Monitoring the response to antiretroviral therapy in resource-poor settings: the Malawi model.
With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. Using the successful DOTS model adapted by National TB Control Programmes throughout the world, Malawi has developed a system of quarterly ARV cohort and cumulative ARV quarterly analyses. Thyolo district, in the southern region of Malawi, has been using this system since April 2003. This paper describes the standardized ARV treatment regimens and the treatment outcomes used in Thyolo to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out. Data are presented for case registration and treatment outcome for the first quarterly cohort (April to June) and the combined cohorts (April to June and July to September). Such quarterly analyses may be useful for districts and Ministries of Health in assessing ARV delivery, although the burden of work involved in calculating the numbers may become large once ARV delivery systems have been established for several years.
Harries
Anthony D
AD
National Tuberculosis Control Programme, Ministry of Health and Population, P.O. Box 30377, Lilongwe, Malawi. adharries@malawi.net
Gomani
Patrick
P
Teck
Roger
R
de Teck
Olga Ascurra
OA
Bakali
Edwin
E
Zachariah
Rony
R
Libamba
Edwin
E
Mwansambo
Andrina
A
Salaniponi
Felix
F
Mpazanje
Rex
R
D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003906:Developing Countries; D004196:Disease Outbreaks; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000379:methods; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents