Original Research
The rollout of paediatric dolutegravir and virological outcomes among children living with HIV in Mozambique
Submitted: 18 February 2024 | Published: 31 July 2024
About the author(s)
Ivete Meque, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, MozambiqueNicole Herrera, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
Amâncio Nhangave, Núcleo Provincial de Pesquisa de Gaza, Direcção Provincial de Saúde de Gaza, Xai-Xai, Mozambique
Dórcia Mandlate, Núcleo Provincial de Pesquisa de Inhambane, Direcção Provincial de Saúde de Inhambane, Inhambane, Mozambique
Rui Guilaze, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
Ana Tambo, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
Abdul Mussa, Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique
Nilesh Bhatt, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
Michelle M. Gill, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
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
Sustainable Development Goal
Metrics
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