Scaling-up antiretroviral therapy in Malawi
In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the p...
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| Veröffentlicht in: | Bulletin of the World Health Organization 2016-10, Vol.94 (10), p.772-776 |
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| creator | Jahn, Andreas Harries, Anthony D Schouten, Erik J Libamba, Edwin Ford, Nathan Maher, Dermot Chimbwandira, Frank |
| description | In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment.
In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics.
By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines. |
| doi_str_mv | 10.2471/BLT.15.166074 |
| format | Article |
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In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics.
By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.</description><identifier>ISSN: 0042-9686</identifier><identifier>EISSN: 1564-0604</identifier><identifier>DOI: 10.2471/BLT.15.166074</identifier><identifier>PMID: 27843168</identifier><identifier>CODEN: BWHOA6</identifier><language>eng</language><publisher>Switzerland: World Health Organization</publisher><subject>Accreditation ; Acquired immune deficiency syndrome ; AIDS ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral therapy ; Benchmarks ; Breastfeeding & lactation ; Clinical outcomes ; Clinics ; Drug therapy ; Electronic health records ; Embedded systems ; Female ; Funding ; Health care facilities ; Health care policy ; Health facilities ; Health Services Accessibility ; Healthcare Disparities ; HIV ; HIV Infections - drug therapy ; HIV-1 - drug effects ; Hospitals ; Human immunodeficiency virus ; Humans ; Immune system ; Implementation ; Leadership ; Lentivirus ; Lessons from the Field ; Malawi ; Male ; Medical records ; Monitoring systems ; Mortality ; Nurses ; Operations research ; Patients ; Program Development ; Public Health ; Public sector ; Retroviridae ; Scaling ; Supervision ; Therapy ; Training ; Treatment programs ; Tuberculosis ; Viruses ; Womens health</subject><ispartof>Bulletin of the World Health Organization, 2016-10, Vol.94 (10), p.772-776</ispartof><rights>Copyright World Health Organization Oct 2016</rights><rights>(c) 2016 The authors; licensee World Health Organization. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-88ddf560e7cf51247a90c600bca6859e300763f9ffffb99cfcaf5063382dcc073</citedby><cites>FETCH-LOGICAL-c448t-88ddf560e7cf51247a90c600bca6859e300763f9ffffb99cfcaf5063382dcc073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043204/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043204/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27843,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27843168$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jahn, Andreas</creatorcontrib><creatorcontrib>Harries, Anthony D</creatorcontrib><creatorcontrib>Schouten, Erik J</creatorcontrib><creatorcontrib>Libamba, Edwin</creatorcontrib><creatorcontrib>Ford, Nathan</creatorcontrib><creatorcontrib>Maher, Dermot</creatorcontrib><creatorcontrib>Chimbwandira, Frank</creatorcontrib><title>Scaling-up antiretroviral therapy in Malawi</title><title>Bulletin of the World Health Organization</title><addtitle>Bull World Health Organ</addtitle><description>In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment.
In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics.
By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.</description><subject>Accreditation</subject><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>Benchmarks</subject><subject>Breastfeeding & lactation</subject><subject>Clinical outcomes</subject><subject>Clinics</subject><subject>Drug therapy</subject><subject>Electronic health records</subject><subject>Embedded systems</subject><subject>Female</subject><subject>Funding</subject><subject>Health care facilities</subject><subject>Health care policy</subject><subject>Health facilities</subject><subject>Health Services Accessibility</subject><subject>Healthcare Disparities</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV-1 - drug effects</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune system</subject><subject>Implementation</subject><subject>Leadership</subject><subject>Lentivirus</subject><subject>Lessons from the Field</subject><subject>Malawi</subject><subject>Male</subject><subject>Medical records</subject><subject>Monitoring systems</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Operations research</subject><subject>Patients</subject><subject>Program Development</subject><subject>Public Health</subject><subject>Public sector</subject><subject>Retroviridae</subject><subject>Scaling</subject><subject>Supervision</subject><subject>Therapy</subject><subject>Training</subject><subject>Treatment programs</subject><subject>Tuberculosis</subject><subject>Viruses</subject><subject>Womens 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Organization</jtitle><addtitle>Bull World Health Organ</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>94</volume><issue>10</issue><spage>772</spage><epage>776</epage><pages>772-776</pages><issn>0042-9686</issn><eissn>1564-0604</eissn><coden>BWHOA6</coden><abstract>In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment.
In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics.
By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.</abstract><cop>Switzerland</cop><pub>World Health Organization</pub><pmid>27843168</pmid><doi>10.2471/BLT.15.166074</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; PMC (PubMed Central); DOAJ Directory of Open Access Journals; PAIS Index; EZB-FREE-00999 freely available EZB journals |
| subjects | Accreditation Acquired immune deficiency syndrome AIDS Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral therapy Benchmarks Breastfeeding & lactation Clinical outcomes Clinics Drug therapy Electronic health records Embedded systems Female Funding Health care facilities Health care policy Health facilities Health Services Accessibility Healthcare Disparities HIV HIV Infections - drug therapy HIV-1 - drug effects Hospitals Human immunodeficiency virus Humans Immune system Implementation Leadership Lentivirus Lessons from the Field Malawi Male Medical records Monitoring systems Mortality Nurses Operations research Patients Program Development Public Health Public sector Retroviridae Scaling Supervision Therapy Training Treatment programs Tuberculosis Viruses Womens health |
| title | Scaling-up antiretroviral therapy in Malawi |
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