Operational research in malawi

Abstract

In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively.

District and facility-based operational research was undertaken to assess the effectiveness of cotrimoxazole preventive therapy (CPT) in reducing death rates in TB patients and subsequently patients starting ART under routine programme conditions.

Studies in this document show the beneficial effects of CPT in HIV-infected TB patients and in HIV-infected patients about to start ART, following which the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications.

The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved, as was demonstrated from routine data, which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death rates in people with HIV starting ART.

This article: • discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, • outlines the steps that were taken to translate these findings into national policy and practice, • shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and; • highlights lessons that can be learnt for other settings and interventions.