Monitoring Antiretroviral Therapy in Children (MARCH)
In ACTIONPlusUp program, the rate of first-line failure based on clinical and immunologic criteria is 5% in the first 12 months on antiretroviral therapy (ART) and 10-15% between 12 and 24 months. One major consequence of this strategy is the likely emergence of high level viral resistance during first-line therapy since viral replication will continue in the presence of circulating suboptimal drug concentrations.Recognizing the detrimental impact of current monitoring strategies on individual patient, the increased costs of unnecessarily switching patients to second line regimens,IHVN developed local capability for HIV-1 genotypic drug resistance testing within the Laboratory of molecular virology and research. With this new technology, the quality of care provided to PLHIVcan be improved by determining what ART drugs will be effective for patients not responding to their ART drug regimens and "failing" treatment.
Children are particularly at risk for treatment failure and the selection of drug resistant HIV variants for a number of reasons. Even before starting treatment, an infant may have already been infected with a drug resistant HIV strain if vertical transmission has occurred despite the use of prophylaxis for the Prevention of Mother-to-Child Transmission (PMTCT). Secondly, plasma viral loads are much higher in children compared with adults. As such, children require more potent ARV regimens to achieve virologic suppression. Thirdly, inappropriate dosing in the context of children's rapidly changing body weights and limited paediatric formulations increase the potential for sub-therapeutic drug concentrations. Fourthly, adherence may be negatively influenced by compliance issues in childhood and adolescence as well as inadequate preparation of medication by caregivers. Lastly, specific risk factors for HIV Drug Resistant (HIVDR) development in African children may include shortages of staff with paediatric skills, drug stock outs and limited laboratory monitoring during treatment just as in the adult population. IHVN is part of the study by 2012 and including a number of sites in Africa (see map) to build capacity for the monitoring of HIVDR in adults and children and evaluate the success of adult and pediatric ART programs to prevent or minimize HIVDR.
Working closely with the molecular diagnostic unit, the department of Implementation Science and Research provide viral load assays and molecular drug resistance determination to other IPs, private health facilities, and the federal government of Nigeria.