title: Scaling-up antiretroviral therapy in Malawi.
abstract: OBJECTIVE
  In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment.
  
  
  METHODS
  In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
  
  
  METHODS
  Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics.
  
  
  RESULTS
  By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
  
  
  CONCLUSIONS
  Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.
authors.affiliation: HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi .
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.affiliation: International Union against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France .
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Management Sciences for Health, Lilongwe, Malawi .
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schouten
authors.affiliation: Independent public health consultant, Lilongwe, Malawi .
authors.forename: Edwin
authors.initials: E
authors.lastname: Libamba
authors.affiliation: Department of HIV and Hepatitis, World Health Organization, Geneva, Switzerland .
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland .
authors.forename: Dermot
authors.initials: D
authors.lastname: Maher
authors.affiliation: HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi .
authors.forename: Frank
authors.initials: F
authors.lastname: Chimbwandira
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008295:Malawi; D008297:Male; D016730:Program Development; D011634:Public Health
chemical_list: D044966:Anti-Retroviral Agents