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

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

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...

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Main Authors: Valériane Leroy, Anandi Sheth, Julie Jesson, Jean Jacques Koffi, Antoine Jaquet, François Dabis, Didier Koumavi Ekouevi, Karen Malateste, Olivia Keiser, Lehila Bagnan, Simon Boni, Madeleine Amorissani Folquet, Mariam Sylla, Olivier Marcy, Raoul Moh, Gildas Boris Hedible, Sophie Desmonde, Joycelyn Dame, Agatha David, Madeleine Amorissani-Folquet, Sylvie N'Gbeche, Elom Takassi, François Tanoh Eboua, Kouadio Kouakou, Lehila Bagnan Tossa, Caroline Yonaba, Jocelyn Dame, Sylvie Marie N’Gbeche, Fatoumata Dicko Traore, Oliver Ezchechi, Rosemary Audu, Charlotte Bernard, Caroline Couturier, Marie Kerbie Plaisy, Elodie Rabourdin, Thierry Tiendrebeogo, Désiré Dahourou, Emile Sodinyessi, Jean-Claude Azani, Kadidja Diarra, Maika Bengali, Abdoulaye Cissé, Guy Gnepa, Eric Komena, Séverin Lenaud, Eulalie Kangah, Igho Ofotokun, Cecile Delille Lahiri, Noëlle Benzekri, Geoffrey Gottlieb
Format: Article
Language:English
Published: BMJ Publishing Group 2025-01-01
Series:BMJ Global Health
Online Access:https://gh.bmj.com/content/10/1/e016512.full
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Summary: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.
ISSN:2059-7908

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