Antiretroviral drug switches to zidovudine‐based regimens and loss to follow‐up during the first COVID‐19 lockdown in Bali, Indonesia

Abstract

Objectives International lockdowns during the COVID‐19 pandemic impacted antiretroviral drug supplies in Indonesia. We assessed the impact of antiretroviral treatment (ART) provision and being lost to follow‐up (LTFU) on people living with HIV, attending a key population‐focused HIV clinic in Denpasar, Bali. Methods This was a retrospective note review of anonymized data from adult Indonesian patients living with HIV. We collected demographic data and information on being LTFU, and assessed the numbers of patients impacted by ART switches from fixed‐dose combination (FDC) tenofovir/lamivudine/efavirenz to multi‐pill zidovudine‐based regimens, during the first international lockdown from March 2020. Results Records of 260 Indonesian adult patients registered for HIV care and prescribed ART were reviewed; 240 (92.3%) were men, and 90% were men who have sex with men. Between 13 March and 28 May 2020, 214 (87%) out of 247 patients (previously diagnosed with HIV) had to switch to individual, multi‐pill zidovudine‐based regimens from their FDC. The switch lasted a mean of 35 days (range 10–85). Twenty‐five patients (10%) were LTFU; patients who switched were more likely to remain in care. Data on viral load status and toxicity are lacking as laboratory testing requires self‐payment. Conclusions The majority of patients living with HIV had no choice but to switch to multi‐pill, zidovudine‐based regimens. Despite significant efforts to minimize the impact of lockdown on care, 10% of patients were LTFU. Patients switching ART required greater clinic attention and support, improving retention. Complete national data are needed to understand the impact of ART stockouts on virological suppression and drug resistance throughout Indonesia.

Bioinformatics and systems-biology analysis to determine the effects of Coronavirus disease 2019 on patients with allergic asthma

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Lived experience, social support, and challenges to health service use during the COVID-19 pandemic among HIV key populations in Indonesia

“…As a result, HIV clinics struggled to deliver quality HIV treatment while coping with spotty medication deliveries and dwindling ARV supplies. Out of necessity, providers found themselves forced to ration dosages or switch to less preferred treatment regimens [ 33 ], and possibly even to dispense dated medications as one of our respondents found. Yet, as also recounted, some participants found ways to go around the system to obtain the mediation they needed.…”

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

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