HIV Drug Resistance: Minister Harps On Surveillance

The Minister of Health, Prof. Isaac Adewole, last Monday, said surveillance and early identification of HIV drug resistance which necessitated prompt intervention, is required to prevent its effect.
Adewole made this known at a Joint Stakeholders Summit on Drug Resistance Monitoring, early Infant Diagnosis and Viral Load held in Lagos,organised by the National HIV/AIDS Control Programme (NASCP), recently.
Adewole, who was represented by the National Coordinator, National AIDs STIs Control Programme, Dr Sunday Aboje said that since the inception of the national HIV response in Nigeria, the programme had witnessed significant improvement orchestrated by the commitment of the various stakeholders.
“More people are getting to know their status and accessing HIV treatment and care; as a result, HIV related deaths are being averted.
“However, there is still pragmatic challenge such as therapy adherence and retention in care with attending issues such as HIV drug resistance, be it pre-ART or acquired among the different population groups.
“Studies have shown that the surveillance and early identification of these issues which necessitates prompt intervention is required to prevent the untold effect of HIV drug resistance, “he said.
The minister said there were still challenges in the management of HIV despite the commitment of government and donor partners to achieving global targets.
According to him, only about 8.9 per cent of infants born to HIV positive women were being tested.
“This is due to difficulty with tracking babies of HIV positive mothers delivered outside public facilities.
“Also, poor Dried Blood Spots (testing of infant blood samples) and viral load testing sample logistic systems.
“And weak mentorship and supportive supervision at the health facility levels among others, “ Adewole said.
The minister said that a well-coordinated programme involving all major implementers in the country would help solve the challenges.
He said, “Also, surmounting these challenges would require improving the implementation of the programme that will ultimately serve as good practice for other countries.”
Also speaking, a Consultant Haematologist, Prof. Sulaiman Akanmu said that regular monitoring of drug resistance mutations in form of studies carried out by institutions would help inform policies.
“The studies about drug resistance is key and any institution offering anti-retroviral therapy must expect that resistance will naturally evolve.
“We must anticipate it and put measures in place to ensure that we are able to contain it.
“Why the research is key is the fact that, unlike elsewhere, before you put a patient to anti-retroviral therapy, drug resistance testing is done to know what type of drugs the individual is sensitive to before applying the drug.
“That is not feasible in our situation; we really need to give it a public approach system in the sense that we will have to find out what is the common form of resistance that occurs in our patients.
“We use the report of the resistance testing study to inform policy on what we should consider as first line drug, second line drug and how we should manage what we call third line regimen.
“That is the reason why you must be able to do drug resistance testing,” he said.
Also, a Senior Virologist, Institute of Human Virology, Nigeria, Dr Nicaise Ndembi, said there was the need to design surveys where studies in a large scale can provide evidence-driven interventions.
Ndembi however said that the country lacked data that showed the problem of transmitted resistance.
“Basically, the concept is that if you have more exposure to anti-retroviral therapy, the virus will select resistant mutations.
“Thus, the reason why we should worry as a nation is that as we have more people being placed on treatment, we have more resistance, “
“ We need more research studies to be able to know the magnitude of the problem, “ he said.
In her remarks, a Consultant in Public Health, Prof. Phyllis Kanki, identified high cost of laboratory test, lack of patience to treatment by the patients as some challenges facing HIV treatment in the country.
“All the laboratory tests have a certain cost, that is one of the challenges and the other challenge is even though the therapy works pretty well it is still life long.
“So you have to have patience and the healthcare system be ready to support a patient for many years.
“And patients may have issues with taking the drugs, they may want to stop which can be a problem for them, “she said.