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. 2024 Dec 1;38(15):2073-2085.
doi: 10.1097/QAD.0000000000004007. Epub 2024 Sep 26.

Transition to dolutegravir-based ART in 35 low- and middle-income countries: a global survey of HIV care clinics

Elizabeth Zaniewski  1 , Veronika Whitesell Skrivankova  1 , Ellen Brazier  2 , Anchalee Avihingsanon  3 , Sandra Wagner Cardoso  4 , Carina Cesar  5 , Henri Chenal  6 , Brenda E Crabtree-Ramírez  7 , Rossana A Ditangco  8 , Peter Vanes Ebasone  9 , Brian Eley  10 , Jonathan George Euvrard  11 , Geoffrey Fatti  12   13 , Jacqueline Madalitso Huwa  14 , Patricia Lelo  15 , Daisy Maria Machado  16 , Eugene Kouassi Messou  17 , Albert Kla Minga  18 , Joseph Muleebwa  19 , Sanjay Mundhe  20 , Gad Murenzi  21 , Winnie R Muyindike  22   23 , Dominique Mahambou Nsonde  24 , Sarah M Obatsa  25 , Joseph Odhiambo  26 , Hans Walter Prozesky  27   28 , Supattra Rungmaitree  29 , Aggrey Semwendero Semeere  30 , Moussa Seydi  31 , Nosisa Sipambo  32 , Tavitiya Sudjaritruk  33 , Karl-Günter Technau  34 , Thierry Tiendrebeogo  35 , Christelle Twizere  36 , Marie Ballif  1   37
Affiliations

Transition to dolutegravir-based ART in 35 low- and middle-income countries: a global survey of HIV care clinics

Elizabeth Zaniewski et al. AIDS. .

Abstract

Objective: We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA).

Design: Site-level survey conducted in 2020-2021 among HIV clinics in low- and middle-income countries (LMICs).

Methods: We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for persons on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors.

Results: Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level [adjusted odds ratio (aOR) 4.00; 95% confidence interval (CI) 1.39-11.47] and secondary-level clinics (aOR 3.66; 95% CI 2.19-6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch.

Conclusions: Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched persons to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among persons switching to dolutegravir may go undetected.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Location of 175 HIV clinics in low- and middle-income countries participating in the survey.
Fig. 2
Fig. 2
Reported rollout of dolutegravir-based ART for first-line, second-line and for both first- and second-line regimens among 175 surveyed HIV clinics by country income, HIV prevalence and clinic level.
Fig. 3
Fig. 3
Univariable and multivariable logistic regression of reported rollout of dolutegravir-based ART for both first- and second-line regimens among 175 HIV clinics.
See this image and copyright information in PMC

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