BACKGROUND: In line with the World Health Organization’s (WHO) recommendation, in 2022, Lao People’s Democratic Republic (PDR) adopted pediatric Dolutegravir (pDTG) into its guidelines for infants and children older than 4 weeks and weighing between 3kg and 20kg. Pediatric clients living with HIV have unique needs and require tailored care. As a result, beyond achieving national adoption, a well-coordinated approach was required to ensure effective introduction and service delivery. We document the approach and lessons learned from pDTG introduction in Lao PDR.
DESCRIPTION: In 2022, Lao PDR’s Center for HIV/AIDS and STIs (CHAS) introduced DTG 10mg scored dispersible tablets (pDTG). This resulted first from establishing consensus amongst clinicians, implementing partners, and key stakeholders. CHAS played a coordinating role, leading critical activities including quantifying commodity need, developing job aids for health workers, training healthcare workers (HCWs), and monitoring rollout progress.
LESSONS LEARNED: Inclusion of guidance on pDTG usage in the guidelines provided HCWs with prescriptive direction. Ahead of product arrival, dosing wheels were distributed to all ART sites. Training HCWs on the dosing wheels and providing them with job aids built their capacity to recommend pDTG to clients and enabled rapid transition once eligible clients were seen. Holding semi-annual workshops for HCWs, policymakers, and partners was critical for a coordinated pDTG rollout strategy. Iterative training sessions for HCWs ensured capacity-building and increased confidence to transition eligible children. Training sessions clarified that viral load testing constraints should not delay transition to pDTG. Finally, addressing both clinical and market concerns from HCWs was crucial to increasing pDTG access. Leveraging existing HIV pharmacovigilance architecture, HCWs were able to monitor and report any adverse drug reactions. Based on this approach, CHAS distributed pDTG to all (12) ART sites in October 2022 and has achieved an active transition of 45% of eligible clients to date (31 January 2023).
CONCLUSIONS: Lao PDR’s approach in implementing pDTG highlights the critical role operational planning plays in achieving effective and rapid transition through national adoption, provision of capacity-building training, and ensuring commodity availability. Countries yet to introduce pDTG can leverage best practices and lessons learned from Lao PDR’s implementation model.