Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes--the case of Malawi.
The rapid and massive scale-up of antiretroviral drug therapy (ART) so needed in sub-Saharan Africa will not be possible using a 'medicalised' model. A more simple approach is required. DOTS has been used now for many years to provide successful anti-tuberculosis treatment to millions of patients in poor countries of the world, and many of the established concepts can be used for the delivery of ART. Malawi, a small and impoverished country in sub-Saharan Africa, is embarking on a national scale-up of ART. In this review we describe how we have adopted several of the principles of DOTS for delivering ART in Malawi: case finding and registration, treatment, monitoring, drug procurement, staffing and the issue of free drugs. We also discuss ART for HIV-infected TB patients. We hope that by using the DOTS approach we will be able to deliver ART to large numbers of HIV-infected patients under controlled conditions, and minimise the risk of developing drug resistance.
Libamba
E
E
Department of Clinical Services, Ministry of Health, Lilongwe, Malawi.
Makombe
S
S
Harries
A D
AD
Chimzizi
R
R
Salaniponi
F M
FM
Schouten
E J
EJ
Mpazanje
R
R
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology; D017954:Africa South of the Sahara / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards*; D003140:Communicable Disease Control / Q000458:organization & administration*; D023801:Directly Observed Therapy; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D015995:Prevalence; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control