title: HIV drug resistance early warning indicators in namibia with updated World Health Organization guidance.
abstract: BACKGROUND
  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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Data 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.
  
  
  CONCLUSIONS
  The 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.
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.affiliation: Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia.
authors.forename: Victor
authors.initials: V
authors.lastname: Sumbi
authors.affiliation: Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia.
authors.forename: Samson
authors.initials: S
authors.lastname: Mwinga
authors.affiliation: Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Michael
authors.initials: M
authors.lastname: DeKlerk
authors.affiliation: Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia.
authors.forename: Francina
authors.initials: F
authors.lastname: Tjituka
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Penney
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.affiliation: World Health Organization Namibia, Klein Windhoek, Namibia.
authors.forename: Tiruneh
authors.initials: T
authors.lastname: Desta
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Tang
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Hong
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D009276:Namibia / Q000453:epidemiology; D017410:Practice Guidelines as Topic
chemical_list: D044966:Anti-Retroviral Agents