STRATEGY 4 - ENSURING QUALITY STRATEGIC INFORMATION AND ITS USE BY POLICY MAKERS AND PLANNERS THROUGH MONITORING, EVALUATION AND
RESEARCH.
4.1 Develop and strengthen M&E framework for all MOH, NGO, One M&E framework for all key players – M&E Framework currently being
projects/programme government MOH, NGO & government agencies in developed and subject to need for
agencies line with GARPR monitoring modification.
My MMT Database is currently being
developed apart from existing PMTCT
and ART Cohort
National AIDS Registry is being upgraded
to include treatment module and co-
infections; scheduled for review 2 yearly
4.2 Conduct timely and high quality surveys including MOH, NGO, Structured study carried out: 3 cycles of IBBS conducted – 2009, 2012
behavioural study (IBBS), population size Academia  IBBS - 2 yearly & 2014
estimations, stigma and other studies. Stigma assessment among KPs has been
 Stigma among KPs, HCW &
community - 2 yearly incorporated as part of IBBS since 2014
Stigma assessment among HCW and
 Pop. Size estimate for KPs once every
community has taken place since 2014
5 years
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4.3 Promote the production, dissemination and effective MOH, NGO, bilateral GARPR report (incorporate IBBS and GARPR is a collaborative work involving
use of strategic information to inform and guide and other Stigma findings from study) produced key stakeholders – MOH, NGO, bilateral
programme and policy decision making. government and disseminated annually and other government agencies
agencies
4.4 Sustain and strengthen data collection mechanism MOH, GPs Standard M&E format for PMTCT, STI Reporting of PMTCT, STI and MMT are
from both private and public health facilities. and MMT for both MOH and GPs currently on-going.
4.5 Coordinate NSPEA evaluation through systematic MOH, NGO, Bilateral Review of NSPEA indicators yearly
data collection and review (MTR) and government MTR every 2 years
agencies
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Annex 4
Indicators for monitoring NSPEA 2016-2030
Data Data
No. Indicator Collection Collection Org. 2014 2016 2017 2018 2019 2020 2030
Frequency Method
STRATEGY 1. Testing and Treatment to end AIDS
OUTCOME INDICATORS
1.1 Percentage of eligible adult and children receiving ART Annually M&E MOH 44% 50% 60% 70% 80% 90% 95%
Numerator: (GARPR)
Number of adults and children currently receiving ART in
accordance with the nationally approved treatment protocol (or
WHO standards) at the end of the reporting period.
Denominator:
Estimated number of adults and children living with HIV
1.2 (a) Percentage of PWID receiving ART 2 yearly IBBS MOH 29.1% 90% 95%
Numerator:
Number of PWID currently receiving ART
Denominator:
Number of PWID living with HIV included in the sample
(b) Percentage of TG receiving ART 2 yearly IBBS MOH 45.7% 90% 95%
Numerator:
Number of TG currently receiving ART
Denominator:
Number of TG living with HIV included in the sample
(c) Percentage of MSM receiving ART 2 yearly IBBS MOH 14.9% 90% 95%
Numerator:
Number of MSM currently receiving ART
Denominator:
Number of MSM living with HIV included in the sample
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Data Data
Frequency Method
(d) Percentage of FSW receiving ART 2 yearly IBBS MOH 16.1% 90% 95%
Numerator:
Number of FSW currently receiving ART
Denominator:
Number of FSW living with HIV included in the sample
1.3 Percentage of PLHIV with late diagnosis (first CD4 cell Annually M&E MOH 53% 40% 30% 20% 10% 5% 0%
count <200 cells/μL)
Numerator: (GARPR)
Number of PLHIV with late diagnosis in reporting year
Denominator:
Total number of PLHIV with first CD4 cell count in reporting
year
1.4 Percentage of PLHIV known to be on treatment 12 months Annually M&E MOH 89% 90% 90% 90% 90% 90% 95%
after initiation of ARV
Numerator: (GARPR)
Number of adults and children who are still alive and on ART
at 12 months after initiating treatment.
Denominator:
Total number of adults and children who initiated ART who
