WHO HIV drug resistance strategy
The emergence of HIV drug resistance (HIVDR) is inevitable, given HIV's high replication and mutation rates and the necessity for lifelong antiretroviral treatment (ART). To maintain the effectiveness of first- and second-line antiretroviral (ARV) regimens, WHO recommends that countries develop a national strategy for HIVDR prevention and assessment.
WHO has brought together experts and institutions working in the area of HIV drug resistance to form WHO HIVResNet, a global network of individuals, institutions, and countries advising WHO on development and implementation of a public health approach to HIV drug resistance prevention and assessment. With the support of this group, WHO has developed a comprehensive strategy to minimize the emergence and transmission of HIV drug resistance, including technical briefing documents and generic protocols.
Key elements of WHO-recommended strategy
The WHO-recommended strategy provides country-level guidance for the following activities:
National HIVDR working groups
HIVDR Early Warning Indicators (EWI)
Surveys to assess acquired HIV drug resistance
Surveillance of transmitted HIV drug resistance
Surveillance of initial HIV drug resistance
National drug resistance database
Global drug resistance laboratory network
- Review of HIVDR prevention activities implemented in the country and contributing to HIVDR prevention, includes:
- National guidelines on ART eligibility and prescribing
- Resources and training to support and monitor adherence
- Removal of barriers to continuous access to care, including patient charges and transport difficulties
- Resources and personnel for follow-up of ART patients
- Ongoing quality assurance for ARV drugs
- Continuity of ARV drug supplies; monitoring of shortages
- Minimum standard ART data recording
- Prevention programs to reduce HIV transmission from persons in treatment
- Analysis of data on HIVDR and HIVDR prevention
- Annual reports
National HIVDR working groups should report on all aspects of the strategy annually, and disseminate the reports. The annual reports should include recommendations for action to prevent HIVDR emergence and transmission.
Implementation of the WHO strategy
Support from our partners
In November 2006 the Bill & Melinda Gates Foundation awarded WHO a five-year grant for $15.2 million to implement the HIVDR strategy in countries most affected by the epidemic which are scaling up access to antiretroviral therapy. In 2007, the WHO global HIVDR strategy also received support from national governments, including Spain, Canada, Italy and the U.S., and support to specific countries from numerous other partners.