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Table 2 Main similarities and differences between the WHO 2003 ART Guidelines and the Malawi 2003 ART Guidelines

From: Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy

  WHO 2003 ART Guidelines Malawi 2003 ART Guidelines
When to start ART Stage 4, Stage 3, Stage 2 with CD4 count or Total Lymphocyte count below threshold, Stage 1 with CD4 count below threshold Followed WHO Guidance
What to start Choice of 4 first-line ART regimens based on d4T/AZT, 3TC or EFV/NVP One first-line ART regimen only (d4T + 3TC + NVP) with alternatives if toxicity occurred
How to start ART No specific advice Advice about staging patients, group counselling and individual counselling and how to manage the first 2 weeks on half-dose nevirapine
Clinical and laboratory monitoring Recommended tiered laboratory capabilities based on level of health care facility Emphasised clinical monitoring only due to poor country-wide laboratory infrastructure
Adherence to medication General advice about adherence and monitoring Specific advice around pill counting
Children Advice about dosing—recommendations for not splitting fixed-dose tablets Advice about splitting first-line fixed-dose ART according to weight
HIV-Tuberculosis Advice based on CD4 count or consideration of ART based on clinical judgement Advice about starting all HIV-infected TB patients on ART in continuation phase with isoniazid and ethambutol
Standardised treatment outcomes on life-long ART No advice given Standardised treatment outcomes defined
Programmatic monitoring, recording and reporting No advice given Advice about patient identity cards, patient treatment master cards, patient ART registers and patient cohort analysis
Supervision No advice given Advice about quarterly supervision of all ART clinics including drug security checks
ARV drug procurement and distribution No advice given Advice about “start packs” and “continuation packs” and how to forecast drug needs
  1. ART antiretroviral therapy, WHO World Health Organization, HIV human immunodeficiency virus, TB tuberculosis, d4T stavudine, AZT zidovudine, NVP nevirapine, EFV efavirenz