Expanding antiretroviral therapy in Malawi: drawing on the country's experience with tuberculosis.

Highly active antiretroviral therapy (HAART) must be expanded in sub-Saharan Africa, where the HIV/AIDS epidemic is taking an appalling toll. Malawi, a small, poor African country, is expanding HAART nationally. The “directly observed treatment, short course” (DOTS) strategy has been successfully used for years to provide effective national control of tuberculosis, and the same concepts are being applied for delivering HAART. We describe how the principles of standardised case finding, standardised treatment regimens, regular monitoring and evaluation, and uninterrupted supplies of drugs can be used to deliver HAART. If implemented well, these principles should ensure a controlled delivery system, which would reduce the risks of inconsistent prescribing practices and the development of drug resistance.