Background World Health Organization has provided countries with “Early Warning Indicators” to monitor ART sites and minimise the emergence of drug resistance, using routine information from medical and pharmacy records. In Brazil the percentage of multiexperienced people is about 8%, at brazilian universal free access, which concerns about complications in quality of life related to therapeutic failure. We evaluated two cohorts at a public health care site at Amazonas state,to propose the indicators validation on this population.

Methods Through electronic local system and following the WHO methodology, patients who started ART treatment twelve months ago, and received care at the unit, were selected for WHO sample size indicated. The research resulted in 315 adults.

Results As results were compared to the original WHO indicators for EWI 1 (percentage of ART prescribing practises with appropriate first-line regimen) at the studied site were 91% and 95%, for 2009 and 2010 respectively, WHO recommends 100% for this indicator. EWI 2 (patients lost of follow-up 12 months after ART initiation): 30% (2009) and 36% (2010) (WHO = less than 20%). EWI 3 (patients on appropriate first-line regimen 12 months after ART initiation): 40% (2009) and 49% (2010); (WHO = up to 70%). About 75% picked up ART drugs on time (EWI 4), instead WHO recommends up to 90%.EWI 8 (patients with viral load supression after 12 months of ART): 31% for 2009, and 30% (2010),WHO recommends up to 70%.

Conclusions EWI were implemented in other Latin America countries to determine a valid tool compared to viral load. Brazil does not have yet a national monitoring system to monitor sites. This one, located at an HIV late diagnosis area showed deficit in maintenance in care. The managers need to improve monitoring adherence and prevent HIV resistance by therapeutic failure, since there was not any local indicator which achieved WHO recommendations.