Throughout the 1990s, Malawi lost 1.2 percent of all teachers annually due to HIV. What impact did the nationwide introduction of free anti-retroviral treatment (ART) in June 2004 have on teachers with HIV?

Research led by Malawi’s Ministry of Health suggests that the programme has stemmed the HIV-related loss of teachers. The researchers analysed records from all 102 public sector and 36 private sector ART clinics in Malawi. By the end of September 2006, the clinics had registered 72,328 people for treatment. Only 3.8 percent of these were in the private sector. Of the 69,547 using public services, 61.3 percent were female and 93.4 percent were 15 years or older.

Teachers made up 3.7 percent of all patients on ART. The researchers estimate that 2,380 teachers accessed ART between June 2004 and September 2006. Looking more closely at this group:

• 15 percent started in World Health Organization clinical stage 1 or 2, with a CD4-lymphocyte count of up to 250/mm3. 85 percent started in stage 3 (when the immune system becomes more damaged) or 4 (when damage eventually leads to an AIDS diagnosis).
• The average age when starting ART was 40 years for men and 37 years for women.
• In the two years prior to registration, nearly a fifth of people had pulmonary tuberculosis (TB), 4.5 percent had extra-pulmonary TB and 6.9 percent had Kaposi’s sarcoma.
• After the national introduction of free treatment, the ART initiation rate increased from 75 teachers in the previous three months to a maximum of 340 in the first three months of 2006.
• At the time of the study, 1,850 teachers were alive on ART (3.5 percent of all teachers in Malawi).
• The probability of being alive on ART at 6 months, 12 months, 18 months and 24 months after starting treatment is 84, 79, 75 and 73 percent, respectively.
• Retention in ART is good. Drop-out rates in treatment are lower for women, younger teachers and those starting ART in clinical stage 1 or 2.

Most teachers access ART in stage 3 or 4. Given that around three quarters of patients in these stages in Malawi die within a year without ART, the introduction of free treatment has had a great impact on the education workforce. The ART programme has already limited the loss of teachers in Malawi and this effect is likely to grow more important. As the national plan increases from 2006 to 2010, more important individuals who provide public services in rural communities will gain access to life-prolonging ART.

Source(s):
‘A National Survey of Teachers on Antiretroviral Therapy in Malawi: Access, Retention in Therapy and Survival’, PLOS ONE 2 (7): e620, by Simon Makombe, Andreas Jahn, Hannock Tweya, Stuart Chuka, Joesph Kwong-Leung Yu, Mindy Hochgesang, John Aberle-Grasse, Lameck Thambo, Erik Schouten, Kelita Kamoto, Anthony Harries, 2007 Full document.

Funded by: Anonymous donor

id21 Research Highlight: 5 April 2008

Further Information:
Simon Makombe
Clinical HIV Unit
Ministry of Health
Lilongwe
Malawi

Tel: +265 8865193
Fax: +265 1788412

Clinical HIV Unit, Ministry of Health. Malawi

Anthony D Harries
HIV Unit
Ministry of Health
PO Box 30377
Capital City
Lilongwe

Tel: +265 8352613
Contact the contributor: adharries@malawi.net

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