MALAWI: Malawi moves to adopt WHO guidelines
The number of people on treatment could rise by about 50 percent
JOHANNESBURG, 27 May 2010 (IRIN) - Developing countries like Malawi are calculating the cost of adhering to new World Health Organization (WHO) guidelines that recommend starting HIV-positive people on antiretroviral drugs (ARVs) sooner.
Malawi is one of three African countries that have conducted WHO-supported feasibility studies to assess what adopting the new guidelines would mean, and has announced plans to roll out the new WHO guidelines
by mid-2011, said Dr Frank Chimbwandira, head of the HIV and AIDS department in the Ministry of Health.
According to the feasibility study, the number of people on treatment would rise by about 50 percent, which could double the cost of the national ARV programme
in terms of additional personnel and equipment, and would probably also mean waiting lists at many clinics.
Implementing the WHO guidelines would mean major changes to national treatment protocols: HIV-positive people would start taking ARVs at a much higher CD4 count of 350, regular CD4 count and viral load
monitoring would be conducted, and potentially more expensive treatment regimens would be adopted – including phasing out the ARV Stavudine, which has been associated with increased side-effects.
Malawi, with a HIV prevalence rate of about 12 percent, last revised its treatment regimen in 2008 and the current first-line course is a combination of Stavudine, Lamivudine and Nevirapine.
Like other countries in the region, it has begun treating HIV-positive pregnant women
at the WHO-recommended CD4 count of 350, but the standard CD4 count threshold for initiating ARV treatment remains 250.
In 2009, Malawi had just 47 operational CD4 count machines, and less than half the HIV-positive patients had access to such tests, the feasibility study noted.
Tanzania, Nigeria and Ivory Coast have undertaken similar studies. "The findings of these feasibility exercises are important for all of us - the national governments and partners, such as WHO - to understand the real bottlenecks and costs of scaling up our collective action against HIV," Dr Marco Antônio de Ávila Vitória, a medical officer in the WHO HIV/AIDS Department, told IRIN/PlusNews.
Finding the funding
Ultimately, each country would decide when and how to implement the recommendations, which would involve a careful balancing act between saving lives and managing costs to ensure sustainable and stronger health systems.
Bridget Chibwana, acting executive director of the Malawi National AIDS Commission, said finance
was among the major hurdles to adopting the guidelines, as well as infrastructure, supply-chain management, and health worker shortages.
She said the country planned to participate in the Global Fund's 20 May call for Round 10 funding applications, and was seriously considering redistributing existing funds in its Global Fund portfolio.
Tatjana Peterson, the Global Fund Portfolio Manager for Malawi, said the country was in the process of conducting more detailed studies of the costs associated with scaling up treatment, and the results were expected by the end of May.