HIV drug resistance early warning indicators in Namibia for public health action

• Published in: PloS one Vol. 8; no. 6; p. e65653
• Main Authors: Jonas, Anna, Gweshe, Justice, Siboleka, Milner, Deklerk, Michael, Gawanab, Michael, Badi, Alfons, Sumbi, Victor, Pereko, Dawn, Blom, Abraham, Mwinga, Samson, Jordan, Michael R, Jerger, Logan, Lau, Kiger, Hong, Steven Y
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.06.2013; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-HIV Agents - pharmacology; Anti-HIV Agents - supply & distribution; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Drug resistance; Drug Resistance, Viral - drug effects; Drug therapy; Emergence; Geography; Health services; Health Status Indicators; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - virology; Human immunodeficiency virus; Humans; Indicators; Infectious diseases; Lost to Follow-Up; Medical care quality; Medicine; Namibia; Operations research; Patient care; Patient compliance; Patients; Population; Practice Patterns, Physicians; Prescription drugs; Prescription writing; Prevention; Public Health; Public sector; Quality of care; Resistance; Social services; World Health Organization; Namibia; United States > US; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0065653

HIV 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. In 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. Records 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. EWI 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.