were expected to achieve 12-month outcomes within the
reporting period, including those who have died since starting
ART, those who have stopped ART, and those recorded as
lost to follow-up at month 12.
1.5 Percentage of people on ART tested for viral load (VL) Annually M&E MOH 81.7% 82% 83% 85% 88% 90% 95%
with undetectable viral load in the reporting period
Numerator: (GARPR)
Number of people on ART tested for viral load in the reporting
period with undetectable viral load (i.e. ≤ 1000 copies)
Denominator:
Number of people on ART tested after 12 months therapy for
VL during the reporting period
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Data Data
Frequency Method
1.6 (a) Percentage of PWID that have received an HIV test and 2 yearly IBBS MOH 85% 88% 90% 90% 95%
knew their results
Numerator: (GARPR)
Number of PWID respondents who have been tested for HV
and who know their results
Denominator:
Number of PWID included in the sample
(b) Percentage of MSM that have received an HIV test and 2 yearly IBBS MOH 55% 70% 80% 90% 95%
knew their results
Numerator: (GARPR)
1.6
Number of MSM respondents who have been tested for HV
Denominator:
Number of MSM included in the sample
(c) Percentage of TG that have received an HIV test and 2 yearly IBBS MOH 67% 70% 80% 90% 95%
knew their results
Numerator: (GARPR)
Number of TG respondents who have been tested for HV and
who know their results
Denominator:
Number of TG included in the sample
(d) Percentage of FSW that have received an HIV test and 2 yearly IBBS MOH 62% 70% 80% 90% 95%
knew their results
Numerator: (GARPR)
Number of FSW respondents who have been tested for HV
Denominator:
Number of FSW included in the sample
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Data Data
Frequency Method
1.7 Percentage of women and men aged 15+ who are HIV+ in Annually M&E MOH 0.09% 0.09% 0.08% 0.08% 0.07% 0.06% 0.04%
the last 12 months
Numerator: (GARPR)
Number of women and men 15+ who are HIV+ out of number
tested
Denominator:
Number of women and men aged 15+ who received HIV test
and know the result
1.8 Percentage of estimated HIV-positive incident TB cases Annually M&E MOH 19.7% 30% 60% 70% 80% 90% 95%
that received treatment for TB and HIV
Numerator: (GARPR)
Number of people with HIV infection who received ARV
combination therapy in accordance with the nationally
approved treatment protocol (or WHO/UNAIDS standards) and
who were started on TB treatment (in accordance with the
national TB programme guidelines) within the reporting year
Denominator:
Estimated number of incident TB cases in people living with
HIV
1.9 Percentage of adults and children living with HIV newly Annually M&E MOH 9.50% 9% 9% 9% 9% 8% 5%
enrolled in care who are detected having active TB
disease
Numerator: (GARPR)
Total number of adults and children newly enrolled in HIV care
who are diagnosed as having active TB disease during the
reporting period
Denominator:
Total number of adults and children newly enrolled in pre-ART
care or on ART during the reporting period
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Data Data
Frequency Method
1.10 Percentage of adult and children newly enrolled in HIV Annually M&E MOH 43% 50% 60% 70% 80% 90% 95%
care starting isoniazid preventive therapy (IPT)
Numerator: (GARPR)
Number of adults and children newly enrolled in HIV care (pre-
ART & ART) who also start (given at least one dose) IPT
during the reporting period
Numerator:
Number of adults and children newly enrolled in HIV care
1.11 Percentage (%) of adults and children enrolled in HIV care Annually M&E MOH 88.2% 89% 90% 90% 90% 90% 95%
who had TB status assessed and recorded during last
visit
Numerator: (GARPR)
Number of adults and children enrolled in HIV care (‘in HIV
care’ includes people in the pre-ART register and people in the
ART register) , who had their TB status assessed and
recorded during their last visit during the reporting period
Denominator:
Number of adults and children newly enrolled in HIV care
