Abstract
BackgroundIn response to concerns about the emergence of HIV drug resistance (HIVDR), the World Health Organization (WHO) has developed a comprehensive set of early warning indicators (EWIs) to monitor HIV drug resistance and good programme practice at antiretroviral therapy (ART) sites.MethodsIn 2012, Namibia utilized the updated WHO EWI guidance and abstracted data from adult and pediatric patients from 50 ART sites for the following EWIs: 1. On-time Pill Pick-up, 2. Retention in Care, 3. Pharmacy Stock-outs, 4. Dispensing Practices, and 5. Virological Suppression.ResultsData for EWIs one through four were abstracted and validated. EWI 5 – Virological Suppression was not included due to poor data entry at many sites. On-time Pill Pick-up national estimate was 87.9% (87.2–88.7) of patients picking up pills on time for adults and 90.0% (88.9–90.9) picking up pills on time for pediatrics. Retention in Care national estimate was 82% of patients retained on ART after 12 months for adults and 83% for pediatrics. Pharmacy Stock-outs national estimate was 99% of months without a stock-out for adults and 97% for pediatrics. Dispensing Practices national estimate was 0.01% (0.003–0.064) of patients dispensed mono- or dual-therapy for adults and 0.25% (0.092–0.653) for pediatrics.ConclusionsThe successful 2012 EWI exercise provides Namibia a solid evidence base, which can be used to make national statements about programmatic functioning and possible HIVDR. This evidence base will serve to contextualize results from Namibia's surveys of HIVDR, which involves genotype testing. EWI abstraction has prompted the national program and its counterparts to engage sites in dialogue regarding the need to strengthen adherence and retention of patients on ART. The EWI collection process and EWI results will serve to optimize patient care and support Namibia in making evidence-based recommendations and take action to minimize the emergence of preventable HIVDR.
Highlights
In recent years, the rapid scale up of antiretroviral therapy (ART) for treatment of HIV infection in resource-limited countries has been highly successful resulting in 9.7 million people receiving ART in low- middle-income countries as of December 2012 [1]
Warning Indicators selection Based on discussion with World Health Organization (WHO) consultants and review of pertinent record-keeping systems, the Namibia HIV drug resistance (HIVDR) technical working group (TWG) determined to abstract the following early warning indicators (EWIs) for abstraction in 2012 with the corresponding WHO-recommended targets summarized in Table 1: On-time pill pick-up, Retention in care, Pharmacy stock-outs, Dispensing practices, and Virological Suppression (Namibia-specific definition due to routine viral load testing done at 6 months in Namibia)
The national estimate for On-time pill pick-up was 87.9% (87.2–88.7) of patients picking up pills on time for adults and 90.0% (88.9–90.9) picking up pills on time for pediatrics
Summary
Background In recent years, the rapid scale up of antiretroviral therapy (ART) for treatment of HIV infection in resource-limited countries has been highly successful resulting in 9.7 million people receiving ART in low- middle-income countries as of December 2012 [1]. Because of the high mutation rate and high replication rate of HIV, the chronic nature of HIV infection and the need for lifelong treatment, the emergence of some drug resistance is inevitable in populations taking ART [2,3]. In response to countries concerns about the emergence of HIV drug resistance (HIVDR), the World Health Organization (WHO) has developed a comprehensive HIVDR surveillance and monitoring strategy based on public health principles. In response to concerns about the emergence of HIV drug resistance (HIVDR), the World Health Organization (WHO) has developed a comprehensive set of early warning indicators (EWIs) to monitor HIV drug resistance and good programme practice at antiretroviral therapy (ART) sites
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