Final Report Summary - UNITE-MORE (Uniformity in testing and monitoring HIV resistance)
The mission of the UNITE-MORE project was to support the establishment of a uniform global network for human immunodeficiency virus (HIV) drug resistance (DR) surveillance and monitoring, including standardised laboratory procedures and quality assurance programmes that provide governments, scientists and (inter-) national, European and World Health Organization (WHO) policymakers with relevant and comparable global data on the prevalence, transmission and trends of HIV DR, by coordinating actions under the European Spread network with, WHO's global programme including liaison with WHO's advisory body, HIVResnet.
The activities of UNITE-MORE in collaboration with the WHO and partners can be divided into three main areas:
(i) supporting the selection and validation of national HIV drug resistance working groups in several countries in Eastern-Europe, Africa, Asia and Latin- and South-America;
(ii) supporting the development of common clinical laboratory standards for the detection of HIV resistance (standard protocols, sample collection methods and standard data storage and analysis);
(iii) supporting the training and operational activities of the country 'Ministry of health' (MOH)/WHO HIV drug resistance working groups.
(1) Selection of national HIV drug resistance working groups
a. Ukraine and the Russian Federation were identified as key countries for UNITE MORE activities in eastern Europe and a joint mission by WHO and UNITE MORE was undertaken in June 2005. During this mission various meetings were organised with MOH officials responsible for laboratory, clinical and epidemiological aspects of HIV drug resistance surveillance in both countries. Following this, a in-country working group on HIV DR was formed in Ukraine. Follow-up on protocol development and laboratory set up were done by regular email and telephone contact with WHO officials in the respective countries. Also, a successful follow-up meeting was organised between MOH officials from Ukraine and Russia, WHO and Spread representatives to discuss the coordination of the WHO studies with the roll-out of the Spread network.
b. UNITE MORE also met with Rwandan MOH officials to prepare a grant application also focusing on capacity building for HIV DR. Funding for HIV drug resistance testing is limited in Rwanda and the identification of additional funding extremely important. UMC Utrecht together with the Rwandan partners agreed to apply for a grant for this purpose as part of a Dutch multi-partner grant from the Dutch government. WHO was not yet actively involved in this preparatory work. The grant application was accepted and work in the framework of this project was started December 2005.
c. Indonesia was identified as UNITE MORE key country in Asia and a joint mission by WHO and UNITE MORE was undertaken in October 2005. During this visit, various meetings were organised together with the working group on HIV DR, which was formed previously, and the strategy for HIV DR surveillance protocol for Indonesia was discussed in detail. Also during this visit, 3 laboratories were evaluated concerning their HIV DR testing capacity. This was done using the tools predominantly developed by UNITE MORE, in collaboration with others, to allow a standardised approach in laboratory assessment.
(2) Support to the WHO HIV DR laboratory network and the development of common laboratory standards
UNITE MORE played a leading role in the design and development of the WHO/HIVResnet global laboratory network for HIV drug resistance testing. UNITE MORE and WHO, together with various others, are in the process of drafting the 'WHO/HIVResnet global HIV drug resistance testing laboratory network' document. This document contains recommendations on various issues related to HIV drug resistance testing: guidelines on standard operation procedures (specimen collection, shipment and storage, genotyping) including a special section on the use of dried blood spots for the purpose of genotyping as well as specifications on quality control and quality assurance. It also contains a section on the design of the WHO HIVResNet Laboratory Network Structure, as well as information on Laboratory Assessment (procedure and criteria). The content of this document was the result of several discussions with international experts during several WHO/HIVResnet laboratory working group meetings, with active UNITE MORE participation. One of these meetings was organised in Utrecht by UNITE MORE. UNITE MORE took the lead in the development of some specific documents within this network.
The work done in this project is of high importance for the coordination of various European initiatives on HIV DR with the WHO global HIV DR network. The project allowed for exchange of experience, knowledge and strategy between the European network and the WHO. Also, the work done in assisting the WHO in the development of the specifics of such a network was invaluable. This global network will be vital to generate quality assured genotyping information to assess surveillance and monitoring of HIV DR in resource-poor settings.
The activities of UNITE-MORE in collaboration with the WHO and partners can be divided into three main areas:
(i) supporting the selection and validation of national HIV drug resistance working groups in several countries in Eastern-Europe, Africa, Asia and Latin- and South-America;
(ii) supporting the development of common clinical laboratory standards for the detection of HIV resistance (standard protocols, sample collection methods and standard data storage and analysis);
(iii) supporting the training and operational activities of the country 'Ministry of health' (MOH)/WHO HIV drug resistance working groups.
(1) Selection of national HIV drug resistance working groups
a. Ukraine and the Russian Federation were identified as key countries for UNITE MORE activities in eastern Europe and a joint mission by WHO and UNITE MORE was undertaken in June 2005. During this mission various meetings were organised with MOH officials responsible for laboratory, clinical and epidemiological aspects of HIV drug resistance surveillance in both countries. Following this, a in-country working group on HIV DR was formed in Ukraine. Follow-up on protocol development and laboratory set up were done by regular email and telephone contact with WHO officials in the respective countries. Also, a successful follow-up meeting was organised between MOH officials from Ukraine and Russia, WHO and Spread representatives to discuss the coordination of the WHO studies with the roll-out of the Spread network.
b. UNITE MORE also met with Rwandan MOH officials to prepare a grant application also focusing on capacity building for HIV DR. Funding for HIV drug resistance testing is limited in Rwanda and the identification of additional funding extremely important. UMC Utrecht together with the Rwandan partners agreed to apply for a grant for this purpose as part of a Dutch multi-partner grant from the Dutch government. WHO was not yet actively involved in this preparatory work. The grant application was accepted and work in the framework of this project was started December 2005.
c. Indonesia was identified as UNITE MORE key country in Asia and a joint mission by WHO and UNITE MORE was undertaken in October 2005. During this visit, various meetings were organised together with the working group on HIV DR, which was formed previously, and the strategy for HIV DR surveillance protocol for Indonesia was discussed in detail. Also during this visit, 3 laboratories were evaluated concerning their HIV DR testing capacity. This was done using the tools predominantly developed by UNITE MORE, in collaboration with others, to allow a standardised approach in laboratory assessment.
(2) Support to the WHO HIV DR laboratory network and the development of common laboratory standards
UNITE MORE played a leading role in the design and development of the WHO/HIVResnet global laboratory network for HIV drug resistance testing. UNITE MORE and WHO, together with various others, are in the process of drafting the 'WHO/HIVResnet global HIV drug resistance testing laboratory network' document. This document contains recommendations on various issues related to HIV drug resistance testing: guidelines on standard operation procedures (specimen collection, shipment and storage, genotyping) including a special section on the use of dried blood spots for the purpose of genotyping as well as specifications on quality control and quality assurance. It also contains a section on the design of the WHO HIVResNet Laboratory Network Structure, as well as information on Laboratory Assessment (procedure and criteria). The content of this document was the result of several discussions with international experts during several WHO/HIVResnet laboratory working group meetings, with active UNITE MORE participation. One of these meetings was organised in Utrecht by UNITE MORE. UNITE MORE took the lead in the development of some specific documents within this network.
The work done in this project is of high importance for the coordination of various European initiatives on HIV DR with the WHO global HIV DR network. The project allowed for exchange of experience, knowledge and strategy between the European network and the WHO. Also, the work done in assisting the WHO in the development of the specifics of such a network was invaluable. This global network will be vital to generate quality assured genotyping information to assess surveillance and monitoring of HIV DR in resource-poor settings.