Evaluation of the early warning indicators of HIV drug resistance surveillance system in Manicaland province, Zimbabwe.

More than 1.1 million people currently receive lifelong antiretroviral treatment in Zimbabwe following the adoption of the test and treat strategy in 2017. The huge numbers of people on antiretroviral therapy (ART), combined with HIV's error-prone replication, increases the probability of HIV drug resistance (HIVDR) developing. HIVDR in resource-limited settings like Zimbabwe has significant human and financial implications. The early warning indicators of HIV drug resistance surveillance system was set up to monitor the ART programme and to identify factors that could raise the risk of HIVDR. Fifty-one health workers at 12 health facilities were interviewed in a cross-sectional study that sought to describe how the system operates and also to identify gaps (knowledge, perceived system usefulness, sensitivity) within the system. The system was seen to have multiple weaknesses including inadequate training, difficulties navigating the system, long duration of data abstraction, and poor feedback mechanisms. Opportunities observed during the evaluation centered on integration and incorporation of indicators into the electronic patient monitoring system and strengthening ownership of the programme.