Free Antiretroviral Treatment In Malawi Proving Effective

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Main Category: HIV / AIDS
Also Included In: Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 09 May 2008 - 0:00 PDT

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According to an article published in The Lancet, adult mortality of HIV patients in Malawi has been significantly reduced after the introduction of free antiretroviral therapy (ART). The effect, say researchers, is large enough to detect at the population level.

Malawi, a country of about 13 million people located in southeastern Africa, sees some 80,000 deaths from AIDS each year. Between 2004 and 2006, the country offered free ART to over 80,000 patients. To evaluate the effectiveness of this program, Dr. Andreas Jahn and Professor Judith Glynn (London School of Hygiene and Tropical Medicine or LSHTM), along with colleagues from LSHTM and the Karonga Prevention Study in Malawi, collected and analyzed population data on HIV-related mortality both before and after the free ART program was introduced.

The population under study included 32,000 Northern Malawians. Mortality measurements were taken from August 2002, before the availability of free ART, to February 2006, eight months after the opening of a free ART clinic. The clinic opening serves as an exogenous shock to the system - independent of other factors that might affect changes in mortality rates - and thus serves as a type of natural or quasi-experiment from which reliable impact estimates can be gathered.

Before June 2005, the researchers report, the mortality rate among adults aged 15-59 years was 9.8 per 1000 person-years of observation. The researchers found that the probability of both men and women dying between these ages was about 43% and about 65% of deaths (229 of 352) were related to AIDS. The data collected eight months after the opening of the free ART clinic indicated that of about 334 who needed treatment, 107 accessed it. Still, there was a 10% reduction in mortality in adults, and a 35% reduction in adults who were near the main road (a location where pre-ART mortality was greatest). When subgrouping by age, the researchers found that mortality rates in adults aged 60 years or more did not change.

"Our findings of a reduction in mortality in adults aged between 15 and 59 years, with no change in those older than 60 years, suggests that deaths from AIDS were averted by the rapid scale-up of free antiretroviral therapy in rural Malawi, which led to a decline in adult mortality that was detectable at the population level," conclude the authors.

Dr. Matthias Egger and Dr. Andrew Boulle (University of Cape Town, South Africa) write in an accompanying Comment that the idea of universal access to ART is a remarkable challenge, especially when noting the difference in mortality rates between groups who lived close to the main road and those who were from more remote areas. They conclude: "Continued monitoring of the public-health effect of ART at the population level, including of such inequalities, is required as the scale-up of treatment in resource-limited settings continues."

Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi
A Jahn et al.
The Lancet (2008): 371[9624]. pp. 1603-1611.
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Written by: Peter M Crosta
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