Integrated monitoring of tuberculosis and HIV: a case study from Malawi

9 July 2009

Integrated monitoring of tuberculosis and HIV: a case study from Malawi

ISBN 978 92 4 159827 9

The dual epidemic of tuberculosis and human immunodeficiency virus (TB/HIV) is a major global public health challenge. WHO estimates that of the 1.4 million people living with HIV who are developing TB annually, up to 0.5 million will die of TB. Effective therapeutic interventions to reduce morbidity and mortality are available for both diseases and to achieve universal access for those in need. These interventions have to be delivered and managed in primary health-care settings using a public health approach. In addition, programmes need to prevent and treat comorbidity from TB/HIV. Ensuring the implementation of good-quality services requires effective and simple monitoring and evaluation systems for programmatic management. Examples from the field that describe in detail how such systems can work are essential.

This monograph is a case study of how integrated monitoring of treatment for HIV/ TB works in Malawi. It describes in detail the delivery of HIV treatment to a large number of people in one of the most resource challenged health systems in the world. The provision of antiretroviral therapy (ART) in Malawi has been impressive. By the end of 2008, the national HIV control programme had kept 147 479 people alive and on ART, in both the public and private sectors, representing around 75% of those who had been registered cumulatively since the start of the programme in 2003. Malawi also has a good national TB control programme, with 26 000 TB patients registered annually and a treatment success rate exceeding 75%. Both programmes have well-functioning monitoring and evaluation systems with the ability to produce national data on case-finding and treatment outcomes for TB, HIV and HIV-related TB.