By the end of December 2009, 198,846 patients were alive and on ART at 377 ART clinics in Malawi (279 static clinics and 98 outreach / mobile clinics).
Out of the 271,105 patients ever initiated on ART, 198,846 (73%) were retained alive on ART, 32,008 (10%) had died, 39,115 (13%) were lost to follow-up (defaulted) and 1,136 (<1%) were known to have stopped ART. 79% of adults and 79% of children were retained alive on ART 12 months after ART initiation. An estimated 181,482 adults and 17,364 children (<15 years) were alive on ART by the end of December 2009.
In the fourth quarter of 2009 (October to December) a total of 17,702 new patients initiated ART. The opening of 55 new ART clinics in the last 6 months resulted in an unprecedented number of ART clinic transfers: 6,623 ART patients transferred between clinics (27% of the total 24,325 new ART clinic registrations). Among new registrations 39% were male, 61% female; 91% were adults and 9% children.
The number of infants starting ART in the fourth quarter of 2009 in WHO stage 1 or 2 with confirmed HIV infection (DNA-PCR) increased from 142 to 163, while children under 18 months starting due to presumed severe HIV disease increased from 97 to 127.
Improved integration of the supervision system for the public and private sector has led to a revision of data shown in previous monitoring reports: Patient retention in the private sector now appears slightly lower than in public sector clinics.
The programme has been affected by a critical ARV drug supply shortage during Q3/Q4 due to the delayed release of funding and the ensuing logistical complications resulting in widespread drug re-distributions between sites. However a targeted survey revealed that patients were affected only in isolated cases, requiring regimen changes or short term treatment interruptions in patients on alternative first line ARVs.
In November 2009, WHO issued a Rapid Advice on revised guidelines for provision of ART for adolescents and adults and for PMTCT in resource-constrained countries. In January 2010, the Department for HIV and AIDS, in collaboration with national stakeholders, launched the technical review and planning process to incorporate these new guidelines into the national programme. Revised national guidelines and new ARV drug regimens are expected to be implemented in the first half of 2011.