Article

A Public Health Approach to Rapid Scale-Up of Antiretroviral Treatment in Malawi During 2004-2006

HIV/AIDS Care and Treatment Branch, Global AIDS Program, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 10/2008; 49(3):287-93. DOI: 10.1097/QAI.0b013e3181893ef0
Source: PubMed

ABSTRACT Approximately 1 million people are infected with HIV in Malawi, where AIDS is the leading cause of death in adults. By December 31, 2007, more than 141,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services.
We analyzed national quarterly and longitudinal cohort data from October 2004 to December 2006 to examine trends in characteristics of patients initiating ART, end-of-quarter clinical outcomes, and 6- and 12-month survival probability.
During a 27-month period, 72,666 patients were initiated on ART, of whom about two-thirds were women. The percentage of patients initiated on ART who were children and farmers increased from 5.5% to 9.0% and 23% to 32%, respectively (P < 0.001 for trends). Estimated survival probability ranged from 85% to 88% at 6 months and 81% to 84% at 12 months on ART.
In Malawi, a public health approach to ART increased treatment access and maintained high 6- and 12-month survival. Resource-limited countries scaling up ART programs may benefit from this approach of simplified clinical decision making, standardized ART regimens, nonphysician care, limited laboratory support, and centralized monitoring and evaluation.

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    • ". National programs [10] [11] [12] [13] have reported large-scale data of HIV treatment in both urban and rural populations [14] [15] [16] [17]; however, delivery of HIV treatment in some settings presents unique challenges and current ART delivery models may significantly limit the accessibility of ART. To have the greatest impact on public health, HIV treatment programs will have to be decentralized and integrated into the existing health care system. "
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    AIDS research and treatment 06/2014; 2014. DOI:10.1155/2014/560623
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    • "By 2010, over 5 million HIV-infected individuals were receiving antiretroviral therapy (ART) in low and middle income countries (UNAIDS 2010), with rapid scale-up achieved in a number of sub-Saharan African coun- tries_ENREF_2 (Vitoria et al. 2009). In the face of resource and infrastructural constraints, Malawi has demonstrated great success in scaling-up the national ART programmes using a decentralized model and with taskshifting of treatment delivery from physicians to other cadres of health providers (Lowrance et al. 2008). By December 2010, over 300 000 individuals had initiated treatment (Ministry of Health of Malawi 2010). "
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    International Archives of Medicine 02/2009; 2(1):6. DOI:10.1186/1755-7682-2-6 · 1.08 Impact Factor
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