Surveillance of antibiotic use in the private sector in Namibia using sales and claims data.

Introduction: Antibiotics are among the most commonly used therapeutic agents for humans globally, and their use has been associated with the development of resistance. The objective of this study was to identify sources for quantifying antibiotic usage patterns and to assess such use in ambulatory patients in the private health sector of Namibia.

Methodology: A retrospective analysis of prescription claims data and sales data for the period 2008 to 2011 was conducted.

HIV drug resistance early warning indicators in Namibia for public health action.

Background: HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, therefore antiretroviral therapy (ART) program and site factors known to be associated with emergence of HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR.

Methods: In 2010, Namibia selected five World Health Organization Early Warning Indicators (EWIs) and scaled-up monitoring from 9 to 33 ART sites: ART prescribing practices, Patients lost to follow-up (LTFU) at 12 months, Patients switched to a second-line regimen at 12 months, On-time antiretroviral (ARV) drug pick-up, and ARV drug-supply continuity.

Results: Records allowed reporting on three of the five selected EWIs.

Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia.

The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation.

Population-based monitoring of HIV drug resistance in Namibia with early warning indicators.

Introduction: HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, therefore, antiretroviral therapy (ART) program and site factors known to be associated with HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR.

Methods: In 2009, Namibia selected 5 World Health Organization Early Warning Indicators (EWIs) and piloted abstraction at 9 ART sites: "ART prescribing practices, patients lost to follow-up at 12 months, patient retention on first-line ART at 12 months, on-time antiretroviral drug pick-up, and antiretroviral drug-supply continuity".

Results: Records supported monitoring of 3 of 5 selected EWIs.