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

Abstract

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.