Transcript Assessment of the World Health Organization ealy warning

Assessment of the World Health
Organization early warning
indicators of HIV drug resistance in
Namibia, 2016
N. Mutenda1, T. Nakanyala1, N. Hamunime1, T. Mekonen1, F. Tjituka1, S.
Natanael1, G. Mazibuko2, S. Mwinga2, D. Mabirizi2, E. Sagwa2, H.
Walkowiak2, R. Indongo3, A. Kerrigan4, S. Hong4
1. Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services,
Windhoek, Namibia, 2. Systems for Improved Access to Pharmaceuticals and Services program,
Management Sciences for Health, Windhoek, Namibia, 3. United States Agency for International
Development, Windhoek, Namibia, 4. Division of Geographic Medicine and Infectious Diseases, Tufts
Medical Center, Boston, Massachusetts, USA
Outline
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Background + Objectives
Methods/Description/Intervention
Results/Lessons Learned
Conclusions
Recommendations/Next Steps
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Background + Objectives
• 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 at least annually at all treatment sites and
integrated into ART program M&E and continuous quality improvement
initiatives
• EWIs have been shown to be associated with and predictive of
HIVDR (St-Jean M, HIV Medicine 2016)
• Namibia has instituted a routine EWI monitoring system and
developed HIVDR survey strategies
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Methods/Description/Intervention
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In 2016, we abstracted the following WHO EWIs from adult and paediatric patients
from all ART sites (50 main ART sites and 199 outreach points) in the state health
sector:
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WHO-recommended definitions and targets used, based on three classifications:
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EWI 1: On-time Pill Pick-up
EWI 2: Retention in Care at 12 months
EWI 3: Pharmacy Stock-outs
EWI 4: Dispensing Practices
EWI 5: Viral Load Suppression at 12 months
EWI 5a: Viral Load Completion at 12 months.
green (excellent performance, achieving desired level)
amber (fair performance, not yet at desired level)
red (poor performance, below desired level)
grey (insufficient data)
Data source:
– Electronic Dispensing Tool (EDT)
– Electronic Patient Management System (ePMS)
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Geospatial location of 249 ART sites for EWI monitoring, 2016
Results/Lessons Learned
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On-time Pill Pick-up:
– Adults: 35% of sites (excellent >90% or fair 80-90%)
– Children: 35% of sites
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Retention in Care at 12 months
– Adults: 36% of sites (excellent >85% or fair 75-85%)
– Children: 39% of sites
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Pharmacy Stock-outs
– Adults: 4% of sites (excellent 100% of months with no stock-outs)
– Children: 2% of sites
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Dispensing Practices
– Adults: 96% of sites (excellent 0% mono- or dual-therapy)
– Children: 97% of sites
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Viral Load Suppression at 12 months
– Adults: 104/121 (86% of sites with available data) (excellent ≥90% or fair 80 to <90%)
– Children: 44/66 (67% sites with available data)
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Viral Load Completion at 12 months
– Adults: 7% of sites (excellent ≥70%)
– Children: 13% of sites
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National Aggregate Results
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On-time Pill Pick-up: (% of patients picking up ART on time)
– Adults: 75%
– Children: 80%
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Retention in Care at 12 months (% of patients retained on ART at 12 months)
– Adults: 77%
– Children: 86%
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Pharmacy Stock-outs (% of months with no stock-outs)
– Adults: 63%
– Children: 58%
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Dispensing Practices (% of patients dispensed mono- or dual-therapy)
– Adults: <1%
– Children: <1%
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Viral Load Suppression at 12 months (% of patients suppressed at 12 months)
– Adults: 93%
– Children: 84%
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Viral Load Completion at 12 months (% of patients with result at 12 months)
– Adults: 48%
– Children: 56%
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Conclusions
1. Namibia has successfully institutionalized EWI
monitoring into routine ART program functioning
2. Many sites performed sub-optimally in adherence and
retention in care
3. A national stock-out seems to have occurred affecting
almost all sites
4. Almost no sites dispensed mono- or dual-therapy
5. Many sites performed well in viral load suppression
6. Many sites did not meet the targets for viral load
completion
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Recommendations/Next steps
• Strengthening patient adherence to treatment, retention in
care, and ensuring the continuous availability of
antiretroviral medicines are all high priorities to minimize
emergence of HIVDR and achieve the 90-90-90 (HIV
epidemic control) goals.
• Additionally, improving routine viral load monitoring and
data capturing is a priority to ensure accuracy of viral load
suppression rates.
• As a result of EWIs, 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
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Acknowledgements
• MoHSS
• Management Sciences
for Health/USAID
• Tufts University/Tufts
Medical Center
• World Health
Organization
• Namibia Institute of
Pathology
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