Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy

BMC Public Health

Correspondence

Nathan Ford¹  Frank Chimbwandira²  Edwin Libamba²  Andreas Jahn³  Anthony D. Harries⁴  Erik J. Schouten⁵  Dermot Maher⁶ 

[1] Department of HIV and Hepatitis, World Health Organization, Geneva, Switzerland;HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi;HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi;ITECH, Malawi and University of Washington, Seattle, USA;International Union against Tuberculosis and Lung Disease, Paris, France;London School of Hygiene and Tropical Medicine, London, UK;Old Inn Cottage, Vears Lane, Colden Common, SO21 1TQ, Winchester, UK;Management Sciences for Health, Lilongwe, Malawi;Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland;

关键词: HIV/AIDS;    Antiretroviral therapy;    Malawi;    Policy;    World Health Organization;   

DOI  :  10.1186/s12889-016-3620-x

 received in 2016-04-02, accepted in 2016-09-01,  发布年份 2016

来源: Springer

【 摘 要 】

The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO) in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.

【 授权许可】

CC BY   
© The Author(s). 2016