Bemelmans, M

Harries, A D

Massaquoi, M

Mwagomba, B

Nalingunkwi, R

Von Pilar, U

Zachariah, R

English

MSF Field Research

XVII INTERNATIONAL
AIDS CONFERENCE
3-8 August 2008 | Mexico City
Oral Abstract Session 
TUAB03 - Access and coverage in Resource Limited Settings  
 
TUAB0303 - Achieving universal access to antiretroviral therapy in a rural district in Malawi: how was it done?  
 
M. Massaquoi1, R. Naligunkwi2, U. Von Pilar2, B. Mwagomba3, M. Bemelmans2, R. Zachariah4, A.D. Harries5 
  
1Médecins Sans Frontières, Medical Coordination, Blantyre, Malawi, 2Médecins Sans Frontières, Thyolo, Malawi, 3District 
Health Office, Thyolo, Malawi, 4Médecins Sans Frontières, Medical Department, Brussels, Malawi, 5Ministry of Health 
and Population, HIV/AIDS Unit, Lilongwe, Malawi 
  
Background: Malawi´s antiretroviral treatment (ART) scale-up plan aims at placing 250,000 people on ART by 2010. 
The country has currently achieved approximately half of this target (125,610).  
Thyolo, a rural district in Malawi, has approximately 600,000 inhabitants and an adult HIV prevalence rate of 21%. There 
are about 60,000 people living with HIV/AIDS of whom about 11,250 are in urgent need of ART. The district managed 
to achieve its universal coverage target of placing 80% of these individuals on ART.  
Methods: To describe the process, outcomes, and lessons learnt in achieving universal access in Thyolo. Scale-up 
was achieved by using a standardized public-health approach viz: 
·Single first-line ART regimen & standardized treatment protocols 
·Clinical eligibility criteria for ART initiation  
·Decentralized ART access  
·Task-shifting  
·Active community involvement  
Results: From April 2003 to January 2008, a total of 11,932 were initiated on ART, of whom 9046 (76%) are alive. 
Overall death and defaulter rates are 11.4% and 7.9% respectively. Task-shifting increased monthly ART initiation 
capacity from an average of 100 patients/month in 2004 using a doctor-based approach to 400/month in 2007 using a 
team that included medical assistants, nurses and lay counselors. This also allowed decentralization to health centres. 
A community network comprising 675 volunteers, 9 community nurses and family care givers is actively involved in 
the symptomatic treatment of opportunistic infections, early referrals, defaulter tracing, adherence counseling and 
social support.  
Conclusions: It is feasible to achieve a universal ART coverage target of 80% or more with acceptable outcomes in a 
district setting in sub-Saharan Africa by adhering to a public-health approach with active community involvement. 
Sustaining universal access is now faced with the challenges of lack of human resources, ensuring quality services 
and providing adequate coverage for those requiring second line therapy.    
Presenting author email: msfb-blantyre-med@brussels.msf.org 

Achieving universal access to antiretroviral therapy in a rural district in Malawi: how was it done?

Achieving universal access to antiretroviral therapy in a rural district in Malawi: how was it done?

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