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Invited speech. Antiretroviral Therapy Scale Up in Malawi

E Libamba, S Makombe, A Harries, E Schouten

Malawi has a severe AIDS epidemic with approximately 170,000 people in need of antiretroviral therapy (ART). In February 2004, a 2-year national ARV scale up plan was developed. The main elements of the plan are as follows;- i) 59 hospitals and clinics in the public health sector are selected for ARV scale up, providing broad geographical coverage throughout the country; ii) ARV drugs are provided free of charge in the public sector; iii) scale up in new facilities involves the use of the first line ARV regimen only, but when health facilities have shown capacity to properly deliver such treatment to eligible patients, they will be provided with alternative first line and second line therapy; iv) facilities are only provided with ARV drugs if they have been formally assessed by the HIV Unit of the Ministry of Health as ready to deliver ARV therapy.

In March 2004, all selected hospitals were briefed about the scale up plan and the National ART Guidelines. Following the briefings, training sessions on ART were, and continue to be, conducted for clinicians and nurses in each of the 59 health facilities. To date, 681 clinicians and nurses in the 59 public sector facilities and 155 in 62 private sector facilities have been trained in the National ART Guidelines and are certified as competent to deliver ART. From the latter half of 2004, the HIV Unit has carried out structured assessments of all health facilities about readiness to start ART, and by the end of March 2005, all facilities were assessed as ready to receive ARV drugs.

There has been a gradual increase in the number of health facilities delivering ART. In 2004, there were cumulatively 9 facilities from January to March, 11 from April to June, 22 from July to September and 24 from October to December. In January 2005, another 10 facilities started, bringing the total to 34.

By the end of December 2004, there were 13183 patients (40% male and 95% adult) who had ever started on ARV therapy. Of patients who ever started on ARV therapy, 84% are alive, 8% are dead and 8% are lost to follow-up. Of those alive and on ARV therapy:- 98% are ambulatory; 85% are fit to work; 10% have one or more major side effects; and 96% based on pill counts show 95% or more adherence to therapy. These are encouraging results.

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