WHO

1. WHO/AFRO HIV Drug Resistance (HIVDR) Monitoring Program Laboratory Support for the HIV/AIDS Regional Program

2. Presentation Outline Background of the HIVDR and antiretroviral therapy (ART) in Africa Description of the laboratory involvement in the provision of HIVDR monitoring Highlight achievements, constraints, challenges and future perspectives in HIVDR monitoring in African Region

3. Background of the HIVDR and ART in Africa

4. Most current HIV-1 ARV drug regimens, HIVDR test and interpretation were designed mainly based on subtype B which are dominant in Europe and US, while non-B subtypes HIV infection predominate in Africa

6. When HIV treatment started, HIV medications will dramatically lower the amount of HIV in your body -- provided you take all your meds on time and your HIV isn't already drug resistant. Some HIV always survives, though, including some mutations

7. laboratory involvement in the provision of HIVDR monitoring Types of HIVDR tests Genotype tests -- look for specific mutations in the genetic structure of reverse transcriptase and protease region Phenotype tests -- measure the sensitivity of HIV to specific ARV WHO/AFRO HIVDR program Surveillance-- estimate frequency of HIVDR in untreated persons recently infected with HIV in specific geographic settings by using standard surveillance protocol Monitoring-- evaluate patterns of HIVDR mutations emerging with first line regimens in sentinel centers by using HIVDR monitoring protocol

8. Achievements (1) 2002, Organize a meeting to develop the first protocol for HIVDR monitoring in the region Countries involved: Uganda Côte d’ivoire Senegal South Africa Partners: CDC, IRD Montpellier WHO/AFRO, WHO/HQ

9. Achievements (2) 2003, A phased implementation plan to initiate in 2 countries: Senegal, South Africa Discussion started with partners to get more findings to support countries MOU signed between WHO and International Atomic Energy Agency (IAEA) Participation of WHO/HIV ResNet meeting in designated / participating genotyping Laboratories

10. Achievements (3) 2004, the first external quality assurance scheme (EQAS) for HIVDR testing was started in the Africa Reference laboratory: IRD, Montpellier, France 4 participating laboratories: Senegal: CHU Le Dantec, Dakar South-Africa: NICD (National institute for communicable diseases) Côte d’Ivoire: RETROCI Botswana: Harvard HIV reference laboratory 4 plasma samples: testing subtypes/ CRF, mutation and VL Technique used in reference Lab----in-house protocol in participating Labs---- 2 Viroseq genotyping 2 in-house premers 2005, HIVDR EQAS 4 countries + Cameroon: IMPM/IRD, Yaounde

11. Conclusions of EQAS 2004 Amplification of the samples 4/4 subtype A 73908 copies/ml 1/4 subtype D 5140 copies/ml 3/4 CRF02-AG 3120 copies/ml 4/4 subtype C 9810 copies/ml Detection of mutations all major mutations detected, more discordances for minor mutations a major NRTI mutation in CQ4 detected from treatment naive patient in 1 laboratory Interpretation of mutations important discordances for certain samples according to algoritm used

14. Achievements (4) 2005, Organize a meeting on HIVDR monitoring , Dakar, 18-20 April Discussed with CCEAC to develop a program for some Central Africa countries Organized briefing/missions to support the development of protocol for HIVDR surveillance To OCEAC (CAR, Chad, Congo, CAE, Gabon) To TAP project (Burkina Faso) Swaziland

15. Countries with HIVDR monitoring data received in AFRO

16. Constraints Limited financial support to HIVDR monitoring in the region Lack of infrastructure for HIVDR monitoring in most of countries Inadequate numbers of laboratory staff trained in the countries

17. Challenges

18. Future Perspectives Train laboratory staff in HIVDR monitoring Establish regional reference laboratories for HIVDR monitoring Re-dynamise a fully functional HIVDR monitoring network Develop a regional database on HIVDR monitoring Assist countries to have harmonized database for HIVDR monitoring

19. Plan for HIVDR Monitoring WHO/AFRO, 2006 CDC: 4 countries --Tanzania, Kenya, Mozambique and Ethiopia OPEC: 4 countries -- Burkina Faso, Swaziland, Uganda, and Zambia IAEA: 5 countries -- Cameroon, Kenya, Ethiopia, South-Africa, and Uganda TAP: 3 countries -- Ghana, Mozambique, and Burkina Faso EQAS: 8 countries