By the end of March 2009, there were 223 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 319 ART service delivery points in Malawi in Q1 2009.
In the first quarter of 2009 (January to March) a total of 17,812 new patients initiated ART and 4,006 ART patients transferred between clinics, resulting in a total of 21,818 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Of those registered, 57% started in WHO Stage 3, 12% in Stage 4 and 29% in Stage 1 or 2 due to a low CD4 count. In the quarter a total of 85 infants started ART in WHO stage 1 or 2 with confirmed HIV infection (DNA-PCR) and 67 children under 18 months started with presumed severe HIV disease. It is encouraging that the number of children started on ART because of DNA-PCR or presumed severe HIV disease has more than doubled compared to previous quarter. However, ART access through early infant diagnosis needs to be further strengthened.
By the end of March 2009, a total of 216,245 patients had ever initiated ART and 29,002 ART patients had transferred between clinics, resulting in a cumulative total of 245,247 ART clinic registrations (39% male, 61% female; 91% adult, 9% children). 30,080 (12%) patients started ART due to TB.
Cumulative treatment outcomes by end of March 2009 were: 158,137 (64%) alive and on ART, 25,775 (11%) died, 28,393 (12%) lost to follow-up, 32,003 (13%) transferred out to another facility and 939 (<1%) were known to have stopped ART.
Of the 158,137 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 March 2009 there were 31 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.
