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Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries

Harries, A.D.; Zachariah, R.; Jahn, A.; Schouten, E.J.; Kamoto, K.

Journal of Acquired Immune Deficiency Syndromes 52(Suppl 1): S14-S16

2009

ISSN/ISBN: 1944-7884
PMID: 19858929
DOI: 10.1097/qai.0b013e3181bbc99e
Document Number: 208500
The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening.

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