A public health approach to rapid scale-up of antiretroviral treatment in Malawi during 2004-2006.
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 141,000 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.


RESULTS
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.


CONCLUSIONS
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.
Lowrance
David W
DW
HIV/AIDS Care and Treatment Branch, Global AIDS Program, US Centers for Disease Control and Prevention, Atlanta, GA, USA. lowranced@rw.cdc.gov
Makombe
Simon
S
Harries
Anthony D
AD
Shiraishi
Ray W
RW
Hochgesang
Mindy
M
Aberle-Grasse
John
J
Libamba
Edwin
E
Schouten
Erik
E
Ellerbrock
Tedd
T
Kamoto
Kelita
K
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011634:Public Health; D013997:Time Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents