Using early warning indicators to prevent HIV drug resistance

Overview

Early warning indicators (EWIs) of HIV drug resistance (HIVDR) are a key component of the World Health Organization (WHO) public health strategy to minimize and assess HIVDR in countries scaling up antiretroviral therapy (ART). EWIs are quality of care indicators which specifically assess factors at individual antiretroviral therapy clinics associated with emergence of HIVDR. Where widely implemented, EWIs provide the necessary programmatic context to interpret results of surveys of transmitted and acquired HIVDR. 

The advisory panel review meeting was held in Geneva in August 2011 to consider revisions of the existing EWIs and associated targets. After a critical review of available medical literature using the GRADE methodology, recommendations were developed to simplify EWI definitions, account for implementation challenges, harmonize with other routinely reported indicators and adjust EWI definitions and targets based on new evidence. 

The recommended set of indicators which is designed to be implemented as a package includes a total of five indicators, one of which (viral load suppression at 12 months), is considered and is designed to be implemented only at clinics where routine viral load monitoring is performed for all patients 12 months after ART initiation.

In the course of 2014 these indicators will be integrated in consolidated guidelines on monitoring and evaluation of the health sector response to HIV. As part of this integration process, methods to report on the indicator “viral load suppression at 12 months” will be updated.