A brief overview of ART services at QECH, Malawi Kudzala Aub. MMEDsc. Student Sr. Lead ART Clinician/ HIV Medicine Registrar.

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Presentation transcript:

A brief overview of ART services at QECH, Malawi Kudzala Aub. MMEDsc. Student Sr. Lead ART Clinician/ HIV Medicine Registrar

Outline Current Challenges Genetic Barriers of Regimens Rationale for the clinical decision

Challenges Drug shortage problems Especially 3TC, NVP Laboratory back up

Challenges Quantity versus Quality Demand versus Supply Shortage of health care personnel Toxicity of the 1st line regime

Lancet expensive - complicated - logistics - adherence

clinician 25 patients Fee-paying

Malawi ART clinics 2002

TM&IH Many lost to follow up - ATN - Poor adherence Personal finance Drug shortage

2004 ART SCALE UP PROGRAMME HIV Unit Ministry of Health Global fund to fight AIDS-TB- Malaria National ART Guidelines Training of > 2000 clinicians and nurses

2004 ART SCALE UP PROGRAMME HIV Unit Ministry of Health Establishments of ART clinics within the existing HCS

PUBLIC HEALTH APPROACH TO ART Large number of ART in RLS Standardized than individualized Simplified monitoring of treatment Predominant use of Clinical Officers and Nurses

PUBLIC HEALTH APPROACH TO ART ART to be free of charge Follow experiences of the national TB programme Standardised monitoring and reporting

PUBLIC HEALTH APPROACH TO ART Quarterly supervision Strong drug logistics Harries et al - BMJ 2004

Cost of ARV drugs Netherlands: Truvada® Stocrin® USD 10,000 / year Malawi: Triomune 30® USD 100 / year

Malawi ART clinics

270,000 patients started ART 9% children 60% females 93% on the same first line regimen 5% on alternative first line regimen <1% on second line regimen

Major Changes to the National ART Programme in 2011 PMTCT, Paediatric, Adult ART integration Strategic phasing out of Stavudine CD4 threshold increase

CHALLENGES Quantity versus Quality Demand versus Supply Shortage of health care personnel Toxicity of the first line regime

CHALLENGES Early ART mortality ART failure ART delivery Infrastructure Limited Laboratory Back up

DRUG SUPPLY CONTINUES Possible reasons for the Drug Shortage? Increased # of clients on non standard regime. Inadequate financing or under- budgeting. Inefficiencies in supply and distribution chain.

SELECTED POINT EXAMPLES OF DRUG SUPPLY Drug shortage is the main problem June TC = 0, NVP = 117 August TC = 0, NVP = 0 Sept TC = 55, NVP = 100

Conclusion

Malawi ART Scale up Programme Successful under difficult circumstances using public health approach Large number of patients on ART Favourable outcomes Many challenges Current Challenges

Acknowledgements Joep van Oosterhout, M.D., PhD, Associate Professor of Internal Medicine, University of Malawi, College of Medicine

Acknowledgements James Blessings Mwambene, Dip.Clin.Med, PGD(Mgt studies), The ART Outreach Coordinator, Queen Elizabeth Central Hospital, Malawi

Acknowledgements Cooper Nyirenda, M.D.,MMED, FRCP, Chief Govt. Physician, Queen Elizabeth Central Hospital