kiesling abstract

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ASSESSMENT OF THE WORLD HEALTH ORGANIZATION EARLY WARNING INDICATORS OF HIV DRUG RESISTANCE IN NAMIBIA FOR PUBLIC HEALTH ACTION, 2015

Nicholus Mutenda1, Tuli Nakanyala1, Ndapewa Hamunime1, Tadesse Mekonen1, Francina Tjituka1, Salomo Natanael1, Greatjoy Mazibuko2, Samson Mwinga2, David Mabirizi3 , Evans Sagwa2, Helena Walkowiak4, Alexandra Kiesling5, Samuel Aptekar5, Michael R. Jordan5,6, Steven Y. Hong5,6

1Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia, 2Systems for Improved Access to Pharmaceuticals and Services program, Management Sciences for Health, Windhoek, Namibia, 3Systems for Improved Access to Pharmaceuticals and Services program, Management Sciences for Health, Arlington, USA, 4Systems for Improved Access to Pharmaceuticals and Services program, Management Sciences for Health, New York USA, 5Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA, 6Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA

Abstract no. TUPDB0101


Background• Early warning indicators (EWIs) of HIV drug resistance (HIVDR)

– foundational element of the World Health Organization (WHO) public health strategy to minimize and monitor emergence of HIVDR in countries rapidly scaling up antiretroviral treatment (ART)

– site-specific, quality-of-care indicators that assess factors associated with virological failure and emergence of HIVDR

– identify gaps in service delivery for which corrective action can be taken at the ART site or program level

– provide necessary program context for interpretation of WHO surveys of HIVDR

– should be monitored annually at all treatment sites and integrated into ART program M&E and continuous quality improvement initiatives

• Namibia has instituted a routine EWI monitoring system and developed HIVDR survey strategies


Methods• In 2015, Namibia abstracted the following WHO EWIs:

– On-time Pill Pick-up– Retention in Care at 12 months– Pharmacy Stock-outs– Dispensing Practices– Viral Load Suppression at 12 months– Viral Load Completion at 12 months

• EWIs abstracted from adult and paediatric patients from all ART sites in the state health sector: 50 main ART sites and 163 outreach points

• WHO-recommended definitions and targets used, based on three classifications: – green (excellent performance, achieving desired level)– amber (fair performance, not yet at desired level)– red (poor performance, below desired level)– grey (insufficient data)


Geospatial location of 213 ART sites for EWI monitoring, 2015


Results• On-time Pill Pick-up:

– Adults: 45% of sites (excellent >90% or fair 80-90%)– Children: 40% of sites

• Retention in Care at 12 months – Adults: 54% of sites (excellent >85% or fair 75-85%)– Children: 38% of sites

• Pharmacy Stock-outs– Adults: 5% of sites (excellent 100% of months with no stock-outs)– Children: 14% of sites

• Dispensing Practices– Adults: 97% of sites (excellent 0% mono- or dual-therapy)– Children: 91% of sites

• Viral Load Suppression at 12 months– Low rates of Viral Load Completion among patients eligible for routine viral

load testing significantly affected monitoring of Viral Load Suppression


Conclusion• Namibia has successfully institutionalized EWI monitoring

into routine ART program functioning• Strengthening patient adherence, retention in care, and

ensuring the continuous availability of ART medicines are all high priorities to minimize emergence of HIVDR and achieve the 90-90-90 (HIV epidemic control) goals

• Improving routine viral load monitoring and data capturing is a priority to enable monitoring of viral load suppression rates

• As a result of these data, program leaders and healthcare providers in regions throughout the country are implementing service quality improvement projects and operational research to improve patient care and minimize the emergence of HIVDR

kiesling abstract

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