Abstract
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. 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. 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%. 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.
Highlights
Since the first reported case of AIDS in Malawi in 1985, this small, poverty-stricken country has experienced a rapid and massive epidemic
Patients are seen at two weeks after antiretroviral therapy (ART) initiation and routinely every month for clinical assessment and ARTdispensing
The reasons for starting ART were documented in 102 cases: 7 (7%) started in World Health Organization (WHO) clinical stage 1 or 2 with a CD4 count ≤250/ul, and 95 (93%) in stage 3 or stage 4
Summary
Since the first reported case of AIDS in Malawi in 1985, this small, poverty-stricken country has experienced a rapid and massive epidemic. There are 90,000 new infections and 86,000 AIDS deaths annually, and 170,000 patients are thought to require initiation of antiretroviral therapy (ART) [1]. 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. Methodology: 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. 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.
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