[The introduction of antiretroviral therapy in Malawi]

The prevalence of HIV infection in Malawi is high. Until mid 2004, antiretroviral therapy (ART) was only available for a fee; later, a programme for free distribution was started. When ART was started, no laboratory tests other than an HIV test were felt to be necessary. After an introductory period in which hospitals were assessed for the presence of sufficient infrastructure and health workers were trained in ART, the number of public and private clinics where ART was distributed rose to 60. By end 2005, the number of patients on ART was 37,840, which is 45% of the target in the so-called '3-by-5' initiative of the WHO/Joint United Nations Programme on HIV/ AIDS (UNAIDS). The goal of this initiative was to have half (85,000) ofthe estimated 170,000 HIV-infected individuals in Malawi for whom ART is indicated on treatment by end 2005. After 12 months of follow-up, 81% of the patients treated were still alive and on treatment, while the mortality was 10%, 8% no longer visited the outpatient clinic, and 1% had stopped ART. Despite facing various challenges, intensive collaboration with all stakeholders involved, under strong leadership of the Ministry of Health, has laid the foundation for this thus far successful programme.