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Antiretroviral Therapy in Primary Health Care: Experience of the Chiradzulu programme in Malawi (Case study)

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Photograph by Gael Turine

The Médecins Sans Frontières (MSF) programme which provides highly active antiretroviral treatment (HAART) to patients living with HIV/AIDS in Chiradzulu, Malawi, has demonstrated the value and feasibility of ARV treatment in a poor rural context. Around 3,000 patients are now on HAART in this programme and clinical results are comparable to those found in developed countries.

Although the Chiradzulu project is still evolving, and treatment systems and point of care continue to be modified, the project has already shown that when treatment is adapted to local conditions and is supported by human and financial resources, rural health systems can effectively provide comprehensive HIV/AIDS care.

The Chiradzulu programme is one of MSF’s largest. MSF currently provides HAART to more than 13,000 patients in 56 projects spread across 25 countries. These programmes provide a continuum of care, including prevention efforts (health education, prevention of mother-to-child transmission of HIV), voluntary counselling and testing, prevention and treatment of opportunistic infections, HAART and nutritional and psychosocial support.

In addition to Chiradzulu, MSF runs an antiretroviral treatment programme in Malawi’s Thyolo district. In March 2004, 385 people were being treated in this project. This case study focuses exclusively on the Chiradzulu programme, however. It outlines the ways in which MSF and the Ministry of Health and population (MoHP) sought to expand the number of patients benefiting from antiretroviral treatment by simplifying treatment and diagnosis protocols and modifying care delivery.