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