By the end of June 2009, there were 224 static ART clinics in Malawi in the public and private health sector; 22 of these static clinics provided ART at a total of 96 outreach or mobile sites, bringing the total to 329 ART service delivery points in Malawi in Q2 2009.
In the second quarter of 2009 (April to June) a total of 18,090 new patients initiated ART and 2571 ART patients transferred between clinics, resulting in a total of 20661 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Of those registered, 61% started in WHO Stage 3, 17% in Stage 4 and 20% in Stage 1 or 2 due to a low CD4 count.
Between the previous quarter and this quarter, the number of infants starting ART in WHO stage 1 or 2 with confirmed HIV infection (DNA-PCR) increased from 85 to 114, while children under 18 months starting due to presumed severe HIV disease increased from 67 to 85. This is an encouraging development and could be as a result of more experience with the EID programme and recent emphasis on presumed severe HIV disease diagnosis in children under 18 months. However, ART access through early infant diagnosis still needs to be further strengthened.
By the end of June 2009, a total of 234,395 patients had ever initiated ART and 31,930 ART patients had transferred between clinics, resulting in a cumulative total of 266,325 ART clinic registrations (39% male, 61% female; 91% adult, 9% children). 31,455 (12%) patients started ART due to TB.
Cumulative treatment outcomes by end of June 2009 were: 169,965 (64%) alive and on ART, 27,899 (10%) died, 31,958 (12%) lost to follow-up(defaulted), 35,624 (13%) transferred out to another facility and 936 (<1%) were known to have stopped ART.
Of the 169,965 patients alive and on ART: 94% were on the first line regimen, 5% were on an alternative first line regimen, fewer than 1% were on second line regimen and 1% were on a non-standard ART regimen. Non-standard regimens are not necessarily substandard regimens; they include patients continuing an ART regimen that was started outside Malawi, patients in research programmes and patients in specialist care in whom specific circumstances lead to the choice of a non-standard regimen.
Improved integration of the supervision system for the public and private sector has led to a revision of previous M&E data in the private sector and patient outcomes in the private sector no longer appear better than in the public sector.
By the end of June 2009 there were 35 sites with 1,001–2,000 patients alive and on treatment; 11 sites with 2,001–5,000 and 5 with over 5,000 patients alive and on treatment.