OUTPUT INDICATORS
1.12 Number of facilities providing HIV screening/testing Annually M&E MOH
services
Numerator: (GARPR) NGO
(a) Government health facilities 1187 100% 100% 100% 100% 100% 100%
(b) Private health facilities 7035
(c) NGO/CBO screening points 5 10 15 20 25 25 25
1.13 (a) Percentage of PWID reached that have received an HIV Quarterly M&E NGO 14% 30% 50% 60% 70% 90% 95%
screening
Numerator:
98 | P a g e
Data Data
Frequency Method
Number of PWID client who have been screened for HIV
Denominator:
Number of active PWID (≥9 times face-to-face outreach)client
in the last 12 months
(b) Percentage of SW reached that have received an HIV Quarterly M&E NGO 12% 20% 40% 60% 80% 90% 95%
screening
Numerator:
Number of active SW client who have been screened for HIV
Denominator:
Number of active SW (≥6 times face-to-face outreach) client in
the last 12 months
(c) Percentage of MSM reached that have received an HIV Quarterly M&E NGO 22% 30% 40% 60% 80% 90% 95%
screening
Numerator:
Number of active MSM client who have been screened for HIV
Denominator:
Number of registered active MSM client in the last 12 months
(>=4 times face-to-face outreach)
1.14 Treatment adherence peer support (TAPS) programme Annually M&E NGO
Numerator:
Number of HIV treatment centers with TAPs programme
a) Hospital 23
b) Health Clinic 5
1.15 Capacity building of outreach/case worker on Harm
Reduction, HIV screening, TB detection and linkages to Annually M&E NGO
care
Numerator: MOH
(a) Appropriate module developed 1
(b) Number of outreach worker or case worker trained 0 60
99 | P a g e
Data Data
Frequency Method
STRATEGY 2. IMPROVING THE QUALITY AND COVERAGE OF PREVENTION PROGRAMMES AMONG KEY POPULATIONS
A. Prevention of HIV transmission through injecting drug use
OUTCOME INDICATORS
2.1 Percentage of PWID who have never shared needle in the 2 yearly IBBS MOH 76% 80% 85% 90% 95%
last 12 months
Numerator:
Number of PWID respondents who have never shared needle
in the last 12 months
Denominator:
Number of PWID included in the sample
2.2 Percentage of PWID who report the use of a condom at last 2 yearly IBBS MOH 20.8% 30% 40% 50% 80%
sexual intercourse
Numerator: (GARPR)
Number of PWID who reported that a condom was used the last
time they had sex
Denominator:
Number of PWID who report having injected drugs and having
sexual intercourse in the last month.
2.3 Percentage of NSEP client referred to OST Annually M&E MAC 21% 30% 40% 50% 60% 70% 80%
Numerator:
Number of active NSEP client who have been referred to OST
service
Denominator:
Number of registered active opiate NSEP clients
100 | P a g e
Data Data
Frequency Method
2.4 Percentage of PWID living with HIV 2 yearly IBBS MOH 16.3% <14% <12% <11% <5%
Numerator: (GARPR)
Number of PWID who test positive for HIV
Denominator:
Number of PWID tested for HIV
2.5 Percentage of Hepatitis C infection among PWID Annual M&E MOH 28% 24% 22% 20% 15%
Numerator:
Number of PWID infected with Hepatitis C
Denominator:
Number of new PWID enrolled in OSTin the current year
2.6 Percentage of PWID on OST Annual M&E MOH 30% 40% 50% 60% 65% 80% 85%
Numerator:
Number of registered OST clients
Denominator:
Number of estimated opiate PWID
2.7 Percentage of PWID reached with prevention programmea 2 yearly IBBS MOH 65% 70% 75% 80% 90%
Numerator: (GARPR)
Number of PWID reached
Denominator:
Number of PWID included in the survey
OUTPUT INDICATORS
2.8 Needles distributed to each PWID in the last 12 month Annually M&E MAC 285 300 300
Numerator: (GARPR)
Number of sterile needles distributed in the past 12 months
Denominator:
Number of active PWID client
101 | P a g e
Data Data
Frequency Method
2.9 Number of substitution therapy (OST) sites Annually M&E MOH 838
(a) Government (GARPR) 472
(b) Private (GP) 366
2.10 OST retention Yearly M&E MOH NA 80 85
Numerator:
Number of OST clients still in treatment 6 months after starting
OST
Denominator:
Number of clients started on OST
2.11 Percentage of PWID reached with minimum prevention Annually M&E NGO 24% 30% 40% 60% 70% 80% 90%
