WHO warns countries of growing risk of HIV drug resistance

18 July 2016 - The World Health Organization issues a new report today highlighting challenges in scaling up access to HIV treatment. It alerts countries of worrying low levels of HIV treatment adherence and retention rates and the need to ensure the quality of their HIV services to achieve long-term impact.

"HIV treatment scale up has been a great success in many developing countries so far. Most countries have been using WHO-recommended medicines," said Dr Gottfried Hirnschall, WHO's Director for Department of HIV. "But we also need to ensure that treatment services are of good quality so that the delivery of treatment is safe and effective, safeguarding against rising levels of HIV drug resistance."

Health worker in Malawi
Martha Namanya, 37 year old, is an ART clerk at Ndirenda health centre of Blantyre, Malawi. The health centre has over 10 000 people receiving antiretroviral drugs. Martha Namanya is responsible for keeping all the patient records. All patients come with their health passports that include an ISBN code. Martha Namanya keeps their records on both hard copy and in the electronic register. Based on good records maintained by health workers like Martha Namanya, all patients can easily and accurately get their prescriptions filled. Good quality documentation is an important ingredient for quality treatment.
WHO/Zakwathu Communications

The "Global report on early warning indicators for HIV drug resistance” released by WHO at the International AIDS Conference taking place in Durban, South Africa today, is based on data from more than 12 000 clinics in 59 countries. Patients receiving antiretroviral therapy (ART) were monitored between 2004 and 2014.

The new report documents existing gaps in the quality of ART services. While almost all patients (99%) were being prescribed WHO-recommended antiretroviral drugs, many were also missing routine check-ups and disappearing from patient records.

On average, 20% of patients were missing in patient records within a year since treatment initiation, and some 73% of patients were not retained on treatment, both indicators failing to comply with WHO targets. The report also shows that 36% of surveyed clinics experienced interruptions in the supply of their ARV drugs, resulting in drug stock-outs.

“The report calls for a renewed global focus on HIV drug resistance as countries further expand ‘treat all’ programmes for wider health and prevention benefits," said Dr Meg Doherty, WHO Coordinator on HIV Treatment and Care. "Out of 144 low- and middle-income countries only 59 monitored programme factors favouring the emergence of HIV drug resistance using the WHO early warning indicator system. This needs to change!"

The report reaffirms the need for a new Global Action Plan for HIV Drug Resistance (HIVDR), which WHO is currently developing in consultation with partners and other stakeholders. WHO reported that up to 2010, HIVDR levels remained moderate at 7% in developing countries. However, recently, some countries have reported levels at or above 10% amongst those starting HIV treatment, and up to 40% among people re-starting treatment. These reports merit attention and stress the urgent need to intensify the routine implementation of nationally representative HIVDR surveys.

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Tunga Namjilsuren
Information Manager