A national survey of prisoners on antiretroviral therapy in Malawi: access to treatment and outcomes on therapy.
BACKGROUND
Malawi is making good progress scaling up antiretroviral therapy (ART), but we do not know the levels of access of high-risk, disadvantaged groups such as prisoners. The aim of this study was to measure access and treatment outcomes of prisoners on ART at the national level.


METHODS
A retrospective cohort study was conducted examining patient follow-up records from all 103 public sector ART clinics in Malawi, and observations were censored on 31 December, 2006.


RESULTS
By 31 December, 2006, a total of 81,821 patients had been started on ART. Of these, 103 (0.13%) were prisoners. At ART initiation, 93% of prisoners were in World Health Organization (WHO) clinical stage 3 or 4 while 7% started in stage 1 or 2 with a CD4-lymphocyte count of < or =250/mm3. Treatment outcomes by the end of December 2006 were as follows: 66 (64%) alive and on ART at their registration facility; 9 (9%) dead; 8 (8%) lost to follow-up; and 20 (19%) transferred out to another facility. The probability of being alive and on ART at 6 and 12 months was 82.5% and 77.7%.


CONCLUSIONS
In spite of the rapid scale-up of ART, only a small number of HIV-positive prisoners had accessed ART by the end of 2006. Treatment outcomes were good. Initiatives are now needed to improve access to HIV testing and ART in Malawi's prisons.
Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi.
Simon D
SD
Makombe
Andreas
A
Jahn
Hannock
H
Tweya
Lameck
L
Thambo
Joseph Kwong-Leung
JK
Yu
Bethany
B
Hedt
Ralf
R
Weigel
Amon
A
Nkhata
Erik J
EJ
Schouten
Kelita
K
Kamoto
Anthony D
AD
Harries
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006297:Health Services Accessibility; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011329:Prisoners; D012189:Retrospective Studies
D044966:Anti-Retroviral Agents