programme
Numerator:
Number of PWID reached
Denominator:
Estimated number of PWID
B. Prevention of sexual transmission of HIV
OUTCOME INDICATORS
2.12 Percentage of FSW reporting use of a condom with their 2 yearly IBBS MOH 84.5% 86% 88% 90% 100%
most recent client
Numerator: (GARPR)
Number of SW who reported that a condom was used with their
last client
Denominator:
Number of SW who reported having commercial sex in the last
12 months.
2.13 Percentage of FSW reached with prevention programmesa 2 yearly IBBS MOH 49.9% 55% 63% 65% 80%
Numerator: (GARPR)
Number of FSW reached with prevention programme in the last
12 months
102 | P a g e
Data Data
Frequency Method
Denominator:
Total number of FSW surveyed
2.14 Percentage of FSW living with HIV 2 yearly IBBS MOH 7.3% 7.0% 6.8% 6.7% 6.5%
Numerator: (GARPR)
Number of FSW who test positive for HIV
Denominator:
Number of FSW tested for HIV.
2.15 Percentage of MSM reporting use of a condom with their 2 yearly IBBS MOH 57% 62% 65% 70% 80%
most recent partner
Numerator: (GARPR)
Number of MSM who reported that a condom was used with
their last sexual partner
Denominator:
Number of MSM who reported having anal sex in the last 12
months.
2.16 Percentage of MSM reached with prevention programmes 2 yearly IBBS MOH 31% 40% 50% 65% 80%
Numerator: (GARPR)
Number of MSM reached with prevention programme in the last
12 months
Denominator:
Total number of MSM surveyed
2.17 Percentage of MSM living with HIV 2 yearly IBBS MOH 8.9% 8.6% 8.5% 8.3% 8.0%
Numerator: (GARPR)
Number of MSM who test positive for HIV
Denominator:
Number of MSM tested for HIV.
2.18 Percentage of TG reporting use of a condom with their 2 yearly IBBS MOH 81% 83% 88% 90% 100%
most recent partner
Numerator: (GARPR)
103 | P a g e
Data Data
Frequency Method
Number of TG who reported that a condom was used with their
last sexual partner
Denominator:
Number of TG who reported having anal sex in the last 12
months.
2.19 Percentage of TG reached with prevention programmes 2 yearly IBBS MOH 64% 68% 70% 75% 80%
Numerator: (GARPR)
Number of TG reached with prevention programme in the last
12 months
Denominator:
Total number of TG surveyed
2.20 Percentage of TG living with HIV 2 yearly IBBS MOH 5.6% 5.4% 5.2% 5% 5%
Numerator: (GARPR)
Number of TG who test positive for HIV
Denominator:
Number of TG tested for HIV.
2.21 Percentage of FSW with active syphilis Annually M&E MOH NA
Numerator: NGO
Number of FSW who are tested positive for syphilis
Denominator:
Number of FSWs who are tested for syphilis
2.22 Percentage of TG with active syphilis Annually M&E MOH NA
Numerator: NGO
Number of TG who are tested positive for syphilis
Denominator:
Number of TGs who are tested for syphilis
2.23 Percentage of MSM with active syphilis Annually M&E MOH NA
Numerator: NGO
Number of MSM who are tested positive for syphilis
Denominator:
104 | P a g e
Data Data
Frequency Method
Number of MSM who are tested for syphilis
OUTPUT INDICATOR
2.24 Percentage of active FSW reached Annually M&E MAC 38% 50% 55% 60% 70% 80% 85%
Numerator:
Number of unique FSW client reached
Denominator:
Estimated number of FSW
2.25 Percentage of TGSW reached with HIV prevention Annually M&E MAC 21% 30% 40% 50% 70% 80% 85%
programme
Numerator:
Number of unique TGSW reached
Denominator:
Number of estimated TG
2.26 Percentage of MSM reached with prevention package Annually M&E MAC 0.70% 20% 30% 40% 60% 80% 85%
Numerator:
Number of unique MSM reached
Denominator:
Number of estimated MSM
C. Elimination of mother-to-child transmission of HIV and syphilis
OUTCOME INDICATORS
2.27 Percentage of pregnant women who know their HIV status Annually M&E MOH 85% 90% 95%
(tested for HIV and received results - during pregnancy, (GARPR) EPP
during labour and delivery, and during the post-partum
period (<72 hours), including those with previously known
HIV status
Numerator:
Number of pregnant women who were tested for HIV in the last
12 months and received their results - during pregnancy, during
