Findings from the WHO/PAHO early warning indicators of HIV drug resistance monitoring system performed in Argentina.

Background In the last years, WHO developed a Global Strategy for HIV Drug Resistance Prevention and Assessment using a public health approach. This strategy supports optimal functioning of treatment programs to minimize emergence of preventable HIV drug resistance and to maintain effectiveness of first- and second-line ART regimens. Since 2011, Argentina has been monitoring some of the indicators of this strategy (called early warning indicators [EWIs]). The aim of this study was to analyze the outcomes measured during the mentioned year. Methods Based on the availability of information in the hospitals' pharmacies, where the data collection took place, and on the relevance for Argentina, some of the EWIs proposed by WHO were selected and adapted. The information is being collected since beginning of 2011, and a first analysis was performed at the end of that year. Since this was a pilot phase, 6 representative hospitals' pharmacies participated. Results Data are available for 4 of the sites. The data produced the following indicators: EWI 1a: Percentage of adult patients initiating ART who are prescribed a non-recommended first-line ART regimen (goal 0%). Site A: 22.5%; Site B: 11.1%; Site C: 0%; Site D: 2.7%. EWI 1b: Percentage of adult patients initiating ART who withdraw a non-recommended first-line ART regimen (goal 0%). Site A: 22.5%; Site B: 25.8%; Site C: 15.5%; Site D: 16.1%. EWI 2: Percentage of patients lost to follow-up 12 months after ART initiation (goal less than 20%): Site A: 41.6%; Site B: 9.3%; Site C: 22.2%; Site D: 0%. EWI 4: percentage of patients who picked up prescribed ARV drugs on time (goal:>90%): Site A: 39.1%; Site B: 72.4%; Site C: 44.5%; Site D: N/D Conclusions There is a high proportion of patients in Argentina which are prescribed non-recommended regimens, and a higher proportion withdraw these regimens from pharmacies: 75% of sites do NOT reach the goal of EWI 1a; 100% do NOT reach the goal for EWI 1b. There is also a high proportion of patients lost to follow up during the first year after treatment initiation: 50% of sites reach the goal of EWI 2. A very high proportion of patients do NOT pick-up ART on time: none of the sites reach EWI 4 goal. The use of these indicators allowed us to visualize that there is a high proportion of patients that would be nonadherent. With these data the Directorate of AIDS will improve efforts to know better the situation, understand the causes and implement strategies to increase adherence. [ABSTRACT FROM AUTHOR]