Barriers and Facilitators of Access to COVID-19 Testing and Treatment in Malawi: A Secondary Qualitative Study of Perspectives from Patients and Healthcare Workers

Abstract

Background: Equitable access to COVID-19 testing and treatment remains a critical challenge in low- and middle-income countries (LMICs), where healthcare infrastructure, supply chains, and patient health literacy differ significantly from high-income settings. Despite the global rollout of oral antivirals like Paxlovid, many LMICs, including Malawi, have faced substantial barriers to effective implementation. This study examines the facilitators and barriers influencing access to COVID-19 testing and treatment in Malawi’s Quick Start Test and Treat (T&T) program from the perspectives of healthcare workers (HCWs) and patients.Methods: This is a secondary qualitative study conducted in Malawi using in-depth, semi-structured interviews with 22 participants, including 12 HCWs and 10 patients who tested positive for SARS-CoV-2 and were offered treatment. Data were analyzed using Levesque’s Conceptual Framework of Access to assess barriers and facilitators across five dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness.Conclusions: The study identified 14 facilitators (8 from HCWs and 6 from patients) and 18 barriers (8 from HCWs and 10 from patients). The highest concentration of barriers occurred in Stage 5 (Healthcare Consequences), where patients reported 7 barriers. Stage 5 presented a stark contrast between HCWs highlighting facilitators and patients experiencing substantial barriers. Fragmented community sensitization, supply chain disruptions, and low HCW engagement weakened program effectiveness. These gaps reduced patient adherence, limited trust in treatment, and hindered the overall impact of the Quick Start initiative. A more integrated, patient-centered approach is essential for improving healthcare interventions in LMICs. Strengthening community engagement, ensuring reliable supply chains, and enhancing HCW motivation will improve equitable treatment access. These findings provide critical insights for policymakers, program implementers, and global health stakeholders working to optimize test-and-treat models in future pandemics.