BRIEF
HIV DRUG RESISTANCE
GLOBAL ACTION PLAN FOR HIV DRUG RESISTANCE 2016-2021 FEBRUARY 2016
HIVDR refers to a reduction in the ability of a particular drug or combination of drugs to block replication of HIV. HIV drug resistance can be categorized as transmitted resistance, which occurs when previously uninfected individuals are infected with a drug-resistant virus; and acquired resistance, which occurs when resistance mutations emerge because of drugselective pressure in individuals receiving antiretroviral therapy.
WHY DO WE NEED A FIVE-YEAR PLAN FOR HIV DRUG RESISTANCE (HIVDR)? The World Health Organization (WHO) is committed to ensuring that the great success of HIV treatment scale-up is not threatened by HIVDR. Preventing HIVDR is an important part of meeting the 90-90-90 targets by the year 2020: 9 0% of all people living with HIV • have been diagnosed • 9 0% of all people with diagnosed HIV infection are receiving antiretroviral therapy • 9 0% of all people receiving antiretroviral therapy have suppressed viral load With the release of the new 2015 WHO guidelines recommending Treat All and PrEP, the need to monitor and address potential increases or changing patterns in HIVDR is essential. Increases in HIVDR could limit global efforts to prevent HIV transmission and achieve sustained viral suppression. If treatment failure and elevated viral loads are witnessed as the world further scales up ART, there is a risk of increased HIVDR (figure 1) which, in turn, can put current ART regimens at risk. FIGURE 1:
The development of a five-year plan reflects a global consensus that HIVDR in lower and middle-income countries requires a coordinated and resourced response. The Global Action Plan is an agreement by key partners about their respective roles in preventing, monitoring, and responding to HIVDR. WHO is the lead agency for facilitating the development of the Global Action Plan, with support from the HIV ResNet Steering Group. The plan is being developed in 2016 with involvement of key partners throughout the world, including the governments of countries impacted by HIV, civil society and NGO representatives, regional bodies, donor countries and organizations, and many others. The plan, when complete, will describe the strategies required to prevent, monitor, and contain HIVDR the roles of stakeholders at all levels to implement the plan the strategy to raise global awareness of the threat of HIVDR the resources needed for its implementation as well as a plan to mobilize the resources; and how the implementation of the plan will be monitored The plan will have five objectives. With stakeholder input, WHO will identify action steps within each objective (see reverse).
RESISTANCE
TREATMENT FAILURE
WHO/HIV/2016.02
OBJECTIVE 1: GENERATE EVIDENCE TO INFORM POLICY • Surveillance • Programmatic data • Global database for timely reporting and dissemination Data sharing at multiple levels • • Integration of HIVDR activities as a routine M&E function OBJECTIVE 2: IMPLEMENT AN INTEGRATED APPROACH TO PREVENT AND RESPOND TO HIVDR FOR SUSTAINED VIRAL LOAD SUPPRESSION (ACHIEVING THE “LAST 90”) Normative guidance to support • clinic, programmatic, national, and global actions Programmatic decisions based • on data to maximize treatment outcomes
OBJECTIVE 3: STRENGTHEN LABORATORY CAPACITY AND QUALITY • HIVDR testing capacity and quality standards • The role of next generation sequencing for surveillance • A ssuring high quality where routine programme data are used for surveillance • Capacity for genotyping for new molecules (integrase inhibitors) • A ssuring high quality where HIVDR genotyping is used for individual patient management OBJECTIVE 4: ENCOURAGE INNOVATIVE RESEARCH • O perational research to better understand resistance including in special populations • Mathematical models to inform policy decisions
• Basic science research to answer new and evolving questions in HIVDR OBJECTIVE 5: MOTIVATE COORDINATED ACTION AND MOBILIZE RESOURCES • Enhanced awareness and understanding of HIVDR among global and regional stakeholders and with countries and communities through effective communication, education, training, and public health capacity building. • Country ownership through national HIVDR working groups and national HIVDR plans • Financial sustainability of HIVDR activities • A lignment of partners through coordinated technical support and policy
TIMELINE OF ACTIVITIES ebruary to June 2016 – •F Stakeholder feedback and input •J uly 2016 International AIDS Society Conference (Durban) – Final draft for public input and comment •F ourth quarter 2016 – Launch
FIGURE 2: CONTINUUM OF HIV TESTING, PREVENTION, TREATMENT AND CARE Strategic data for decisions Step-up Prevention PrEP VMMC Strategic approaches to testing Key populations Treat All Service Quality and Delivery HIV Drug Resistance Resourcing the response
TO ADD YOUR IDEAS AND PRIORITIES See the WHO web site for ways to make comments: http://www.who.int/hiv/topics/drugresistance/en/ Email Silvia Bertagnolio at bertagnolios@who.int Attend a stakeholder meeting (see the WHO web site for the schedule)
PREVENTION
TESTING
LINK TO CARE
TREATMENT
VIRAL SUPPRESSION
For more information, contact: World Health Organization Department of HIV/AIDS 20, avenue Appia 1211 Geneva 27 Switzerland E-mail: hiv-aids@who.int www.who.int/hiv © World Health Organization 2016
BRIEF
HIV DRUG RESISTANCE