Michaela Tse is a Senior at UNC-Chapel Hill majoring in Global Studies and minoring in both Business and Japanese. This past summer, she spent eight weeks in Malawi to do research for her senior thesis, mentored by Professor Irving Hoffman, PA, MPH, UNC Project Malawi’s International Director. The opportunity came about after she joined the Institute as a student worker, to help with a variety of tasks.
“Michaela is an example of how an undergraduate student interested in global health can become involved with the Institute,” Professor Hoffman said. “She came to us, Michael Owino and me, without any expectations, only a desire to get involved with global health, and she was willing to help in any way so that we could get to know her. She did that for many months, and that was to her great benefit.”
Michaela’s thesis will look at HIV care in Malawi and funding that supports programming, with an evaluation of how international aid, specifically PEPFAR, aligns with the National Strategic Plan for Malawi. She explains in the following.
What is PEPFAR?
PEPFAR is the President’s Emergency Plan for HIV AIDS. It is an international AIDs resource through the U.S. government that funds 80 to 95% of HIV programming in Malawi. PEPFAR works in 20+ countries, and a majority of its funding supports Asia and Africa. The plan is standardized, so it’s very hard to tailor it to Malawi’s problems specifically. In large part, this is due to Malawi dealing with situations vastly different from other countries in terms of HIV programming needs.
How does PEPFAR align with The National Strategic Plan for Malawi?
What I found is that PEPFAR has been very successful in Malawi and is an instrument of success in achieving most of the UNAIDS Goal 95-95-95. However, there are several key gaps, as I have begun my programmatic evaluation of PEPFAR’s alignment with Malawi’s National Strategic Plan.
Reports show there’s a lack of routine viral load monitoring and a high viral load testing turnaround time. Contributing factors include provider inability to follow up on test results. I also identified gaps in human resources and support for key populations, which hasn’t been focused on enough. These were some of the most prominent limitations.
I’m looking at the Malawi Country Operational Plan (COP) which provides recommendations that help tailor PEPFAR operations to better fit Malawi’s needs. For example, the COP recognizes that PEPFAR should address the lack of routine viral load monitoring, the lack of personnel, and the need to retrain healthcare providers about the importance of a quick turnaround time in viral load testing. Faster turnaround times help patients as any necessary treatment adjustments can be made more quickly.
How did you collect your qualitative research?
I met with key implementing partners who have been working with PEPFAR for the past 15-20 years to learn more about their experiences. Because they have their own experiences and opinions, I wanted to get qualitative data to back up the quantitative data I was gathering. I met with people from the Malawi Ministry of Health, as well as faith-based organizations, community-based organizations, and facility-based organizations including, but not limited to Tingathe and the Lighthouse Trust.
What tools are you using to collect data?
I’m using a database called PALMS, which has data on service delivery and maps the key populations that I mentioned earlier, and the program areas, whether that be PrEP or antiretroviral therapy. I’m also looking at the USAID’s DEC database, which includes quarterly reports for the different implementing partners. It lets me look at historical data centered on PEPFAR and Malawi.
How might this contribute to your professional interests?
I’m passionate about quality care, increasing access to facilities/resources, and reforming institutionalized disparities. Translating these aspirations to a global scope, I hope to use the foundational knowledge I am learning in school to advocate for equitable access to healthcare among marginalized communities.
Seeing firsthand how international aid disseminates to countries like Malawi, has helped me understand the challenges and limitations that arise when implementing healthcare solutions in low-resource settings. This experience has deepened my commitment to advocating for sustainable, community-driven health initiatives that not only address immediate needs but also empower local systems to achieve long-term improvements. My thesis will echo the gaps and successes and justify them with data modeling that I hope can contribute to the next COP meeting that oversees community-based programming. I’d also like to publish my thesis and potentially connect with PEPFAR representatives to see if my work can contribute to 2026 planning.
How did this opportunity come about?
It was a bit spontaneous. I interviewed Professor Hoffman about HIV in Malawi during my freshman year for a Global Health class. Following that, one of my friends did a research project in Malawi during the summer of her junior year, which inspired me. When I approached Irving the second time, I expressed interest in working in public health and asked about internships and global health projects. He suggested I write a thesis, so we discussed topics, and it really took off from there. I worked in Bioinformatics the semester before I traveled to Malawi, with my supervisor Mike Owino, who helped me learn different data processing tools. He taught me standard operating procedures in research, and how to build a survey design. I felt very supported by the Institute.
Tell us something unique about your experience in Malawi.
One of the most unique experiences I had was backpacking to the beautiful Mount Mulanje in the southernmost area known as Blantyre. Although the first day was strenuous and sometimes felt impossible, my co-workers and friends cheered me up the mountain. Swimming in the stunning waterfalls at the end of the trek was equally rewarding as it was freezing.
In my daily life of living in Lilongwe, I enjoyed daily lunches right outside the KCH Hospital campus. Lunch consisted of Msamba (greens), Miemba (beans), Nkhuku (chicken), Ensima, and Mpunga (rice). For just a few dollars, I was able to eat colorful and flavorful meals surrounded by inspiring leaders dedicated to solving public health issues.
-Rita Kazezian, PR Communications Intern