Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 31;25(1):1578.
doi: 10.4102/sajhivmed.v25i1.1578. eCollection 2024.

The rollout of paediatric dolutegravir and virological outcomes among children living with HIV in Mozambique

Ivete Meque  1 , Nicole Herrera  2 , Amâncio Nhangave  3 , Dórcia Mandlate  4 , Rui Guilaze  1 , Ana Tambo  1 , Abdul Mussa  1 , Nilesh Bhatt  2 , Michelle M Gill  2
Affiliations

The rollout of paediatric dolutegravir and virological outcomes among children living with HIV in Mozambique

Ivete Meque et al. South Afr J HIV Med. .

Abstract

Background: In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings.

Objectives: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV.

Method: We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors.

Results: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]).

Conclusion: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.

Keywords: Mozambique; antiretroviral treatment; children; paediatric dolutegravir; viral suppression.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Flowchart of study screening, enrolment and follow-up.
See this image and copyright information in PMC

References

    1. UNICEF . Paediatric care and treatment [homepage on the Internet]. 2022. [cited 23 Jun 02]. Available from: https://data.unicef.org/topic/hivaids/paediatric-treatment-and-care/
    1. UNAIDS . In danger: UNAIDS global AIDS update [homepage on the Internet]. 2022 [cited 23 Jun 02]. Geneva: Joint United Nations Programme on HIV/AIDS; 2022. Available from: https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-...
    1. Boerma RS, Boender TS, Bussink AP, et al. . Suboptimal viral suppression rates among HIV-infected children in low- and middle-income countries: A meta-analysis. Clin Infect Dis. 2016;63(12):1645–1654. 10.1093/cid/ciw645 - DOI - PubMed
    1. Instituto Nacional de Saúde . Inquérito Nacional sobre o Impacto do HIV e Sida em Moçambique INSIDA 2021 – Resumo dos Principais Resultados [homepage on the Internet]. 2022. [cited 23 Jun 02]. Available from: https://ins.gov.mz/divulgados-resultados-do-inquerito-sobre-o-impacto-do...
    1. John Nutor J, Duodu PA, Agbadi P, Duah HO, Oladimeji KE, Gondwe KW. Predictors of high HIV+ prevalence in Mozambique: A complex samples logistic regression modeling and spatial mapping approaches. PLoS One. 2020;15(6):e0234034. 10.1371/journal.pone.0234034 - DOI - PMC - PubMed

LinkOut - more resources