Monitoring HIV Drug Resistance: Early Warning Indicators to Assess Performance of Thailand’s Antiretroviral Treatment Program
Cheewanan Lertpiriyasuwat MD, MPH*, Achara Teeraratkul MD, MSc**, Yolsilp Suchonwanich MD***, Nartlada Chatharojwong MSc**, Kunjanakorn Phokasawad MEc**, Porntip Yuktanon MS*, Naparat Pattarapayoon MBE*, Sorakij Bhakeecheep MD***, Silvia Bertagnolio MD****, Thierry H Roels MD, MSc**, Sombat Thanprasertsuk MD, MPH*****
Affiliation : * Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand ** Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand *** National Health Security Office, Bangkok, Thailand **** HIV Department, World Health Organization, Geneva, Switzerland ***** Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
Objective : To describe trends in Thailand’s antiretroviral treatment (ART) program performance assessed by HIV drug
resistance early warning indicators (EWIs), as recommended by WHO, between 2009 and 2013.
Material and Method: Seven EWIs were monitored, viral load (VL) testing coverage, VL suppression, retention in ART,
lost to follow-up (LTFU), antiretrovirals (ARVs) dispensing practices, on-time pill pick-up, and pharmacy stock-outs. Data
from ART adult patients in National Health Security Office Scheme were analyzed except for pharmacy stock-outs, which
were reported from hospitals. Aggregated averages were calculated for each EWI. Chi-square for trend was applied to
measure significant changes.
Results : By September 2013, 174,284 adults were receiving ART at 929 hospitals. Over time, improvement in VL testing
coverage (53.8% in 2009 to 79.8% in 2013) was observed. VL suppression and on-time pill pick up rates were well above
90%. Rates of retention in ART declined from 84.0 to 82.9%, whereas LTFU rates increased from 8.3 to 9.2% (p<0.001).
Prescriptions with inappropriate ARVs decreased from 0.32 to 0.10% (p<0.001). Of reporting hospitals, 96.1%, 96.3%,
and 96.2% observed no ARVs stock-out between 2011 and 2013.
Conclusion : EWI is a useful tool to monitor ART program performance and to identify area where improvement is needed.
Keywords : HIV, Drug resistance, Early warning indicator, Antiretroviral treatment, Thailand
