Faculty Opinions recommendation of Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment.

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Abstract
This paper shows that the provision of a simplified model of antiretroviral therapy (ART) delivery in a rural district of Malawi is effective and associated with good treatment outcomes: the results support the implementation of large-scale treatment programmes in Africa. In Chiradzulu, a rural district in Malawi, a simplified ART programme focusing on a fixed-dose combination of stavudine, lamivudine and nevirapine was associated with good results in a cohort of 1308 patients. At 12 months follow-up, the probability of patients still in care was 0.76 and the median CD4 cell count gain was 165 cells per ul. In a cross-sectional survey of 398 patients, 84% had a viral load of less than 400 copies per ml. These data show that large numbers of patients can benefit from ART in rural resource-poor settings and strongly supports the implementation of such large-scale simplified programmes in Africa.

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