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Free Content Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes—the case of Malawi [State of the Art Series. HIV infection in low-income, high-burden settings. Edited by J. F. Murray. Number 6 in the series]

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The rapid and massive scale-up of antiretroviral drug therapy (ART) so needed in sub-Saharan Africa will not be possible using a ‘medicalised’ model. A more simple approach is required. DOTS has been used now for many years to provide successful anti-tuberculosis treatment to millions of patients in poor countries of the world, and many of the established concepts can be used for the delivery of ART. Malawi, a small and impoverished country in sub-Saharan Africa, is embarking on a national scale-up of ART. In this review we describe how we have adopted several of the principles of DOTS for delivering ART in Malawi: case finding and registration, treatment, monitoring, drug procurement, staffing and the issue of free drugs. We also discuss ART for HIV-infected TB patients. We hope that by using the DOTS approach we will be able to deliver ART to large numbers of HIV-infected patients under controlled conditions, and minimise the risk of developing drug resistance.

Keywords: ARV therapy, ART; Africa; DOTS; Malawi

Document Type: Miscellaneous

Affiliations: 1: Department of Clinical Services, Ministry of Health, Lilongwe, Malawi 2: Department of Clinical Services, Ministry of Health, Lilongwe, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom; and Family Health International, Arlington, Virginia, USA 3: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 4: Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi

Publication date: October 1, 2005

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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