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A pilot project using 'early warning indicators' (EWIs) to minimise antiretroviral (ART) resistance in Namibia has provided further evidence of the potential value of this strategy in settings where routine viral load monitoring is not feasible. With more than four million people in the developing world now receiving antiretroviral therapy, but few of those people able to access the relatively costly laboratory tests that are a standard component of HIV medical care in wealthy countries, there is ongoing concern that high rates of undetected treatment failure could cause widespread drug resistance.