Adherence, Effectiveness and Safety of Dolutegravir Based Antiretroviral Regimens among HIV Infected Children and Adolescents in Tanzania

Mutagonda, Ritah; Mlyuka, Hamu J; Maganda, Betty A; Kamuhabwa, Appolinary

doi:10.1177/23259582221109613

Cited by 18 publications

(10 citation statements)

References 36 publications

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“…Results are higher than those found in the NAMSAL trial (31%) (10) possibly because the trial used self-reports combined with pill count. Results are, however, consistent with a crosssectional study (11), and a prospective cohort in Tanzania (22).…”

Section: Prevalence Of Suboptimal Adherence To Dolutegravir-based Art...supporting

confidence: 86%

Prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among people living with HIV in a specialized clinic in Kampala, Uganda

Namakula,

Mugerwa,

Kitutu

et al. 2023

Preprint

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Background Suboptimal adherence to dolutegravir is up to 31% globally. In Uganda, 54% of people living with HIV(PLHIV) on first-line Antiretroviral Therapy (ART) were taking dolutegravir-based regimens. This study aimed to determine the prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens in PLHIV in a specialized clinic in Uganda. Methods We conducted a cross-sectional study with both quantitative and qualitative aspects in a specialized HIV clinic in Kampala, Uganda, from July 2022 to August 2022. We collected quantitative data, using questionnaires, and data abstraction tools; from 366, consecutively sampled, and consented PLHIV. We collected qualitative data using in-depth interviews, among 13 purposively sampled, consented participants. We analyzed quantitative data using modified Poisson regression in STATA, to obtain factors associated with suboptimal adherence at the 5% level of significance. Qualitative data was analyzed using thematic analysis in Open Code. Results The prevalence of suboptimal adherence to dolutegravir-based regimens was 49% (179/366; 95%Confidence Interval (CI): 44–54). Alcohol consumption (adjusted Prevalence Ratio (aPR): 1.25; 95%CI: 1.012–1.543), being unemployed (aPR: 1.27; 95%CI: 1.002–1.609), not having neighbor’s support (aPR: 0.78; 95%CI: 0.619–0.993), and participants who preferred to talk to the doctor in case of a health problem (aPR: 0.44; 95%CI: 0.307–1.270) were associated with suboptimal adherence, to dolutegravir-based ART regimens. Barriers to dolutegravir adherence included: unemployment, lack of social support, alcohol consumption, and inadequate counselling. Conclusion Suboptimal adherence to dolutegravir-based ART was high. PLHIV should start-up projects that are economically viable. Dolutegravir-related virological failure in PLHIV should be investigated.

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Section: Prevalence Of Suboptimal Adherence To Dolutegravir-based Art...supporting

confidence: 86%

Prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among people living with HIV in a specialized clinic in Kampala, Uganda

Namakula,

Mugerwa,

Kitutu

et al. 2023

Preprint

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“…A Tanzania cohort reported similar rates of children with a VL of <1,000 copies/mL: 84% after 1 year on DTG. 26 More ART-experienced children were unsuppressed pre-DTG (35%) compared to the Tanzania study which reported 18%. 26 Among children in 6 SSA countries, VLS after 12 months on DTG was 93%, though the cohort had a much higher VLS rate of 95% before DTG introduction than our cohort.…”

Section: Discussionmentioning

confidence: 84%

“…26 More ART-experienced children were unsuppressed pre-DTG (35%) compared to the Tanzania study which reported 18%. 26 Among children in 6 SSA countries, VLS after 12 months on DTG was 93%, though the cohort had a much higher VLS rate of 95% before DTG introduction than our cohort. 16 We are likely to have seen higher VLS among children on DTG in our study if we had higher suppression rates from the pre-DTG period as in these other studies.…”

Section: Discussionmentioning

confidence: 84%

Virologic Outcomes and ARV Switch Profiles 2 Years After National Rollout of Dolutegravir to Children Less Than 15 Years in Southern Mozambique

