Free anti-retroviral treatment slows the loss of teachers in Malawi

Throughout the 1990s, Malawi lost 1.2 percent of all teachers annually due to HIV. What impact did the nationwide introduction of free anti-retroviral treatment (ART) in June 2004 have on teachers with HIV?

Researchled by Malawi’s Ministry of Health suggests that the programme has stemmed theHIV-related loss of teachers. The researchers analysed records from all 102public sector and 36 private sector ART clinics in Malawi. By the end ofSeptember 2006, the clinics had registered 72,328 people for treatment. Only3.8 percent of these were in the private sector. Of the 69,547 using publicservices, 61.3 percent were female and 93.4 percent were 15 years or older.

Teachersmade up 3.7 percent of all patients on ART. The researchers estimate that 2,380teachers accessed ART between June 2004 and September 2006. Looking moreclosely at this group:

• 15percent started in World Health Organization clinical stage 1 or 2, with a CD4-lymphocytecount of up to 250/mm3. 85 percent started in stage 3 (when theimmune system becomes more damaged) or 4 (when damage eventuallyleads to an AIDS diagnosis).
• Theaverage age when starting ART was 40 years for men and 37 years for women.
• Inthe two years prior to registration, nearly a fifth of people had pulmonarytuberculosis (TB), 4.5 percent had extra-pulmonary TB and 6.9 percent had Kaposi’ssarcoma.
• Afterthe national introduction of free treatment, the ART initiation rate increasedfrom 75 teachers in the previous three months to a maximum of 340 in the first threemonths of 2006.
• Atthe time of the study, 1,850 teachers were alive on ART (3.5 percent of allteachers in Malawi).
• Theprobability of being alive on ART at 6 months, 12 months, 18 months and 24months after starting treatment is 84, 79, 75 and 73 percent, respectively.
• Retentionin ART is good. Drop-out rates in treatment are lower for women, youngerteachers and those starting ART in clinical stage 1 or 2.

Mostteachers access ART in stage 3 or 4. Given that around three quarters ofpatients in these stages in Malawi die within a year without ART, the introductionof free treatment has had a great impact on the education workforce. The ARTprogramme has already limited the loss of teachers in Malawi and this effect islikely to grow more important. As the national plan increases from 2006 to2010, more important individuals who provide public services in ruralcommunities will gain access to life-prolonging ART.