labour and delivery, and during the post-partum period (<72
hours), including those with previously known HIV status
105 | P a g e
Data Data
Frequency Method
Denominator:
Estimated number of pregnant women
2.28 Percentage of HIV+ pregnant women who received ARV to Annually M&E MOH 78% 80% 82% 85% 90% 95% 100%
reduce the risk of mother-to-child transmission
Numerator: (GARPR)
Number of HIV-positive pregnant women who received
antiretroviral medicine during the past 12 months to reduce the
risk of mother-to-child transmission during pregnancy and
delivery.
Denominator:
Number of HIV-positive women who delivered within the past
12 months
2.29 Percentage of child HIV infections from HIV+ women Annually M&E MOH 1.3% 1.0% 1.0% <1% <1% <1% <1%
delivering in the past 12 months
Numerator: (GARPR)
Number of children newly infected with HIV due to mother-to-
child transmission among children born in the previous 12
months to HIV-infected women
Denominator:
Number of HIV positive women who delivered in the previous
12 months
2.30 Percentage of antenatal care attendees who were positive Annually M&E MOH 0.06% 0.05% 0.03%
for syphilis
Numerator: (GARPR)
Number of antenatal care attendees who tested positive for
syphilis
Denominator:
Number of antenatal care attendees who were tested for
syphilis
106 | P a g e
Data Data
Frequency Method
2.31 Number of adults reported with syphilis Annually M&E MOH 0.01% <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
(primary/secondary and latent/unknown) in the past 12 % % % % % %
months
Numerator: (GARPR)
Number of adults reported with syphilis during the reporting
period
Denominator:
Number of individuals aged 15 and older
2.32 Number of men reported with gonorrhoea in the past 12 Annually M&E MOH 0.01% <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
months % % % % % %
Numerator: (GARPR)
Number of men reported with gonorrhoea in the past 12 months
Denominator:
Number of males aged 15 and older
2.33 Number of men reported with urethral discharge in the past Annually M&E MOH 0.01% <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
12 months % % % % % %
Numerator: (GARPR)
Number of men reported with urethral discharge in the past 12
months
Denominator:
Number of males aged 15 and older
2.34 Number of adults reported with genital ulcer in the past 12 Annually M&E MOH <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
months % % % % % % %
Numerator: (GARPR)
Number of adults reported with genital ulcer in the past 12
months (disaggregated by sex)
Denominator:
Number of individuals aged 15 and older (disaggregated by
sex)
107 | P a g e
Data Data
Frequency Method
2.35 Percentage of congenital syphilis M&E MOH 0.01% <0.01 <0.01 <0.01 <0.01 <0.01 <0.01
Annually
% % % % % %
Numerator: (GARPR)
Number of congenital syphilis born in the previous 12 months
Denominator:
Number of deliveries in the previous 12 month
OUTPUT INDICATORS
2.36 Percentage of male partner screened for HIV Annually M&E MOH 8% 20% 30% 50% 70% 75% 90%
Numerator: (GARPR)
Number of spouse/male partner screened
Denominator:
Number of mother attending antenatal care
2.37 Percentage of woman known to be living with HIV who Annually M&E MOH NA 20% 40% 60% 80% 95% 100%
come for early booking (<12w POA) in the current year
Numerator:
Number of woman known to be living with HIV who come for
booking within <12 week of gestation
Denominator:
Number of woman known to be living with HIV attended
antenatal care
2.38 Percentage of women accessing antenatal care (ANC) Annually M&E MOH 98.9% 99% 99.2% 99.5 99.8% 99.9% 100%
services who were tested for syphilis at first ANC visit %
Numerator: (GARPR)
Number of women attending ANC services who were tested for
syphilis at first ANC visit
Denominator:
Number of women attending ANC services
108 | P a g e
Data Data
Frequency Method
2.39 Percentage of infants born to HIV-infected women Annually M&E MOH 100% 100% 100% 100% 100% 100% 100%
receiving antiretroviral prophylaxis for prevention of
