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MSF in Malawi, 2011
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The HIV epidemic in Malawi has reduced life expectancy to just 43 years. More than 10 percent of Malawians aged between 15 and 49 are living with HIV. In the southern district of Chiradzulu, home to around 310,000 people, the prevalence of HIV is even higher, at over 17 percent.
Doctors Without Borders/Médecins Sans Frontières (MSF) began providing antiretroviral (ARV) treatment and follow-up at Chiradzulu district hospital in 2001. The program was designed to demonstrate that ARV treatment was effective in resource-poor rural contexts. Ten years later, more than 55 percent of the patients who started treatment in 2001 are still alive and healthy. At the end of 2011, 22,000 patients were on ARV treatment in Chiradzulu, including 2,700 children.
New approaches to treatment
The scale of health needs in Malawi, and the shortage of medical staff – there are just two doctors in Chiradzulu district – have prompted MSF, in collaboration with the Ministry of Health, to adopt new approaches that enable more people to access care. For example, certain medical tasks have been delegated from doctors to nurses – an approach known as task-shifting. Thanks to this, MSF has been able to extend HIV treatment activities from the hospital to 10 health centers across Chiradzulu.
As the program has developed, the ‘six month appointment system’ has been introduced. Stable patients, who have no special health issues other than their HIV infection, need see medical staff only every six months. This system reduces the workload of health staff and saves patients both time and money as they make fewer trips to health facilities. Some 3,500 people were on the six-month program at the end of the year, representing 7,000 fewer consultations.
Scaling up treatment elsewhere
MSF began offering ARV treatment in Thyolo district in 2003, implementing the same models as in Chiradzulu, and is now able to provide treatment to everyone who needs it. At the end of 2011, more than 24,420 patients were receiving care. As the national treatment program has grown and strengthened, MSF has started handing over responsibility for HIV services to the Ministry of Health.
Staff will now share lessons learned from the successful program in Thyolo with medical personnel in the neighboring districts of Nsanje and Chikhwawa. In an effort to boost HIV services, MSF will mentor staff, support the scaling-up of treatment and work to improve both the accessibility and quality of care.
Preventing mother-to-child transmission (PMTCT)
Without appropriate treatment, the rate of mother-to-child transmission of HIV is close to 40 percent. For those who have access to prevention services, this figure falls to just three percent.
There are two recommended treatment options for pregnant women. ‘Option B’ involves administering ARV medication during pregnancy and breastfeeding, stopping only when the baby has been weaned. Under ‘option B+’, pregnant and breastfeeding women start ARV treatment and continue taking it for life. In both cases, the baby receives ARV medication until it is six weeks old. Option B+ was introduced in Malawi in October 2011 and is now part of the national treatment program. MSF fully supports this decision.
By December, more than 1,650 pregnant women in Chiradzulu and 1,500 in Thyolo had enrolled in the PMTCT B+ program. Overall, in 2011, MSF assisted the births of nearly 3,400 babies.
Circumcision of adult men
Evidence from several recent studies has shown that male circumcision reduces the risk of HIV being sexually transmitted from women to men by approximately 60 percent. MSF has developed a programto offer circumcision to adult male patients in Chiradzulu. The service will be available from April 2012.
More than 80 percent of tuberculosis (TB) patients who register for treatment at Chiradzulu district hospital are HIV positive. TB and HIV care have therefore been integrated, and patients need only go to one appointment to receive all the treatment they need for both diseases.
At the end of 2011, MSF had 819 staff in Malawi. MSF has been working in the country since 1986.