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Lessons Learned From a Paying Antiretroviral Therapy Service in the Public Health Sector at Kamuzu Central Hospital, Malawi

1-Year Experience

University of North Carolina Project, Lilongwe, Malawi

Florian H. Neuhann, MD, PhD

Lighthouse Trust Clinic, Lilongwe, Malawi; Department of Tropical Hygiene and Public Health, University Heidelberg, Heidelberg, Germany

Cecelia C. Kanyama, MD

University of North Carolina Project, Lilongwe, Malawi

Dan C. Namarika, MD

Kamuzu Central Hospital, Lilongwe, Malawi

Ralf Weigel, MD, PhD, MScInfD

Lighthouse Trust Clinic, Lilongwe, Malawi

William Miller, MD, MPH, PhD

University of North Carolina, Chapel Hill, North Carolina

Sam J. P. Phiri, MScSTI/HIV, DiplClinMed

Lighthouse Trust Clinic, Lilongwe, Malawi

Background:In October 2001, a paying antiretroviral therapy service was introduced at a Central Hospital in Malawi using stavudine 40 mg/lamivudine 150 mg/nevirapine 200 mg (triomune). The objective of this study was to determine characteristics of patients seeking antiretroviral therapy, retention in care, clinical outcomes, and outlines for program improvement. Methods: Retrospectively, all patients seeking anti-retroviral therapy initiation (October 2001 to October 2002; follow-up through April 2003) were evaluated for laboratory results, retention in care, toxicity, and mortality. Hazard ratios for factors associated with dropout were determined.Results: Of 757 patients seeking evaluation, 625 began treatment. Documented mortality rate was 61 of 757. Total dropout rate was 50%. Factors associated with dropout include CD4 count <50 cells/mm₃ and Kaposi's sarcoma. Twenty-seven of 625 patients discontinued therapy for toxicity. Conclusions: The paying antiretroviral therapy program showed an unacceptable dropout rate associated with advanced baseline disease. Severe toxicity rate was low. Areas for improved program performance include lower cost, wide and earlier access to antiretroviral therapy, and targeted retention strategies.

Key Words: antiretroviral therapy • Africa • AIDS • HIV infection

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 5, No. 3, 103-108 (2006)
DOI: 10.1177/1545109706288722


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