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Who has access to counseling and testing and anti-retroviral therapy in Malawi - An equity analysis

Makwiza, I., Nyirenda, L., Bongololo, G., Banda, T., Chimzizi, R. and Theobald, Sally (2009) 'Who has access to counseling and testing and anti-retroviral therapy in Malawi - An equity analysis'. International Journal for Equity in Health, Vol 8, Issue 13.

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Abstract

Background. The HIV and AIDS epidemic in Malawi poses multiple challenges from an equity perspective. It is estimated that 12% of Malawians are living with HIV or AIDS among the 15-49 age group. This paper synthesises available information to bring an equity lens on Counselling and Testing (CT) and Antiretroviral Therapy (ART) policy, practice and provision in Malawi. Methods. A synthesis of a wide range of published and unpublished reports and studies using a variety of methodological approaches was undertaken. The analysis and recommendations were developed, through consultation with key stakeholders in Malawi. Findings. At the policy level Malawi is unique in having an equity in access to ART policy, and equity considerations are also included in key CT documents. The number of people accessing CT has increased considerably from 149,540 in 2002 to 482,364 in 2005. There is urban bias in provision of CT and more women than men access CT. ART has been provided free since June 2004 and scale up of ART provision is gathering pace. By end December 2006, there were 85,168 patients who had ever started on ART in both the public and private health sector, 39% of the patients were male while 61% were female. The majority of patients were adults, and 7% were children, aged 14 years or below. Despite free ART services, patients, especially poor rural patients face significant barriers in access and adherence to services. There are missed opportunities in strengthening integration between CT and ART and TB, Sexually Transmitted Infections (STI) and maternal health services. Conclusion. To promote equitable access for CT and ART in Malawi there is need to further invest in human resources for health, and seize opportunities to integrate CT and ART services with tuberculosis, sexually transmitted infections and maternal health services. This should not only promote access to services but also ensure that resources available for CT and ART strengthen rather than undermine the provision of the essential health package in Malawi. Ongoing equity analysis of services is important in analyzing which groups are unrepresented in services and developing initiatives to address these. Creative models of decentralization, whilst maintaining quality of services are needed to further enhance access of poor rural women, men, girls and boys.

Item Type: Article
Additional Information: Export Date: 24 November 2009 Source: Scopus Art. No.: 13 doi: 10.1186/1475-9276-8-13 Language of Original Document: English Correspondence Address: Makwiza, I.; Research for Equity and Community Health Trust, P.O. Box 1597, Lilongwe, Malawi; email: ireen@reachtrust.org
Uncontrolled Keywords: antiretrovirus agent acquired immune deficiency syndrome article controlled study female health care policy health service highly active antiretroviral therapy human Human immunodeficiency virus Human immunodeficiency virus infection major clinical study Malawi male patient counseling sexually transmitted disease
Subjects: WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.4 Epidemiology
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WB Practice of Medicine > Therapeutics > WB 305 Instructions or non-drug prescriptions for devices or therapy (General)
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Therapeutics > WB 340 Drug Administration
WB Practice of Medicine > Therapeutics > WB 330 Drug therapy
WC Communicable Diseases > Sexually Transmitted Diseases > WC 142 Public health control measures
WA Public Health > Health Administration and Organization > WA 525 General works
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WC Communicable Diseases > Sexually Transmitted Diseases > WC 140 Sexually transmitted diseases
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI): https://doi.org/10.1186/1475-9276-8-13
Depositing User: Philomena Hinds
Date Deposited: 25 Mar 2010 15:14
Last Modified: 06 Feb 2018 12:59
URI: http://archive.lstmed.ac.uk/id/eprint/321

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