Figure 2: Algorithm to reduce risks of HIV drug resistance at the ART site

Collect and analyze data on Early Warning Indicators(**) using pharmacy stock records, patient registers and the records of patients on ARV treatment

% of months without ARV stock-out during the past year

% of patients starting ART to whom an appropriate 1st line ART regimen was prescribed

Rate of lost to follow up

% of patients who picked up on timeall the prescribed ARV drugs

% Retention on first line ART regimen, 12 monthsafter initiation

< 100%

100%

< 100%

> 20%

≤ 20%

< 90%

≥ 90%

< 70%

•You have a well functioning ART programme•Continue to ensure good quality of ART

services to your patients

Strengthen the management system andsupply of ARVs

•Refresher/training for prescribers•Strengthen supervision and mentoring

•Allocate adequate human resources to find lost to folow-up patients• Strengthen community care •Fight against discrimination and stigma in health facilities

• Improve counseling services and adherence support

• Rearrange pharmacy services (Opening hours, waiting room, etc...)

Improve the quality of care and patients monitoring tools

What to do for reducing risks of HIV drug resistancein PLWHAs management centres/units

≥ 70%

100%

% Patients with viral loads <1000 copies RNA at 12 months from the beginning of 1st line ART

Conduct a cohort study of patients on 1st line ART regimen (viral load tests, genotyping)

•Perform genotyping for patients with a viralload > 1000 RNA copies/ml to identify ARVs against which resistances are observed•Analyze the factors that determine the resistance profiles and propose appropriate actions

(**) Use the national protocol for assessing EWI( Early warning indicatorsfor HIV drug resistance)

Key actionsFindingsStrategies

≥ 70%

< 70%