Malawi's contribution to "3 by 5": achievements and challenges

Hdl Handle:
http://hdl.handle.net/10144/116352
Title:
Malawi's contribution to "3 by 5": achievements and challenges
Authors:
Libamba, Edwin; Makombe, Simon D; Harries, Anthony D; Schouten, Erik J; Yu, Joseph Kwong-Leung; Pasulani, Olesi; Mhango, Eustice; Aberle-Grasse, John; Hochgesang, Mindy; Limbambala, Eddie; Lungu, Douglas
Journal:
Bulletin of the World Health Organization
Abstract:
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.
Affiliation:
Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi; HIV Coordinator, Ministry of Health, Lilongwe, Malawi; Taiwan Medical Mission, Mzuzu Central Hospital, Mzuzu, Malawi; Médecins sans Frontières Belgium, Thyolo District Hospital, Malawi; Lighthouse Clinic, Lilongwe, Malawi; Centres for Disease Control, Lilongwe office, Malawi; WHO country office, Lilongwe, Malawi; Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
Issue Date:
1-Feb-2007
URI:
http://hdl.handle.net/10144/116352
PubMed ID:
17308738
Additional Links:
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000200015&lng=en&nrm=iso&tlng=en
Type:
Article
Language:
en
ISSN:
0042-9686
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorLibamba, Edwinen
dc.contributor.authorMakombe, Simon Den
dc.contributor.authorHarries, Anthony Den
dc.contributor.authorSchouten, Erik Jen
dc.contributor.authorYu, Joseph Kwong-Leungen
dc.contributor.authorPasulani, Olesien
dc.contributor.authorMhango, Eusticeen
dc.contributor.authorAberle-Grasse, Johnen
dc.contributor.authorHochgesang, Mindyen
dc.contributor.authorLimbambala, Eddieen
dc.contributor.authorLungu, Douglasen
dc.date.accessioned2010-11-25T19:10:57Z-
dc.date.available2010-11-25T19:10:57Z-
dc.date.issued2007-02-01-
dc.identifier.citationBull. World Health Organ. 2007;85(2):156-60en
dc.identifier.issn0042-9686-
dc.identifier.pmid17308738-
dc.identifier.urihttp://hdl.handle.net/10144/116352-
dc.description.abstractPROBLEM: 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.en
dc.language.isoenen
dc.relation.urlhttp://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000200015&lng=en&nrm=iso&tlng=enen
dc.rightsArchived with thanks to Bulletin of the World Health Organizationen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshChilden
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHealth Services Accessibilityen
dc.subject.meshHealth Services Needs and Demanden
dc.subject.meshHumansen
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshProgram Evaluationen
dc.subject.meshPublic Health Administrationen
dc.subject.meshPublic Sectoren
dc.subject.meshResource Allocationen
dc.titleMalawi's contribution to "3 by 5": achievements and challengesen
dc.typeArticleen
dc.contributor.departmentClinical HIV Unit, Ministry of Health, Lilongwe, Malawi; HIV Coordinator, Ministry of Health, Lilongwe, Malawi; Taiwan Medical Mission, Mzuzu Central Hospital, Mzuzu, Malawi; Médecins sans Frontières Belgium, Thyolo District Hospital, Malawi; Lighthouse Clinic, Lilongwe, Malawi; Centres for Disease Control, Lilongwe office, Malawi; WHO country office, Lilongwe, Malawi; Department of Clinical Services, Ministry of Health, Lilongwe, Malawien
dc.identifier.journalBulletin of the World Health Organizationen

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