Progress of implementation of the World Health Organization strategy for HIV drug resistance control in Latin America and the Caribbean

• Published in: Revista panamericana de salud pública Vol. 30; no. 6; pp. 657 - 662
• Main Authors: Ravasi, Giovanni, Jack, Noreen, Alonso Gonzalez, Mónica, Sued, Omar, Pérez-Rosales, María Dolores, Gomez, Bertha, Vila, Marcelo, Riego, Amalia del, Ghidinelli, Massimo
• Format: Journal Article
• Language: English
• Published: United States Organización Panamericana de la Salud 01-12-2011
• Subjects: Anti-HIV Agents - pharmacology; Anti-HIV Agents - supply & distribution; Caribbean; Caribbean Region - epidemiology; Drug Resistance, Viral - genetics; Drug use; Epidemiology; Feasibility Studies; Global Health; Health Plan Implementation; Health Policy & Services; Health Surveys; HIV; HIV Infections - epidemiology; HIV Infections - virology; HIV-1 - drug effects; Humans; Latin America; Latin America - epidemiology; Organizational goals; Population Surveillance; Public health; Resistance; Sexually transmitted diseases; Surveys; Time Factors; World Health Organization; World Health Organization - organization & administration; Caribbean Region; Latin America; América Latina; resistencia a medicamentos; región del Caribe; Latin America; Caribbean region; estrategias regionales; VIH; HIV; world strategies; vigilancia epidemiológica; regional strategies; estrategias mundiales; drug resistance; epidemiologic surveillance
• ISSN: 1020-4989; 1680-5348; 1680-5348
• DOI: 10.1590/S1020-49892011001200026

By the end of 2010, Latin America and the Caribbean (LAC) achieved 63% antiretroviral treatment (ART) coverage. Measures to control HIV drug resistance (HIVDR) at the country level are recommended to maximize the efficacy and sustainability of ART programs. Since 2006, the Pan American Health Organization has supported implementation of the World Health Organization (WHO) strategy for HIVDR prevention and assessment through regional capacity-building activities and direct technical cooperation in 30 LAC countries. By 2010, 85 sites in 19 countries reported early warning indicators, providing information about the extent of potential drivers of drug resistance at the ART site. In 2009, 41.9% of sites did not achieve the WHO target of 100% appropriate first-line prescriptions; 6.3% still experienced high rates (> 20%) of loss to follow-up, and 16.2% had low retention of patients (< 70%) on first-line prescriptions in the first year of treatment. Stock-outs of antiretroviral drugs occurred at 22.7% of sites. Haiti, Guyana, and the Mesoamerican region are planning and implementing WHO HIVDR monitoring surveys or threshold surveys. New HIVDR surveillance tools for concentrated epidemics would promote further scale-up. Extending the WHO HIVDR lab network in Latin America is key to strengthening regional lab capacity to support quality assured HIVDR surveillance. The WHO HIVDR control strategy is feasible and can be rolled out in LAC. Integrating HIVDR activities in national HIV care and treatment plans is key to ensuring the sustainability of this strategy.