Published in PLOS One on 2026-04-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A Spencer, Nateiya M Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Source: PLOS One • DOI 10.1371/journal.pone.0346493
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.
Introduction
Multimorbidity, the presence of multiple chronic conditions, is a stressor to health systems, leading to poor quality of life, disability, treatment complications, and mortality [1]. In southern Africa, Roomaney, Kasambara and colleagues report a rising double burden of chronic communicable such as the human immunodeficiency virus (HIV) and non-communicable diseases (NCDs; e.g., hypertension). In Malawi, the health system is heavily dependent on donor funding for vertical (single-disease focused) health programmes, which leads to fragmented care for people with multimorbidity, that is inefficient and costly to the health system [2].
The World Health Organization (WHO) advocates for patient-centred care focusing on individual’s needs, values and preferences and integrated, holistic disease management for people living with multimorbidity (PLMM) [3]. Malawi’s Health Sector Strategic Plan III 2023–2030 reflects this commitment [4]. However, implementation is uneven and often relies on external funders. Integrated chronic care models, such as the Integrated Chronic Care Clinic (IC3) supported by Partners in Health, have demonstrated improved retention, clinical outcomes, and cost-effectiveness [5–7]. Yet, disease-specific guidelines and service organisation continue to constrain integrated multimorbidity management, contributing to poorly controlled chronic disease at hospital and community [8–11].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A Spencer, Nateiya M Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Pathways of health care for people living with multimorbidity in two Southern African countries
- Evidence brief: High performance of point-of-care rapid tests for advanced HIV disease diagnosis by lay providers in Malawi: Results from a prospective diagnostic accuracy study supporting decentralized advanced HIV disease screening
- Evidence brief: Implementation bottlenecks of near point of care HIV viral load monitoring for children and young people in Tanzania: A Qualitative Study
