Scaling-up antiretroviral therapy in Malawi

• Published in: Bulletin of the World Health Organization Vol. 94; no. 10; pp. 772 - 776
• Main Authors: Jahn, Andreas, Harries, Anthony D, Schouten, Erik J, Libamba, Edwin, Ford, Nathan, Maher, Dermot, Chimbwandira, Frank
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.10.2016
• Subjects: Accreditation; Acquired immune deficiency syndrome; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Benchmarks; Breastfeeding & lactation; Clinical outcomes; Clinics; Drug therapy; Electronic health records; Embedded systems; Female; Funding; Health care facilities; Health care policy; Health facilities; Health Services Accessibility; Healthcare Disparities; HIV; HIV Infections - drug therapy; HIV-1 - drug effects; Hospitals; Human immunodeficiency virus; Humans; Immune system; Implementation; Leadership; Lentivirus; Lessons from the Field; Malawi; Male; Medical records; Monitoring systems; Mortality; Nurses; Operations research; Patients; Program Development; Public Health; Public sector; Retroviridae; Scaling; Supervision; Therapy; Training; Treatment programs; Tuberculosis; Viruses; Womens health; Malawi
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.15.166074

In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme. Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics. By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system. Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.