December 1, 2004
For the last three years, Doctors Without Borders/Médecins Sans Frontières (MSF) has been treating people living with HIV/AIDS in the Chiradzulu region of Malawi with antiretroviral (ARV) therapy. By simplifying admission criteria and patient treatment procedures, and working with local health centers to provide follow-up care, MSF has been able to put 2500 new patients on ARVs in a single year.
A recent virological study showed the efficacy of triple therapy in Malawi, where extremely encouraging results are comparable to those obtained in the United States and European countries. But unless new treatments are made available in the future, concerns remain about how long patients will continue to enjoy this new lease of life.
Patient numbers were initially limited by a quota and extremely strict admission criteria. “It was clear,” says the program's manager, Chris Brasher, MD, “that the technological 'case by case' treatment of patients, based on the Western model, could not work in the context of a soaring epidemic in which increasingly large numbers of patients required treatment.”
Simplifying ARV treatment using a generic “3-in-1,” or fixed-dose combination, medicine allows medical staff and nurses with antiretroviral training to monitor patients twice monthly and dispense treatment to clinically “stable” patients. There are currently only 3 doctors for 2500 patients under ARV treatment. “In the future, we would like these nurses to manage the patient inclusion process,” explains Dr. Brasher. “Tasks normally performed by doctors, who are in short supply in Malawi, as in the rest of sub- Saharan Africa, must be delegated to nurses and health workers.”
In addition to the simplification of treatment procedures, a decentralized activity has been set up in ten community health centers offering services similar to those of the hospital in Chiradzulu: testing, education, dispensing ARV drugs, and follow-up. CD4 samples are taken on site before being sent to the hospital. The MSF team and doctor currently visit each center twice monthly. The long-term aim is for nurses who have completed a training course to run the health center autonomously.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)