HIV drug-resistance early-warning indicators and quality care in India: preliminary findings from a pilot study in Pune city

ABSTRACT

Background: India has rapidly scaled up its programme for antiretroviral therapy(ART). There is high potential for the emergence of HIV drug resistance (HIVDR),with an increasing number of patients on ART. It is not feasible to perform testingfor HIVDR using laboratory genotyping, owing to economic constraints. This studypiloted World Health Organization (WHO) early-warning indicators (EWIs) forHIVDR, and quality-of-care indicators (QCIs), in four ART clinics in Pune city.Methods: A retrospective study was conducted in 2015, among four ART clinicsin Pune city, India. The data on four standardized EWIs (EWI 1 On-time pill pickup, EWI 2 Retention of patients in ART care at 12 months after initiation, EWI 3Pharmacy stock-out, EWI 4 Pharmacy dispensing practices) and three QCIs(QCI 1 Regularity in CD4 testing in patients taking ART, QCI 2 Percentage ofpatients initiating ART within 30 days of medical eligibility, QCI 3 Percentage ofpatients initiating ART within 30 days of initiation of anti-tuberculosis therapy) wereabstracted into WHO Excel HIV data abstractor tools, from the patient recordsfrom April 2013 to March 2014.Results: All four ART clinics met the EWI 4 target (100%) for ART dispensingpractices. The target for EWIs on-time pill-pick (EWI 1 >90%) and pharmacy stockouts (EWI 3 no stock-outs, 100%) were achieved in one clinic. None of the clinicsmet the EWI 2 target for retention in care at 12 months (>90%) and the overallretention was 76% (95% confidence interval 73% to 79%). The targets for QCI 1and QCI 2 (>90% each) were achieved in one and two clinics respectively. Noneof the clinics achieved the target for QCI 3 (>90%).Conclusion: ART dispensing practices (EWI 4) were excellent in all clinics. Effortsare required to strengthen retention in care and timely pill pick-up and ensurecontinuity of clinic-level drug supply among the programme clinics in Pune city.The clinics should focus on regularity in testing CD4 count and timely initiation ofART