Rapid feasibility appraisal in Malawi for the introduction of revised WHO ART recommendations 2009
Issues: The key recommendations being considered in the WHO guidelines for resource limited countries include early CD4 dependant initiation of ART(< 350), transitioning to more expensive but potentially more efficacious regimens ( TDF or AZT), phasing out D4T, and introduction of routine CD4/VL monitoring for ART failure. These recommendations may have a huge impact on health systems in resource limited countries in terms of feasibility, risk-benefit, acceptability and costs/financial implications.
Description: The rapid appraisal was conducted using desk reviews of available policies, guidelines, ART scale up plans and reports (financial & programmatic)
Interviews were conducted with key stake holders.
Field visits were conducted to selected ART sites . A SWOT analysis was done to determine the programatic implications of the recommendations
Lessons learned: The earlier CD4 threshold would result in 30-40% more people being elligible for ART immediately, from pre-ART programme. This may result in a waiting list due to the limited infrastructure & human resources base.
Change in regimen will result in doubling or even tripling of the cost of drugs. The appraisal has shown that the additional cost of ARV ´s alone would reach 200-300 million dollars by 2014 depending on regimen chosen. Guidelines will need to be revised and training conducted on the new guidelines.
About 200,00-400,000 CD4 tests will need to be performed per year, (currently 80,000), and 200,000-400,000 Viral loads (currently 20,000) to monitor ART failure routinely. This has cost/resource implications in terms of equipment, reagents, laboratory personnel (recruitment and training)
Next steps: It may be critical for resource limited countries to conduct a rapid appraisal similar to the above for their national programmes to consider which recommendations to adopt immediately, which ones to adopt in a phased or partial manner and which cannot be considered at this time for adoption in the country.
AIDS 2010 - XVIII International AIDS Conference
"Z.Chirwa, et al.
Rapid feasibility appraisal in Malawi for the introduction of revised WHO ART recommendations 2009.
AIDS 2010 - XVIII International AIDS Conference: