Abstract
The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO) in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.
Highlights
In 2004, Malawi, which is one of the poorest countries in the world [1], started scaling up antiretroviral therapy (ART) on a national scale
Since 1985, the country had been struggling to cope with a massive Human immunodeficiency virus (HIV)/Acquired immune deficiency syndrome (AIDS) epidemic, and when ART scale-up began in 2004, approximately 930,000 people
National ART guidelines, which were developed by a working technical committee formed by the National AIDS Commission and which were published in late 2003, laid out for the first time a simplified and standardised approach taking into account the severe health system constraints and the huge epidemic burden of disease [3]
Summary
Background In 2004, Malawi, which is one of the poorest countries in the world [1], started scaling up antiretroviral therapy (ART) on a national scale. National ART guidelines, which were developed by a working technical committee formed by the National AIDS Commission and which were published in late 2003, laid out for the first time a simplified and standardised approach taking into account the severe health system constraints and the huge epidemic burden of disease [3] These guidelines informed the national scale up plan that was launched in February 2004. By 30th June 2015, (11 years after the start of national scale-up) there were 711 ART clinics in the public and private sector that had newly registered 820,367 patients on ART [4] Both the public and private health sectors implement the same standardised systems of delivering and monitoring treatment, and by the end of June 2015 a total of 565,105 patients were recorded as alive and on ART (see Table 1). Reason for starting ART: Presumed severe HIV disease Confirmed HIV infection—WHO Stage 1 or 2 Confirmed HIV infection—WHO Stage 3 Confirmed HIV infection—WHO Stage 4 Unknown
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
