title: HIV drug resistance early warning indicators in Namibia for public health action.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Anna
authors.initials: A
authors.lastname: Jonas
authors.forename: Justice
authors.initials: J
authors.lastname: Gweshe
authors.forename: Milner
authors.initials: M
authors.lastname: Siboleka
authors.forename: Michael
authors.initials: M
authors.lastname: Deklerk
authors.forename: Michael
authors.initials: M
authors.lastname: Gawanab
authors.forename: Alfons
authors.initials: A
authors.lastname: Badi
authors.forename: Victor
authors.initials: V
authors.lastname: Sumbi
authors.forename: Dawn
authors.initials: D
authors.lastname: Pereko
authors.forename: Abraham
authors.initials: A
authors.lastname: Blom
authors.forename: Samson
authors.initials: S
authors.lastname: Mwinga
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.forename: Logan
authors.initials: L
authors.lastname: Jerger
authors.forename: Kiger
authors.initials: K
authors.lastname: Lau
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Hong
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000600:supply & distribution / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral / Q000187:drug effects*; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006305:Health Status Indicators; D006801:Humans; D059012:Lost to Follow-Up; D009276:Namibia; D010818:Practice Patterns, Physicians'; D011634:Public Health; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents