Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
AIDS Rev. 2013 Oct-Dec;15(4):221-9.
Tremendous progress has been made with the scale-up of antiretroviral therapy in Africa, with an estimated seven million people now receiving antiretroviral therapy in the region. The long-term success of antiretroviral therapy programs depends on appropriate strategies to deal with potential threats, one of which is the emergence and spread of antiretroviral drug resistance. Whilst public health surveillance forms the mainstay of the World Health Organization approach to antiretroviral drug resistance, there is likely to be increasing demand for access to drug resistance testing as programs mature and as HIV clinical management becomes more complex. African-owned research initiatives have helped to develop affordable resistance testing appropriate for use in the region, and have developed delivery models for resistance testing at different levels of the public health system. Some upper-middle-income countries such as Botswana and South Africa have introduced drug resistance testing for selected patient groups to guide clinical management. The scale-up of resistance testing will require substantial expansion of clinical and laboratory capacity in the region, but the expertise and resources exist in Africa to support this. The long-term population health impact and cost-effectiveness of resistance testing in the region will also require further investigation.
在非洲，抗逆转录病毒疗法的规模扩大方面取得了巨大进展，该地区估计有 700 万人正在接受抗逆转录病毒疗法。抗逆转录病毒疗法项目的长期成功取决于应对潜在威胁的适当策略，其中之一是抗逆转录病毒药物耐药性的出现和传播。虽然公共卫生监测构成了世界卫生组织对抗逆转录病毒药物耐药性方法的基础，但随着项目的成熟和 HIV 临床管理变得更加复杂，对耐药性检测的需求可能会增加。非洲拥有的研究计划有助于开发适合该地区使用的具有成本效益的耐药性检测方法，并为公共卫生系统不同层面的耐药性检测制定了交付模式。博茨瓦纳和南非等一些中等偏上收入国家已经为选定的患者群体引入了耐药性检测，以指导临床管理。耐药性检测的扩大将需要该地区临床和实验室能力的大幅扩大，但非洲拥有支持这一能力的专业知识和资源。该地区耐药性检测的长期人口健康影响和成本效益也需要进一步研究。