mother-to-child transmission (PMTCT)
Numerator: (GARPR)
Number of infants born to HIV-infected women receiving
antiretroviral prophylaxis for PMTCT
Denominator:
Number of HIV-infected pregnant women giving birth
2.40 Percentage of infants born to HIV-infected women started Annually M&E MOH 100% 100% 100% 100% 100% 100% 100%
on cotrimoxazole (CTX) prophylaxis within two months of
birth
Numerator: (GARPR)
Number of infants born to HIV-infected women started on CTX
prophylaxis within two months of birth
Denominator:
Number of HIV-infected pregnant women giving birth
2.41 Percentage of infants born to HIV+ women receiving a Annually M&E MOH 68.5% 70% 75% 80% 80% 80% 95%
virological test for HIV within 2 months of birth
Numerator: (GARPR)
Number of infants who received an HIV test within two months
of birth, during the reporting period. Infants tested should only
be counted once
Denominator:
Number of HIV-positive pregnant women giving birth in the last
12 months
2.42 Percentage of syphilis infected mother receiving treatment Annually M&E MOH 100% 100% 100% 100% 100% 100% 100%
Numerator: (GARPR)
Number of syphilis infected mother receiving treatment
Denominator:
Number of mother infected with syphilis
109 | P a g e
Data Data
Frequency Method
D. Prevention of HIV among young key population
OUTCOME INDICATORS
2.43 Percentage of young women & men (15–24 years) who Annually Survey MOH 40% 42% 45% 50% 55% 60% 80%
correctly identify ways of preventing sexual transmission
of HIV and reject major misconceptions about HIV
transmission
Numerator: (GARPR)
Number of respondents aged 15-24 years who gave the correct
answer to all five questions
Denominator:
Number of all respondents aged 15–24
2.44 Percentage of young women aged 15-24 who are living with
Annually M&E MOH 0.08% 0.05% 0.02%
HIV
Numerator: (GARPR)
Number of antenatal clinic attendees (aged 15-24) tested
whose HIV test results are positive
Denominator:
Number of antenatal clinic attendees (aged 15-24) tested for
their HIV infection status
2.45 Percentage of young key populations (<25 years) reported 2 yearly IBBS MOH
use condom with last sexual partner:
(a) Numerator: Number of FSW aged <25 years reported use
(GARPR) 78% 79% 79.5% 80% 90%
of condom with last sexual partner
Denominator: Number of FSW aged <25 years
(b) Numerator: Number of MSM aged <25 years reported use
57% 60% 70% 80% 90%
of a condom with last sexual partner
Denominator: Number of MSM aged <25 years
(c) Numerator: Number of TG aged <25 years reported use of
77% 79% 80% 80% 90%
a condom with last sexual partner
Denominator: Number of TG aged <25 years
110 | P a g e
Data Data
Frequency Method
2.46 Percentage of young PWID reported use sterile N/S in the
2 yearly IBBS MOH 95% 98% 99% 100% 100%
past 12 month
Numerator: (GARPR)
Number of PWID aged <25 years reported use of clean N/S
during last injection
Denominator:
Number of PWID aged <25 years
OUTPUT INDICATORS
2.47 Percentage of schools with trained teacher counselor in Annually M&E MOE NA 50% 80%
HIV/STIs & SRH
Numerator: MOH
Number of school with trained teacher counselor
Denominator:
Number of schools
STRATEGY 3. REDUCTION OF STIGMA AND DISCRIMINATION
OUTCOME INDICATORS
3.1 Percentage of respondents (aged 15–49 years) who 2 yearly Survey MOH 19% 18% 16% 15% 10%
respond “No” or “It depends” to both of the two NGO
questions:
(a) 'Would you buy fresh vegetables from a shopkeeper or
vendor if you knew that this person had HIV?' and (b) 'Do
you think children living with HIV should be able to attend
school with children who are HIV negative?
Numerator: (GARPR)
Number of respondents (aged 15–49 years) who respond “No”
or “It depends” to both of the two questions
Denominator:
Number of all respondents aged 15–49 years who have heard
of HIV
111 | P a g e
Data Data
Frequency Method
OUTPUT INDICATORS
3.2 Number of HCW undergo internship at ID Clinic (1-2 week) Annually M&E MOH NA
Numerator:
Number of HCW (doctor, paramedics, counselors) trained in
HIV care
3.2 Managing Stigma (HCW & KP) Once MOH

