Population-Based Monitoring of HIV Drug Resistance in Namibia With Early Warning Indicators

Hong, Steven Y.; Jonas, Anna; Dumeni, Efraim; Badi, Alfons; Pereko, Dawn; Blom, Abraham; Muthiani, Victor S; Shiningavamwe, Andreas; Mukamba, James; Andemichael, Ghirmay; Barbara, Rony; Bennett, Diane; Jordan, Michael R.

doi:10.1097/qai.0b013e3181f5376d

Cited by 29 publications

(35 citation statements)

References 19 publications

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“…[15] In 2010, Namibia analyzed these same EWIs, scaling up from nine to 33 ART sites. [16] In 2012, Namibia utilized the updated WHO guidelines for EWI data abstraction at 50 ART sites.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the World Health Organization’s HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia

et al. 2016

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BackgroundThe World Health Organization (WHO) early warning indicators (EWIs) of HIV drug resistance (HIVDR) assess factors at individual ART sites that are known to create situations favourable to the emergence of HIVDR.MethodsIn 2014, the Namibia HIV care and treatment program abstracted the following adult and pediatric EWIs from all public ART sites (50 main sites and 143 outreach sites): On-time pill pick-up, Retention in care, Pharmacy stock-outs, Dispensing practices, and Viral load suppression. Comparisons were made between main and outreach sites and between 2014 and 2012 using the Wilcoxon signed-rank test in a matched analysis.ResultsThe national estimates were: On-time pill pick-up 81.9% (95% CI 81.1–82.8) for adults and 82.4% (81.3–83.4) for pediatrics, Retention in care 79% retained on ART after 12 months for adults and 82% for pediatrics, Pharmacy stock-outs 94% of months without a stock-out for adults and 88% for pediatrics, and Dispensing practices 0.01% (0.001–0.056) dispensed mono- or dual-therapy for adults and 0.01% (0.001–0.069) for pediatrics. Viral load suppression was significantly affected by low rates of Viral load completion. Main sites had higher On-time pill pick-up than outreach sites for adults (p<0.001) and pediatrics (p<0.001), and no difference between main and outreach sites for Retention in care for adults (p = 0.761) or pediatrics (p = 0.214). From 2012 to 2014 in adult sites, On-time pill pick-up (p = 0.001), Retention in care (p<0.001), and Pharmacy stock-outs (p = 0.002) worsened. In pediatric sites, On-time pill pick-up (p<0.001) and Pharmacy stock-outs (p = 0.012) worsened.ConclusionsResults of EWIs monitoring in Namibia provide evidence about ART programmatic functioning and contextualize results from national surveys of HIVDR. These results are worrisome as they show a decline in program performance over time. The national ART program is taking steps to minimize the emergence of HIVDR by strengthening adherence and retention of patients on ART, reducing stock-outs, and strengthening ART data quality.

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“…[15] In 2010, Namibia analyzed these same EWIs, scaling up from nine to 33 ART sites. [16] In 2012, Namibia utilized the updated WHO guidelines for EWI data abstraction at 50 ART sites.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the World Health Organization’s HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia

et al. 2016

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“…Several countries are using EWI in order to focus efforts towards improving healthcare delivery in those settings with suboptimal EWI scores. [4][5][6] Although these ''system-level'' factors are useful at a programmatic and regional level, clinicians need ''individuallevel'' factors that could help identify and predict which patients may be at risk of VF while on ART or prior to initiation. While many studies have explored psychosocial, structural, or clinical factors associated with clinic retention, ART adherence or VF, none have attempted a comprehensive assessment in this setting.…”

Section: Introductionmentioning

confidence: 99%

Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic

Marconi

Hampton

et al. 2013

AIDS Patient Care and STDs

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We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ‡ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL) > 1000 copies/mL] and controls (2:1) if they had VL £ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF ( p < 0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

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“…Based on 2008 antenatal sero-surveillance data, an estimated 17.8% Namibians aged 15 -49 years were infected with HIV [2]. Namibia had an estimated 14.3% HIV prevalence between the ages of 15 and 49 years in 2013.…”

mentioning

confidence: 99%

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

Shanyengana¹,

Mukesi²,

Colf³

et al. 2016

WJA

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Elevated alanine aminotransferase (ALT) levels in Human Immunodeficiency Virus (HIV) infected people is a major concern in the world and especially in Africa. It may lead to liver failure and even death. Certain antiretroviral (ARV) drugs, such as nevirapine and efavirenz, are known to cause toxicity. Other causes of elevated ALT are viral hepatitis, the HIV virus itself and other drugs such as anti-tu-berculosis drugs and alcoholism. The study aimed at determining the prevalence of elevated ALT levels in HIV positive patients on antiretroviral therapy during the period 2013 to 2014. This was a retrospective study which included 267 patient records from Katutura and Windhoek Central hospitals in Windhoek, Namibia. The subjects' ages ranged from 21 to 82 years. The patients enrolled were on the first line treatment and their ALT levels were recorded at each monitoring period. ALT levels, viral hepatitis results and the antiretroviral therapy (ART) regimen were the most important aspects included in the study. Out of 267 patients, 18% had ALT elevation associated with grade 1 to 4 toxicity levels. The study found that 1.4% of patients developed severe liver toxicity (grade 3 and 4 toxicity). Toxicity occurred throughout the treatment period but was the highest at six months of treatment. Patients on nevirapine based regimens had lower toxicity compared to those receiving efavirenz based regimens. Patients who had HIV and viral hepatitis co-infection had high toxicity although the study found no severe hepatotoxicity in these patients.

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Population-Based Monitoring of HIV Drug Resistance in Namibia With Early Warning Indicators

Cited by 29 publications

References 19 publications

Assessment of the World Health Organization’s HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia

Assessment of the World Health Organization’s HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia

Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic

Serum Alanine Aminotransferase Elevations in HIV Positive Patients on Antiretroviral Therapy in Namibia

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