Document Detail

MedLine Citation:
PMID:  17308738     Owner:  NLM     Status:  MEDLINE    
PROBLEM: Many resource-poor countries have started scaling up antiretroviral therapy (ART). While reports from individual clinics point to successful implementation, there is limited information about progress in government institutions at a national level. APPROACH: Malawi started national ART scale-up in 2004 using a structured approach. There is a focus on one generic, fixed-dose combination treatment with stavudine, lamivudine and nevirapine. Treatment is delivered free of charge to eligible patients with HIV and there is a standardized system for recruiting patients, monthly follow-up, registration, monitoring and reporting of cases and outcomes. All treatment sites receive quarterly supervision and evaluation. LOCAL SETTING: In January 2004, there were nine public sector facilities delivering ART to an estimated 4 000 patients. By December 2005, there were 60 public sector facilities providing free ART to 37,840 patients using national standardized systems. Analysis of quarterly cohort treatment outcomes at 12 months showed 80% of patients were alive, 10% dead, 9% lost to follow-up and 1% had stopped treatment. LESSONS LEARNED: Achievements were the result of clear national ART guidelines, implementing partners working together, an intensive training schedule focused on clinical officers and nurses, a structured system of accrediting facilities for ART delivery, quarterly supervision and monitoring, and no stock-outs of antiretroviral drugs. The main challenges are to increase the numbers of children, pregnant women and patients with tuberculosis being started on ART, and to avert high early mortality and losses to follow-up. The capacity of the health sector to cope with escalating case loads and to scale up prevention alongside treatment will determine the future success of ART delivery in Malawi.
Edwin Libamba; Simon D Makombe; Anthony D Harries; Erik J Schouten; Joseph Kwong-Leung Yu; Olesi Pasulani; Eustice Mhango; John Aberle-Grasse; Mindy Hochgesang; Eddie Limbambala; Douglas Lungu
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Bulletin of the World Health Organization     Volume:  85     ISSN:  0042-9686     ISO Abbreviation:  Bull. World Health Organ.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-19     Completed Date:  2007-04-11     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  7507052     Medline TA:  Bull World Health Organ     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  156-60     Citation Subset:  IM    
Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi.
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MeSH Terms
Anti-Retroviral Agents / economics,  supply & distribution*,  therapeutic use
HIV Infections / drug therapy*,  economics
Health Services Accessibility / economics,  organization & administration*
Health Services Needs and Demand
Program Evaluation*
Public Health Administration*
Public Sector
Resource Allocation / economics,  organization & administration*
Reg. No./Substance:
0/Anti-Retroviral Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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