HIV drug resistance among adults and children in sub-Saharan Africa

One of the biggest medical accomplishments of the beginning of this century has been the expanded access to life-saving antiretroviral treatment for HIV-infected people living in sub-Saharan Africa. A potential downside of the large-scale exposure to antiretroviral drugs is the emergence of HIV drug resistance. This risk is increased by the weak health systems in many African countries, characterized by poor infrastructure, intermittent drug supply, and shortage of skilled staff. In order to evaluate the extent of HIV drug resistance in Africa, the PharmAccess African Studies to Evaluate Resistance (PASER) network was established in 2006. In six countries - Kenya, Nigeria, South Africa, Uganda, Zambia and Zimbabwe - over fifteen clinics participated in observational studies among HIV-infected adults. In Uganda, a pediatric study was initiated to investigate the development of HIV drug resistance among children. The studies included in this thesis were conducted as part of the PASER adult and pediatric programs.