Malawi’s contribution to “3 by 5” strongachievementsstrong and challenges.pdfVIP

Malawi’s contribution to “3 by 5”: achievements and challenges a a a b c Edwin Libamba, Simon D Makombe, Anthony D Harries, Erik J Schouten, Joseph Kwong-Leung Yu, d e f f g Olesi Pasulani, Eustice Mhango, John Aberle-Grasse, Mindy Hochgesang, Eddie Limbambala Douglas Lungu h 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 sup