Abstract
BackgroundHIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, therefore antiretroviral therapy (ART) program and site factors known to be associated with emergence of HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR.MethodsIn 2010, Namibia selected five World Health Organization Early Warning Indicators (EWIs) and scaled-up monitoring from 9 to 33 ART sites: ART prescribing practices, Patients lost to follow-up (LTFU) at 12 months, Patients switched to a second-line regimen at 12 months, On-time antiretroviral (ARV) drug pick-up, and ARV drug-supply continuity. ResultsRecords allowed reporting on three of the five selected EWIs. 22 of 33 (67%) sites met the target of 100% initiated on appropriate first-line regimens. 17 of 33 (52%) sites met the target of ≤20% LTFU. 15 of 33 (45%) sites met the target of 0% switched to a second-line regimen.ConclusionsEWI monitoring directly resulted in public health action which will optimize the quality of care, specifically the strengthening of ART record systems, engagement of ART sites, and operational research for improved adherence assessment and ART patient defaulter tracing.
Highlights
As of December 2011, over 8 million people infected with HIV were receiving antiretroviral therapy (ART) in low- and middleincome countries which represents a 26-fold increase since 2003 [1]
Warning Indicators Selection Namibia chose the following five indicators based on relevance to anticipated program interventions and availability of data: ART Prescribing Practices, Patients lost to follow-up 12 months after ART initiation, Patients switched to second-line ART during first 12 months, Ontime ARV drug pick-up, and ARV drug supply continuity [16]
Two different cohorts of ‘eligible patients’ were formed: 1) Patients consecutively initiating ART for the first time on or after the Early Warning Indicators (EWIs) sample start date of July 1, 2008 (ART prescribing practices, Patients lost to follow-up (LTFU) at 12 month, and Patients switched to a second-line regimen at 12 months), and 2) Patients consecutively picking up ART on or after the EWI sample start date of January 1, 2010, regardless of duration of regimen (On-time ARV drug pick-up)
Summary
As of December 2011, over 8 million people infected with HIV were receiving antiretroviral therapy (ART) in low- and middleincome countries which represents a 26-fold increase since 2003 [1]. For example: HIVDR testing is not required to predict the emergence of drugresistant HIV in settings where inappropriate prescribing practices (mono- or dual-therapy), treatment interruptions due to suboptimal patient adherence, poor patient retention on ART, or ART supply shortages or stock-outs occur at unacceptably high levels. These factors have been shown to be associated with the development of HIVDR [6,7,8,9,10,11,12]; their monitoring may alert national ART program planners to issues which may be adjusted to minimize the emergence of HIVDR. HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, antiretroviral therapy (ART) program and site factors known to be associated with emergence of HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR
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