title: A national survey of prisoners on antiretroviral therapy in Malawi: access to treatment and outcomes on therapy.
abstract: 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 December 31, 2006.
  
  
  RESULTS
  By December 31, 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.
authors.affiliation: Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Makombe
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Lameck
authors.initials: L
authors.lastname: Thambo
authors.forename: Joseph Kwong-Leung
authors.initials: JK
authors.lastname: Yu
authors.forename: Bethany
authors.initials: B
authors.lastname: Hedt
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Amon
authors.initials: A
authors.lastname: Nkhata
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schouten
authors.forename: Kelita
authors.initials: K
authors.lastname: Kamoto
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents