Global Action Plan on HIV Drug Resistance 2017–2021. Geneva: World Health Organization; 2017
(2017; 40 pages)

Abstract

Combatting antimicrobial resistance (AMR) is a global priority that needs coordinated action across all government sectors and levels of society. Minimizing the emergence and transmission of HIV drug resistance (HIVDR) is a vital part of the global commitment to address the challenges of AMR. Increasing levels of resistance to commonly used antiretroviral (ARV) drugs could jeopardize the success of the scale-up of antiretroviral therapy (ART), and the broader HIV response, if not urgently addressed.

WHO’s Report on HIV drug resistance 2017 demonstrates a steady increase in the prevalence of HIVDR in individuals initiating first-line ART since 2001, most notably in Southern and Eastern Africa. The prevalence of HIVDR in people initiating first-line ART (pretreatment resistance: PDR) was 6.8% in 2010, and estimates from recent nationally representative surveys indicate levels of PDR above 10% to the WHO-recommended and widely used first-line ARV drugs in many countries.

At the end of 2016, 19.5 million people were taking life-saving ART. WHO’s recommendation to “treat all” will result in an additional 17.2 million individuals starting ART, to reach a total of 36.7 million people who must be successfully maintained on treatment for life. HIVDR is associated with poor clinical outcomes and reduced effectiveness of ARV drugs. As HIV treatment continues to be scaled up, the global community needs to be vigilant about the emergence of HIVDR and the urgent need to protect the effectiveness of currently available and new ARV drugs.

Preventing and managing the emergence of HIVDR is a key component of a comprehensive and effective HIV response, and should be integrated into broader efforts to ensure sustainability and greatest impact. It is essential that actions to monitor, prevent and respond to HIVDR are implemented at the clinical, programme and policy levels to address the many drivers of HIVDR.

The goal of this Global Action Plan is to articulate synergistic actions that will be required to prevent HIVDR from undermining efforts to achieve global targets on health and HIV, and to provide the most effective treatment to all people living with HIV including adults, key populations, pregnant and breastfeeding women, children and adolescents. The Global Action Plan has five strategic objectives: 1) prevention and response; 2) monitoring and surveillance; 3) research and innovation; 4) laboratory capacity; and 5) governance and enabling mechanisms. It is built on the guiding principles of a public health approach; comprehensive, coordinated and integrated action; country ownership; a focus on high-impact countries; sustainable investment; and use of standardized methods to monitor resistance and achieve impact from actions.

The Global Action Plan was developed with the full involvement of key partners (e.g. CDC, the Global Fund and PEPFAR). It provides countries and national and international partners with a framework, which – when implemented collectively between 2017 and 2021 – will contribute to the achievement of the Fast-Track global targets of 90-90-90 by 2020 (90% of all people living with HIV will know their HIV status; 90% of all people diagnosed with HIV infection will receive ART; and 90% of all people accessing ART will have viral load suppression), and to ending the AIDS epidemic as a public health threat by 2030.

 
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