A national survey of prisoners on antiretroviral therapy in Malawi: access to treatment and outcomes on therapy
Makombe, S.D.; Jahn, A.; Tweya, H.; Thambo, L.; Yu, J.Kwong-Leung.; Hedt, B.; Weigel, R.; Nkhata, A.; Schouten, E.J.; Kamoto, K.; Harries, A.D.
World Hospitals and Health Services the Official Journal of the International Hospital Federation 44(1): 26-29
2008
ISSN/ISBN: 1029-0540 PMID: 18549031 Document Number: 208654
Malawi is making good progress scaling up antiretroviral therapy (ART), but we do not know the levels of access of high-risk, disadvantaged groups such as prisoners. The aim of this study was to measure access and treatment outcomes of prisoners on ART at the national level. A retrospective cohort study was conducted examining patient follow-up records from all 103 public sector ART clinics in Malawi, and observations were censored on 31 December, 2006. By 31 December, 2006, a total of 81,821 patients had been started on ART. Of these, 103 (0.13%) were prisoners. At ART initiation, 93% of prisoners were in World Health Organization (WHO) clinical stage 3 or 4 while 7% started in stage 1 or 2 with a CD4-lymphocyte count of < or =250/mm3. Treatment outcomes by the end of December 2006 were as follows: 66 (64%) alive and on ART at their registration facility; 9 (9%) dead; 8 (8%) lost to follow-up; and 20 (19%) transferred out to another facility. The probability of being alive and on ART at 6 and 12 months was 82.5% and 77.7%. In spite of the rapid scale-up of ART, only a small number of HIV-positive prisoners had accessed ART by the end of 2006. Treatment outcomes were good. Initiatives are now needed to improve access to HIV testing and ART in Malawi's prisons.