Outcomes of tuberculosis patients who start antiretroviral therapy under routine programme conditions in Malawi.

SETTING: Public sector facilities in Malawi providing antiretroviral therapy (ART) to human immunodeficiency virus (HIV) positive patients, including those with tuberculosis (TB). OBJECTIVES: To compare 6-month and 12-month cohort treatment outcomes of HIV-positive TB patients and HIV-positive non-TB patients treated with ART. DESIGN: Retrospective data collection using ART patient master cards and ART patient registers. RESULTS: Between July and September 2005, 7905 patients started ART, 6967 with a non-TB diagnosis and 938 with a diagnosis of active TB. 6-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (77%) compared with non-TB patients (71%) (P < 0.001). Between January and March 2005, 4580 patients started ART, 4179 with a non-TB diagnosis and 401 with a diagnosis of active TB. 12-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (74%) compared with non-TB patients (66%) (P < 0.001). Other outcomes of default and transfer out were also significantly less frequent in TB compared with non-TB patients. CONCLUSION: HIV-positive TB patients on ART in Malawi have generally good treatment outcomes, and more patients need to access this HIV treatment.

Providing An audit of how patients get on to antiretroviral therapy in Malawi, and the weight gain they experience in the first six months.

An operational study was conducted in 6 public sector health facilities in the Southern Region of Malawi to determine a) drop-out rates during the referral process of patients to antiretroviral therapy (ART) and b) weight gained during the first 6 months in patients who were alive and on ART at that time. There were 738 adult HIV-infected eligible patients booked for group counseling, of whom 550 (74.5%) attended individual counseling and started ART. 16% of patients dropped out between booking and group counseling and 9.5% between group counseling and start of ART. In patients who were alive and on ART 6 months after starting, there was a gradual increase in weight with a mean gain of 6.0 kg in men and 5.0 kg in women. There was a slight increase in weight gain in patients in WHO Clinical Stage 3 and 4 compared with those in Stage 1&2, although this was only significant at 6-months between women in Stage 4 compared with women in Stage 1&2 (p <0.05). More information is needed on why patients drop out of the counseling process before starting ART, and whether weight gain is a marker for survival in the early months of ART.

Who is accessing antiretroviral therapy in Malawi? A study in the Southern Region on the occupation category "other".

As part of quarterly national reports on the scale up of antiretroviral therapy (ART), demographic and clinical characteristics are recorded including data on occupation. The largest occupational category is that of "other". As there is no information on the composition of the different occupations of patients placed in this category, a formal study was therefore conducted in 6 representative public sector facilities in the Southeastern Region of Malawi. Between January to June 2006, there were 126 adult patients recorded as "other" in the occupation column. A great variety of different occupations was recorded including no employment 30%, administration jobs 24%, general labourers 11%, builders 10%, tailors 9% and drivers 7%. A wide range of people with different jobs are accessing ART, and this should help in improving the economy of the patients as well as the country at large.

Improving completeness, accuracy & timeliness of HIV voluntary counseling & testing client data in Malawi using touchscreen computers.

A real-time data collection system can mitigate problems of data completeness, accuracy and timeliness often experienced using paper-based data collection and subsequent data entry. The Client Management Information System developed for the Malawi AIDS Counseling and Resource Organization employs touchscreen computers to collect client information during voluntary counseling and testing sessions. A user-friendly interface allows counselors with low levels of computer literacy to electronically capture client data in real-time without compromising the quality of counseling.