NAIROBI, 29 October 2009 (PlusNews) - Malawi's successful use of
a well-known tuberculosis (TB) treatment system to scale up
antiretroviral treatment (ART) for HIV could improve chronic
disease management in other African nations, experts say.
Directly observed treatment short course (DOTS), has been used to
successfully deliver tuberculosis treatment in some of the
world's poorest countries.
The main elements of DOTS include political commitment, case
detection, standardized treatment with supervision and patient
support, an effective drug supply and management system, and a
monitoring and evaluation system.
"The key to rapid and massive scale-up [in Malawi] was to keep
the principles and practices of ART delivery as simple as
possible," said the authors of an article on scaling up
antiretroviral therapy, in the latest edition of the Journal of
Acquired Immune Deficiency Syndromes.
"A standardized system was put in place so that the same system
of assessing patients for ART eligibility, initiating treatment,
and registering and reporting cases and outcomes was followed
wherever ART was being delivered - from central hospital to
health centre, and from public health facility to private
clinic," the authors said.
Malawi began its national ART rollout in 2004 with just nine
health facilities providing the medication to about 3,000 people.
Using the DOTS framework, by the end of 2008, 170 health
facilities in the public health sector had registered 215,449
A study published in 2008 in the British medical journal, The
Lancet, found that rapid scale-up of free ART in rural Malawi had
led to a decline in adult mortality that was detectable at the
The article's authors attribute the success of Malawi's ART
scale-up to government commitment and leadership; clear national
ART guidelines, with emphasis on the system of registration,
monitoring and recording of results; intensive training of
clinical officers and nurses in ART guidelines, with practical
experience at ART sites; an efficient drug-supply chain to
Taking DOTS further
They note that with the rise in prevalence - even in
resource-poor sub-Saharan Africa - of non-communicable diseases
such as heart attacks, strokes, cancers, diabetes and respiratory
diseases, there is a need to put in place simple yet effective
systems to give people access to treatment.
The World Health Organization (WHO) forecasts that deaths from
non-communicable diseases are likely to increase by 17 percent
globally over the next 10 years, with the greatest increase
projected in Africa.
"Although patients with these non-communicable diseases usually
need chronic care and treatment over their lifetimes, it is
simply not provided in most resource-poor countries, outside a
few centres of excellence, and there are no systems to monitor
patient access or outcomes," they stated.
"The system put in place in Malawi to facilitate the management
and monitoring of lifelong ART can also be used for patients with
If handled properly, HIV and chronic disease management systems
could be used to strengthen health systems in resource-poor
nations, particularly by improving laboratory infrastructure and
service delivery, monitoring, supervision, quality assurance, and
rational drug forecasting and procurement.
"Any attempt to better the management and monitoring of special
diseases must include a vision of how the work will improve the
health sector and health care delivery as a whole," they said.