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


Lowrance, DW; Makombe, S; Harries, AD; Shiraishi, RW; Hochgesang, M; Aberle-Grasse, J; Libamba, E; Schouten, E; Ellerbrock, T; Kamoto, K; (2008) A Public Health Approach to Rapid Scale-Up of Antiretroviral Treatment in Malawi During 2004-2006. Journal of acquired immune deficiency syndromes (1999), 49 (3). pp. 287-293. ISSN 1525-4135 DOI: https://doi.org/10.1097/QAI.0b013e3181893ef0

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Abstract

Background: 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 14 1,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services. Methods: 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. Findings: 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. Interpretation: 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.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 18845953
Web of Science ID: 260485700009
URI: http://researchonline.lshtm.ac.uk/id/eprint/6647

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