Community support is associated with better antiretroviral therapy outcomes in Malawi

Since 1999, Médécins Sans Frontières (MSF) has been developing an AIDS programme with the ministry of health in Thyolo, a rural district of southern Malawi. The programme includes community support.  In 2003, Thyolo introduced antiretroviral therapy (ART) for some individuals. Has the presence of community support influenced ART outcomes?

Between 2003 and 2005, researchers led by Médécins Sans Frontières (MSF) reviewed ART outcomes in the areas of Thyolo where community support was available and compared them with areas which lacked such support. At the same time, three of the seven traditional authorities in Thyolo were providing community support through volunteers, community nurses and trained family carers.

The basic package of care included home management of opportunistic infections (diseases associated with HIV and AIDS), early referral to medical help for patients with possible drug reactions and risk signs, counselling on drug adherence, support to family carers, and tracing defaulters (those who had not attended follow-up appointments for three months or more). Further activities included information, education and communication; nutritional support; and vocational training for AIDS orphans.

Between April 2003 and December 2004, there were 1,634 HIV-positive people involved in the study who were on ART. Of these, 55 percent lived in areas offering community support while 45 percent were from areas without such support. The researchers found that the risk of death, defaulting or stopping ART were all significantly less for those offered community support. Results showed that:

• ninety-six percent of those who received community support were alive and continuing ART at the end of the study, compared with 76 percent of those who did not receive community support
• the death rate was 3.5 percent for those who received community support, compared with 15.5 percent for those who did not
• the percentage of defaulters was 0.1 for those receiving community support and 5.2 percent for those without support
• only 0.8 percent of those who had community support stopped ART, compared with 3.3 percent of those without community support.

The researchers conclude that a decentralised community network of support leads to much lower death rates and better overall outcomes for ART. They note that in a country like Malawi with high HIV prevalence (14 percent of those aged 15-49) and limited resources, health workers are reluctant to take on the burden of community-based outreach work. They argue that:

• HIV and AIDS are chronic lifelong conditions whose treatment and care, including ART, must be continuous and ongoing. The community can play an important role in this regard.
• local communities are a largely unexploited resource that could contribute significantly to ART outcomes on a national scale
• communities are not an unlimited resource and will require support
• policymakers should think of ways to sustain community resources and identify the parts of the community that will need further support
• policymakers need to make sure that they do not simply pass on to communities those activities that should be the responsibility of the public services or other partners.

Source(s):
'Community support is associated with better antitretroviral treatment outcomes in a resource-limited rural district in Malawi', Transactions of the Royal Society of Tropical Medicine and Hygiene 101(1), pages 79-84, by Rony Zachariah, Roger Teck, Leopold Buhendwa, Margaret Fitzgerald, Sandy Labana, Christina Chinji, Pierre Humblet and Anthony D. Harries, 2007
HINARI subscribers can access the full-text article here. Full document.

Funded by: Médécins Sans Frontières

id21 Research Highlight: 23 January 2007

Further Information:
Rony Zachariah
Médécins Sans Frontières (MSF)
Medical Department (Operational Research)
Brussels Operational Center
68 Rue de Gasperich
L-1617
Luxembourg

Tel: +352 332515
Fax: +352 335133
Contact the contributor: zachariah@internet.lu

Médécins Sans Frontières (MSF) in Malawi

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