(2008; 126 pages)
In 2004, Malawi developed and started to implement a 2-year scale up plan for antiretroviral therapy (ART) to HIV-infected patients who were eligible for treatment. In January 2004, about 3,000 – 4,000 patients were accessing ART in 9 public health facility sites around the country. At that time, there was no standardised treatment, and no standardised system of training, monitoring, evaluation and drug procurement. However, this was about to change. The publication and dissemination of the 2003 First Edition of the Antiretroviral (ARV) Treatment Guidelines provided the core material to ensure that Malawi moved forward to deliver ART to large numbers of HIV-infected eligible patients using a public health structured approach.
The country has done well. By the end of 2007, there were 109 facilities in the public sector (central, district, mission, and defence force hospitals and clinics) and 45 in the private sector delivering ART using national systems, and 145,000 patients had been registered for therapy.
The Ministry of Health developed a 5-year ART scale up plan (2006-2010) which lays out the path of how to deliver ART to over 250,000 HIV-infected eligible patients by the end of 2010. This will be a challenging time, as the field of HIV-treatment is continually changing.
With these thoughts in mind, I welcome the 2008 Third Edition of the “Guidelines for the Use of Antiretroviral Therapy in Malawi”. This has built on the first and second editions, and takes into account the experience developed in the country in the last 4 years as well as changes that have occurred in international recommendations. I thank all the people who have given their time in the writing committee, consultation groups and dissemination meetings, and who have worked together to ensure the successful completion of an excellent and useful booklet. What now remains is to distribute this booklet to all health care workers in the public and private sector, and to insist that health care workers read, understand, digest and adhere to the contents. If this can be done, then patients with AIDS in Malawi will be offered an excellent standard of care.
They deserve no less.