ZNSP

As part of the national response to antimicrobial resistance (AMR), the Zambia Ministry of Health has been routinely implementing HIVDR surveillance in both children and adults living with HIV since 2021.

Even in settings with optimal ART program management, some degree of HIVDR is expected to emerge in populations receiving ART and may be a source spread of HIVDR. To maximize the long-term effectiveness of first-line ART and ensure the sustainability of ART programs; it is essential to monitor and minimize the further spread of human immunodeficiency virus (HIV) drug resistance (HIVDR).

Monitoring HIVDR is critical to informing treatment guidelines. Based on findings from 2021 HIVDR of 16% NNRTI resistance, Zambia fast-tracked the transition from non-nucleoside reverse-transcriptase (NNRTIs) to dolutegravir-based regimens. Capacity for HIVDR surveillance in Zambia is being strengthened for the estimation of the occurrence of HIV drug resistance among PLHIV who are on DTG-based regimens. This surveillance effort utilizes Cyclical Acquired HIV drug resistance surveillance which is a laboratory-based HIV drug resistance monitoring process. For these purposes, Continuous Acquired Drug Resistance Monitoring in Zambia (CADRE ZM) uses existing laboratory networks to conduct genetic testing on leftover viral load specimens that are routinely collected for patient care. Aside from monitoring for the emergence of HIVDR and informing HIV treatment guidelines, data from CADRE ZM is critical to understanding risk factors for HIV drug resistance.

Other considerations for HIVDR surveillance include those that seroconvert while on Preexposure prophylaxis (PrEP)

https://www.who.int/publications/i/item/9789240038608
https://www.who.int/publications-detail-redirect/978-92-4-151009-7
Lhttps://www.cdc.gov/globalhivtb/images/2024CADRE_Factsheet_MonitoringHIV.pdf