Disparities in dolutegravir utilisation in children, adolescents and young adults (0-24 years) living with HIV. An analysis of the IeDEA Pediatric West African cohort

Abstract

Introduction: We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa.

Methods: We included all patients aged 0-24 years on ART from nine clinics in Côte d'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit ≥7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity.

Results: Since 2019, 3350 patients were included; 47.2% were female; 78.9% had been on ART ≥12 months. Median baseline age was 12.5 years (IQR 8.4-15.8). Median follow-up was 14 months (IQR 7-22). The overall cumulative incidence of DTG initiation reached 22.7% (95% CI 21.3 to 24.2) and 56.4% (95% CI 54.4 to 58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and female were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females aged >10 years were less likely to initiate DTG compared with males of the same age (adjusted HR among 10-14 years: 0.62, 95% CI 0.54 to 0.72; among ≥15 years: 0.43, 95% CI 0.36 to 0.50), as were those with detectable VL (>50 copies/mL) compared with those in viral suppression (aHR 0.86, 95% CI 0.77 to 0.97) and those on PIs compared with those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI 0.65 to 0.86).

Conclusion: Paediatric DTG uptake was incomplete and unequitable in west African settings: DTG use was least likely in children <5 years, females ≥10 years and those with detectable VL. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake.

Keywords: Cohort study; HIV; Paediatrics; Public Health.

Figure 1. Overall cumulative incidence function of DTG initiation among the 3350 children, adolescents and young adults living with HIV and enrolled in the IeDEA pediatric west African sites rolling out DTG.

Figure 2. Cumulative incidence function of DTG initiation by clinic among the 3350 children, adolescents and young adults living with HIV and enrolled in the IeDEA pediatric west African clinics rolling out DTG.

Figure 3. Cumulative incidence function of DTG initiation among the 3350 children, adolescents and young adults living with HIV and enrolled in the IeDEA pediatric west African clinics rolling out DTG by sex (A), baseline age (B), baseline viral load (C) and baseline ART regimen (D).