Malawi extended its free HIV drug treatment through its public health service to reach 17,000 patients by March 2005. But who is getting treatment? Is drug distribution fair? Research by the Ministry of Health shows steady progress but a need to improve access for children, pregnant women and patients with tuberculosis (TB).
An estimated 900,000 adults and children in Malawi are living with HIV and AIDS. Up to 170,000 need anti-retroviral therapy (ART) immediately. By January 2005, 34 public health facilities were delivering ART free of charge, using the first line combination of stavudine, lamivudine and nevirapine. But there are worries that users may not be representative of the population in need of treatment. To study this, researchers looked at patient cards and registers for patients who started on ART in the last three months of 2004 (3,261 patients) and the first three months of 2005 (4,530 patients). They found that of these:
- About 40 percent are male.
- Some 95 percent are at least 13 years old.
- The women are in general 10 years younger than the men.
- Up to 90 percent started ART because of a clinical assessment of World Health Organization stages III or IV of HIV disease; the rest due to a low CD4 cell counts.
- Eleven to 15 percent have TB.
- Only 29 pregnant women were part of programmes to prevent mother-to-child transmission of HIV.
- Around 56 to 62 percent are subsistence farmers, housewives or in small-scale businesses such as being a market vendor or selling fish.
- Six percent and four percent of patients, respectively, are teachers and health care workers.
These results show that the characteristics of patients receiving ART reflect those of adults with HIV in terms of gender, age and occupation. However, 10 to 15 percent rather than five percent should be children and many more pregnant women require ART. In addition, only 1,053 of the predicted 10,000 TB patients who needed ART joined the programme in this six month period. The rural population may also be underserved. Improving access for these groups requires:
- new technical recommendations to simplify the diagnosis and management of HIV in children, especially infants
- more user-friendly paediatric drug formulations
- prioritising the limited number of free CD4 tests for patients in stage II or pregnant women in stage I of HIV
- better access to HIV testing for TB patients
- addressing drug interaction between TB and HIV treatments
- resolving the tension between delivery of ART largely through hospitals and of TB treatment through health centres.
Source(s):
‘Who is accessing antiretroviral therapy during national scale-up in
Malawi’, Transactions of the Royal Society of Tropical Medicine and Hygiene,
by Simon Makombe et al., 2006 (in press)
HINARI subscribers can access the full-text article here. Full document.
id21 Research Highlight: 28 July 2006
Further Information:
Anthony Harries
Family Health International
Malawi Country Office
Arwa House, 3rd Floor
PO Box 30455
Lilongwe 3
Malawi
Fax:
+265 1 774 307
Contact the contributor: adharries@malawi.net
Ministry of Health and Population, Malawi
Other related links:
'Passing the test: allocating antiretroviral therapy in Malawi'
'Counting the cost of HIV in Southern Africa'
'Insights Health Editorial: Delivering the goods - HIV treatment for the
poor'
'Antiretrovirals offer good value for South Africa'
'How can developing countries access HIV/AIDS drugs?'
'Botswana stumbles while Uganda checks HIV/AIDS: what policies for Africa?'
'Equity and access to HIV/AIDS treatment: getting the balance right in
southern Africa'
