Development and implementation of a pilot operations research-based project for surveillance of drug resistance in HIV-infected pregnant women from a resources limited population
D.M. Cecchini1, I. Zapiola2, S. Fernandez Giuliano2, M. Martinez1, C. Rodriguez1, M.B. Bouzas2
1Hospital Cosme Argerich, Working Group in Prevention of HIV Mother-to-Child Transmission, Buenos Aires, Argentina, 2Infectious Diseases Hospital “Francisco J. Muñiz”, Virology Unit, Buenos Aires, Argentina
Issues: HIV-infected pregnant women (HPW) are a vulnerable population where presence of drug-resistance may have serious consequences (treatment failure/transmission to the newborn). However resistance tests (RTs) are not routinely available for HPW in Argentina and data regarding the prevalence of drug-resistance mutations (MARS) are lacking.
Description: With the aim of describing prevalence of MARS in HPW, a collaborative liaison was established between the Group in Prevention of Mother-to-Child Transmission (MTCT), Hospital Argerich (GPMTCT) and the Virology Unit of Hospital Muñiz (VUMUH) both in Buenos Aires (BA). The GPMTCT assists HPW from areas with highest national HIV prevalence (BA and surrounding areas). Assistance is “one-stop-shop”-based to guarantee that each HPW and its newborn have an interdisciplinary evaluation (infectologist/obstetrician/pediatrician/social services?) and routine/specialized analysis (i.e. viral load samples [VL]) in the same day. The VUMUH routinely process VL and RTs for public hospitals. An observational protocol for MARS surveillance in HPW was written between both institutions and gain ethical approval. A research proposal outline was submitted to Operations Research “Learning by doing” Professional Development Programme (IAS 2009 Conference). Upon acceptance, final strategic/logistical improvements were made based on faculty and participant's recommendations.
Lessons learned: Since November 2008, every naïve or experienced HPW with VL>800-1000 copies/mL is offered a RT. Upon written informed consent, RT is fast-track done in the same sample used for VL. Overall preliminary MARS prevalence was 27.3% (6/22): 2/10 (20%) in naïve and 4/12 (30%) in experienced HPW. This information has led to major improvements in ARV selection during pregnancy.
Next steps: A critical number of 50-70 RTs is expected to be reached in mid-2010, what will provide national authorities an accurate estimate of MARS in HPW from a critical geographical area, information that may influence local recommendations for MTCT. This collaborative approach offers a practical model for scaling-up resistance surveillance among resources-limited populations.
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