Monitoring the response to antiretroviral therapy in resource-poor settings: the Malawi model

Authors:
  • PGPatrick Gomani
    Patrick Gomani
  • RTRoger Teck
    Roger Teck
  • OTOlga Ascurra de Teck
    Olga Ascurra de Teck
  • EBEdwin Bakali
    Edwin Bakali
  • RZRony Zachariah
    Rony Zachariah
  • ELEdwin Libamba
    Edwin Libamba
  • AMAndrina Mwansambo
    Andrina Mwansambo
  • FSFelix Salaniponi
    Felix Salaniponi
  • RMRex Mpazanje
    Rex Mpazanje
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Abstract
With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. Using the successful DOTS model adapted by National TB Control Programmes throughout the world, Malawi has developed a system of quarterly ARV cohort and cumulative ARV quarterly analyses. Thyolo district, in the southern region of Malawi, has been using this system since April 2003. This paper describes the standardized ARV treatment regimens and the treatment outcomes used in Thyolo to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out. Data are presented for case registration and treatment outcome for the first quarterly cohort (April to June) and the combined cohorts (April to June and July to September). Such quarterly analyses may be useful for districts and Ministries of Health in assessing ARV delivery, although the burden of work involved in calculating the numbers may become large once ARV delivery systems have been established for several years.