By the end of September 2009, there were 236 static ART clinics in Malawi in the public and private health sector; 22 of these static clinics provided ART at a total of 103 outreach or mobile sites, bringing the total to 339 ART service delivery points in Malawi in Q3 2009.
In the third quarter of 2009 (July to September) a total of 18,292 new patients initiated ART and 3,030 ART patients transferred between clinics, resulting in a total of 21,322 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Of those registered, 52% started in WHO Stage 3, 10% in Stage 4 and 37% in Stage 1 or 2 due to a low CD4 count. 1% were infants with confirmed HIV infection (DNA-PCR) and 1% started due to other reasons.
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 114 to 142, while children under 18 months starting due to presumed severe HIV disease increased from 85 to 97. This is an encouraging development and could be as a result of more experience with the EID programme and recent refresher trainings on presumed severe HIV disease diagnosis in children under 18 months and EID using DNA-PCR. However, ART access through early infant diagnosis still needs to be further strengthened.
By the end of September 2009, a total of 253,154 patients had ever initiated ART and 35,009 ART patients had transferred between clinics, resulting in a cumulative total of 288,163 ART clinic registrations (39% male, 61% female; 91% adult, 9% children). 33,715 (12%) patients started ART due to TB.
Cumulative treatment outcomes by end of September 2009 were: 183,147 (64%) alive and on ART, 30,150 (10%) died, 34,841 (12%) lost to follow-up (defaulted), 39,074 (14%) transferred out to another facility and 951 (<1%) were known to have stopped ART.
Of the 183,147 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 are similar to those in the public sector.
By the end of September 2009 there were 185 sites with less than 1000 patients registered, 36 sites with 1,001–2,000 patients registered; 33 (Q2-11) sites with 2,001–5,000 and 10 sites (Q2-5) with over 5,000 patients registered. The number of sites with over 2000 patients has increased slightly from 37 to 43 resulting in HCW facing a larger workload.
The National programme has been affected by serious ARV drug supply shortage during Q3 due to the delayed release of funding and the ensuing logistical complications resulting in widespread drug re-allocations between sites. However a targeted survey revealed that patients were affected only in isolated cases, requiring regimen changes or short term treatment interruptions.