HIV drug resistance early warning indicators in the Caribbean
N. Jack1, G. Ravasi2, W. Schrooten1, A. Del Riego1, G. Hirnschall3
1Pan American Health Organization, PAHO HIV Caribbean Office, Port of Spain, Trinidad and Tobago, 2Pan American Health Organization, Representacao no Brasil, Brasilia, Brazil, 3Pan American Health Organization, HIV/STI Project, Washington DC, United States
Background: Caribbean countries have implemented antiretroviral treatment (ART) programmes and are working towards the goals of universal access. HIV drug resistance (HIVDR) genotyping is still unaffordable for routine clinical care and prevention of resistance is mandatory. Since 2006, PAHO/WHO has promoted and supported the implementation of the WHO Global strategy for HIVDR prevention, monitoring and surveillance based on a public health approach.
Methods: Through annual Caribbean regional meetings, in-country consultations and technical assistance to 16 Caribbean countries, progress has been made in implementing HIVDR Early Warning Indicators (EWIs). EWIs are ART site based indicators of quality of care which provide useful strategic information for HIVDR prevention through quality improvement actions. Technical assistance included support for the development of national HIVDR plans, strengthening of patient monitoring systems and capacity building to generate EWIs.
Results: In 2009, 15 countries produced HIVDR reports and 14 piloted EWIs in at least one treatment and care site. Adequate data for 2008 was available from 58 sites in 10 countries representing 20,794 patients on ARVs. For EWI 1 (% appropriate prescribing practices), 23/57 sites (40%) achieved the WHO target of 100%. For EWI 2 (% lost to follow-up during first 12 months) 38/55 sites (69%) reported < 20%. For EWI 3 (% patient retention on first-line ART at 12 months), 35/55 sites (64%) achieved the WHO target of >70%. For EWI 6 (Drug supply continuity) 21/57 sites (36%) had no stock-outs during the selected 12 months.
Conclusions: Efforts must be strengthed to support Caribbean countries to improve their patient monitoring systems; expand the reporting of EWIs to all HIV care and treatment sites; appropriately interpret the results and implement strategies, both site and programmatic to prevent HIVDR by ensuring adherence to national ART guidelines, recalling defaulters, enhancing drug supply continuity and patient retention on first-line.
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