Gill,

Herrera,

Guilaze

et al. 2023

Pediatric Infectious Disease Journal

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Background: Dolutegravir (DTG) was scaled up globally to optimize treatment for children living with HIV. We evaluated the rollout and virological outcomes after DTG introduction in Mozambique. Methods: Data from children 0–14 years with visits from September 2019 to August 2021 were extracted from records in 16 facilities in 12 districts. Among children ever on DTG, we report treatment switches, defined as changes in anchor drug, regardless of changes to nucleoside reverse transcriptase inhibitor (NRTI) backbones. Among those on DTG for ≥6 months, we described viral load suppression rates by children newly initiating and switching to DTG and by the NRTI backbone at the time of the DTG switch. Results: Overall, 3,347 children were ever on DTG-based treatment (median age 9.5 years; 52.8% female). Most children (3,202, 95.7%) switched to DTG from another antiretroviral regimen. During the 2-year follow-up, 9.9% never switched from DTG; 52.7% had 1 regimen change, of which 97.6% were switched to DTG. However, 37.2% of children experienced ≥2 anchor drug changes. Overall median time on DTG was 18.6 months; nearly all children ≥5 years (98.6%) were on DTG at the last visit. Viral suppression was 79.7% (63/79) for children newly initiating DTG and 85.8% (1,775/2,068) for those switching to DTG. Suppression rates were 84.8% and 85.7% among children who switched and maintained NRTI backbones, respectively. Conclusions: Viral suppression rates of ≥80% with minor variations by backbone were achieved during the 2-year DTG rollout. However, there were multiple anchor drug switches for over one-third of children, which may be attributable in part to drug stockouts. Long-term pediatric HIV management will only be successful with immediate and sustainable access to optimized child-friendly drugs and formulations.

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“…In studies in Kenya and at Baylor sites in Botswana, Eswatini, Lesotho, Malawi, Tanzania, and Uganda [ 23 , 33 ], the authors reported viral suppression rates of 93.4–95.8% when applying a threshold of 1000 copies/ml, where in our study, 96.1% had a viral load less than 1000 copies/ml at 24 months. However, other studies have reported lower viral suppression rates after transition to dolutegravir (Mozambique: 76.2% [ 25 ]; Tanzania: 82.5% [ 34 ]), raising questions about the comparability of HIV programs and its populations in sub-Saharan Africa [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

Devendra,

Kohler,

Letsika

et al. 2024

Aids

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Background: Treatment failure is common among children and adolescents with HIV. Antiretroviral therapy (ART) containing dolutegravir has recently been rolled out across Africa, though long-term real-world data in paediatric populations are lacking. Here, we report treatment outcomes among children and adolescents in Lesotho who transitioned from non-nucleoside reverse transcriptase inhibitor- (NNRTI-) to dolutegravir-based ART through two years’ follow-up. Methods: Data were derived from two open cohort studies in Lesotho. Children and adolescents aged < 18 years who transitioned from NNRTI- to dolutegravir-based ART at least 18 months before data closure were included. We report viral load results <12 months before, 12 (window: 6–17) months after, and 24 (window: 18–29) months after transition to dolutegravir. Associations of pre-transition demographic and clinical factors with 24-month viraemia were assessed through multivariable logistic regression. Results: Among 2126 included individuals, 1100 (51.7%) were female, median age at transition to dolutegravir was 14.0 years (interquartile range [IQR] 11.5–15.8), and median time taking ART at transition was 7.6 years (IQR 4.4–10.6). Among those with a viral load result at the respective time points, viral suppression to <50 copies/mL was achieved by 1635/1973 (82.9%) <12 months before, 1846/2012 (91.8%) 12 months after, and 1725/1904 (90.6%) 24 months after transition to dolutegravir. Pre-transition viraemia was associated with viraemia at 24 months, though >80% of individuals with pre-transition viraemia achieved resuppression to <50 copies/mL at 24 months. Conclusions: The proportion of children and adolescents with viral suppression increased after transition to dolutegravir, though further progress is needed to reach global targets.

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Adherence, Effectiveness and Safety of Dolutegravir Based Antiretroviral Regimens among HIV Infected Children and Adolescents in Tanzania

Cited by 18 publications

References 36 publications

Prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among people living with HIV in a specialized clinic in Kampala, Uganda

Prevalence and factors associated with suboptimal adherence to dolutegravir-based regimens among people living with HIV in a specialized clinic in Kampala, Uganda

Virologic Outcomes and ARV Switch Profiles 2 Years After National Rollout of Dolutegravir to Children Less Than 15 Years in Southern Mozambique

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study

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