The National Scale up of ART in Malawi - PowerPoint PPT Presentation

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The National Scale up of ART in Malawi

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The National Scale up of ART in Malawi. Dr Kelita Kamoto. Head of HIV and AIDS Department ... Malawi: important steps to ART. Dec 2000: Vice-president AIDS conference ... – PowerPoint PPT presentation

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Title: The National Scale up of ART in Malawi


1
The National Scale up of ART in Malawi
  • Dr Kelita Kamoto
  • Head of HIV and AIDS Department
  • Ministry of Health
  • Malawi

2
Malawi
  • 13 million people GNP 200 per capita
  • 900,000 people infected with HIV
  • 170,000 people needing ART
  • 4,000 people on ART in January 2004
  • 9 sites no standardised systems

3
Malawi important steps to ART
  • Dec 2000 Vice-president AIDS conference
  • Aug 2001 DOTS for ART Lancet 2001
  • Jul 2002 Global fund submission
  • Oct 2003 National ARV Guidelines (1st ED)
  • Feb 2004 National ART Scale-up Plan

4
The Key is Keep it simple
5
ART Plan main elements for the public sector
  • Free ART to HIV-positive eligible patients
  • One first-line ART regimen only Triomune
  • Push system of ART supply to facilities
  • Standardized system of monitoring/reporting
  • Quarterly structured supervision

6
ART Administration-Monthly Follow-up
  • Nurse led clinic clinician review 3-monthly
    unless there is an earlier need
  • Patients weighed and screened with symptom-based
    enquiry
  • Patient master card completed
  • ARV drugs dispensed from clinic

7
Standardised Treatment Outcomes
  • Primary outcomes
  • Alive on ART
  • Dead
  • Defaulted
  • Stopped treatment
  • Transferred out
  • Of those alive on ART
  • Regimen
  • Ambulatory
  • Work
  • Side effects
  • Drug adherence

8
Progress in the ART Programme
9
National Data up to March 31st, 2008
10
Patients started on ART (1)
  • Quarter Jan Mar 2008
  • 18,311 patients registered
  • Males 39
  • Females 61
  • Adults 91
  • Children 9
  • Cumulative to Mar 2008
  • 165,187 patients registered
  • Males 39
  • Females 61
  • Adults 92
  • Children 8

11
Patients started on ART (2)
  • Quarter Jan Mar 2008
  • Stage III 61
  • Stage IV 14
  • Low CD4 count 25
  • TB 9
  • Cumulative to Mar 2008
  • Stage III 64
  • Stage IV 20
  • Low CD4 count 16
  • TB 13

12
Outcomes (cumulative analysis)
13
Of the 18425 patients dying on ART-
  • Dying in first month 32
  • Dying in second month 21
  • Dying in third month 12
  • Dying in first 3 months 65
  • Dying in month 4 or later 35

14
Of those alive and on ART110,790
  • First line regimen 96
  • Alternative first line regimen 4 (4,377)
  • Second line regimen

15
Operational Research (1)
  • Study
  • A study in the Northern
  • Region to determine the
  • true outcome status in
  • patients who have been
  • registered as defaulter
  • Results
  • 253 defaulters
  • 50 dead
  • 23 alive 10 still on ART from another site
    and 13 stopped ART
  • 27 not traced

16
Operational Research (2)
  • Results
  • 5 sites providing CPT and 6 not
  • 6-month mortality rate with CPT 11.8
  • 6-month mortality rate without CPT 19.7
  • Mortality risk reduction of 40

Study A study in the mission hospitals to deter
mine whether 6-month mortality rates are reduce
d in ART patients who are also started on CPT at
the same time
17
Operational Research (3)Public and Private
sector outcomes
18
Other ART updates
  • Drug supplies
  • Procurement (to start 6 months earlier)
  • Increased complexity
  • Revised ART and OI guidelines (3rd edition)
  • All stakeholders involved in the review
  • Updated to reflect recent insights, e.g. KS and
    CM

19
New Initiatives
20
CHALLENGES
  • Human resources (increased demand with limited
    human resources)
  • Physical infrastructure
  • Drug supplies
  • Quality training of HCWs in ART
  • Ability to continue with national ME
  • Integrity of the First Line regimen
  • Centralised vs Decentralised management
  • HTC services not available in all ART sites in
    the private sector
  • Some employees are not willing to access ARVs at
    the institutions due to stigma and
    discrimination.
  • Provision of integrated TB and ART services

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