BMJ  2004;329:1163-1166 (13 November), doi:10.1136/bmj.329.7475.1163

Education and debate

Expanding antiretroviral therapy in Malawi: drawing on the country's experience with tuberculosis

¹ HIV/AIDS Unit, Ministry of Health, PO Box 30377, Lilongwe, Malawi, ² National Tuberculosis Control Programme, Ministry of Health, Malawi, ³ Department of Clinical Services, Ministry of Health, Malawi, ⁴ National AIDS Commission, Lilongwe, Malawi

The DOTS ("directly observed treatment, short course") strategy has been successfully used in developing countries to provide effective control of tuberculosis. Field workers in Malawi are promoting the same approach for HIV infection through the expansion of highly active antiretroviral therapy

The first 150 words of the full text of this article appear below.

Introduction

Highly active antiretroviral therapy (HAART) must be expanded in sub-Saharan Africa, where the HIV/AIDS epidemic is taking an appalling toll. Malawi, a small, poor African country, is expanding HAART nationally. The "directly observed treatment, short course" (DOTS) strategy has been successfully used for years to provide effective national control of tuberculosis, and the same concepts are being applied for delivering HAART. We describe how the principles of standardised case finding, standardised treatment regimens, regular monitoring and evaluation, and uninterrupted supplies of drugs can be used to deliver HAART. If implemented well, these principles should ensure a controlled delivery system, which would reduce the risks of inconsistent prescribing practices and the development of drug resistance.

Response to Malawi's HIV/AIDS epidemic

In 2003 sub-Saharan Africa had an estimated 3.4 million new cases of HIV infection and up to 2.4 million deaths.¹ Malawi has one of the highest HIV/AIDS prevalence rates in sub-Saharan Africa, with 14% of those . . . [Full text of this article]

Fast countrywide expansion of HAART

Learning from tuberculosis control

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Framework for delivering antiretrovirals

Eligibility criteria for treatments when resources are limited

Standardised antiretroviral therapy

Registration, recording, and reporting

Conclusion

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