International AIDS Society


Rapid feasibility appraisal in Malawi for the introduction of revised WHO ART recommendations 2009

Z. Chirwa, F. Chimbwandira, J. Njala, E. Mhango, S. Makombe, A. Jahn, A. Maida, E. Schouten

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.
Routine CD4/VL
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
Abstract no. WEAE0202

Suggested Citation
"Z.Chirwa, et al. Rapid feasibility appraisal in Malawi for the introduction of revised WHO ART recommendations 2009. : AIDS 2010 - XVIII International AIDS Conference: Abstract no. WEAE0202 "