Development of Module - 'Managing Stigma' NGO
112 | P a g e
References:
1) MoH: Malaysia National HIV Strategic Plan on HIV and AIDS 2011-2015 (2011)
2) MoH: Mid Term Review of National Strategic Plan (2013)
3) MoH: Malaysia Global AIDS Response Progress Report (GARPR) (2014 AND 2015)
4) MoH: National Commitments and Policy Instrument (NCPI) (2015)
5) MoH: Ending AIDS in Malaysia, Myth or Reality (5 May 2015)
6) MoH: Development of the National Strategic Plan for Ending AIDS, NSPEA 2016-2030
(2015)
7) MoH: IBBS survey results (2014)
8) MoH: Ending AIDS in Malaysia; presentation by Anita Suleiman at CCM (19 June 2015)
9) MTAAG+: The people living with HIV Stigma Index (2012)
10) WB: Return on Investment and cost effectiveness of harm reduction in Malaysia (2013)
11) UNGA: Special Rapporteur on trafficking in persons; mission report to Malaysia (15 June
2015)
12) Malaysia Human Rights Commission: Round Table discussions on the right to health
and HIV/AIDS in Sarawak, Sabah and Kuala Lumpur (November 2014)
13) MAC: Community dialogue; Mona Sheikh Mohamud presentation (2015)
14) MAC: Community Assessment, preliminary results; Mona Sheikh Mohamud (2015)
15) MAC: Report on operational research to map existing HIV services for MSM and to
identify factors to increase utilization of these services in four States of Malaysia (2014)
16) MAC: Global Fund project progress update Jan-March 2015; Joselyn Pang at CCM 19
June 2015
17) MAC: Global Fund grant MYS-H-MAC progress report and reprogramming proposal
(2015)
18) UNAIDS: Aidsinfo fact sheet Malaysia HIV and AIDS estimates (2013)
19) UNAIDS: Global report (2013)
20) UNAIDS: Gap report (2014)
21) UNAIDS: The Cities report (Outlook 2014)
22) UNAIDS: Understanding Fast Track; Accelerating action to end the AIDS epidemic by
2030 (2015)
23) UNAIDS: 90-90-90; An ambitious treatment target to help end the AIDS epidemic (2014)
24) UNAIDS: Fast Track strategy; Malaysia country specific targets and resource needs
(2015)
25) UNAIDS/Lancet Commission: Defeating AIDS, Advancing global health (2015)
26) UNAIDS: Biomedical AIDS research, recent and upcoming advances, references (2015)
27) UNAIDS: How AIDS changed everything (2015)
28) UNAIDS: HIV and AIDS Strategy 2016-2021 (PCB 2015)
29) UNAIDS: Implications of the START study; questions and answers (2015)
30) UNAIDS and UNHABITAT: Ending urban epidemic (2015)
31) WB/UNAIDS: National HIV Strategy for Impact; Guidance note getting to zero (2014)
32) ILO: Code of Practice on Prevention and Management of HIV/AIDS at the Workplace
33) UNGA: Political Declaration on HIV/AIDS (2011)
34) UNGA: Sustainable Development Goals 2016-2030 (September2015)
35) ASEAN: 19th Summit Declaration; Getting to Zero (November 2011)
36) ASEAN: ATFOA meeting in Manila (July 2015)
113 | P a g e
37) UNESCAP: Asia-Pacific intergovernmental meeting on HIV/AIDS (January 2015)

38) High Level Expert Panel: Investing in Results; How Asia Pacific countries can invest for
ending AIDS (January 2015)
39) WHO: Guidelines on HIV prevention and treatment for sex workers (2011)
40) WHO: Guidelines on HIV prevention and treatment for MSM and transgender people
(2012)
41) WHO: HIV and adolescents, guidelines for testing, treatment and care (2013)
42) WHO: Consolidated guidelines on use of ARVs for treating and preventing HIV (2013)
43) WHO: Prevention, diagnosis, treatment and care for Key Populations (2014)
44) WHO: Global update on health sector response to HIV (2014)
45) WHO: Consolidated guidelines on HIV testing services (July 2015)
114 | P a g e
HIV/STI Sector
Disease Control Division
www.moh.gov.my
115 | P a g e

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NATIONAL STRATEGIC PLAN FOR ENDING AIDS

MINISTRY OF HEALTH MALAYSIA |Page

Report prepared by:

The National Strategic Plan for Ending AIDS 2016-2030

This document was coordinated and

The editorial team would like

Dr. Fazidah Yuswan Our heartfelt thanks go to

Dr. Olavi Elo

Dr. Chong Chee Kheong

Dr. Anita bt Suleiman (Coordinator)

Dr. Mohd Nasir bin Abd Aziz

Dr. Fazidah bt Yuswan

Dr. Salina bt Md Taib

Datuk Dr. Christopher Lee

Dato’ Dr Ghazali bin Ismail

Mohd Nazri Mohd Dazali

Hairuddin bin Masnin

Dr. Ilias Yee

The resources are deployed in the most effective and

DATUK DR. NOOR HISHAM BIN ABDULLAH

List of annexed AEM figures and tables:

Figure A1 Treatment and prevention coverage, Malaysia 2013

Acronyms and Abbreviations

NSEP Needle and Syringe Exchange Programme

Terms and definitions

Evaluation is a rigorous, scientifically-based collection of information about programme

Impact evaluation is conducted to assess changes in disease incidence and prevalence as

Intervention is a set of activities implemented by a project often at the community level.

Outcome indicators measure the effectiveness of programmes implemented to change risk

Programme refers to an overarching national or subnational response to a disease and

Project refers to a mix of activities supported by resources, implemented often at the

 Reduction of Sexual Transmission

 Reduction of Stigma and Discrimination

PROGRAMME INTERVENTION COVERAGE (BASED ON AEM):

 Quality information and evidence

1.1 The Big Picture

THE TREATMENT TARGET

Diagnosed On treatment Virally suppressed

CHAPTER 2: HIV EPIDEMIC SITUATION, RESPONSE AND

2.1 HIV situation in the country

HIV/AIDS related deaths 35

Table 1. Percentage of new HIV infections by Mode of transmission, Malaysia 1990-2014

<13 years 13-29 years 30-49 years ≥50 years indeterminate

Figure 4. Age-specific HIV Prevalence, Malaysia 2000-2014

<13 13-29 30-49 50+

Figure 5. Gender-specific HIV Prevalence, Malaysia 1986 – 2014

Gender-specific Rate (per 100,000

6000 Female Specific Rate

2.2 HIV/TB Co-infection

TB HIV TB/HIV prev.

2.3 Geographic differences in HIV prevalence

2.4 HIV Testing, Surveillance and Surveys

Figure 7. Testing of pregnant women, Malaysia 1998-2014

Total ANC Screened %HIV+

No. of antenatal mother

Antenatal Premarital Blood Donor

2.5 Key populations

(a) People who inject Drugs (PWID)

(b) Men Who Have Sex with Men (MSM)