Title

Outcomes from the Transitioning children to Optimal Regimens of Paediatric Dolutegravir (TORPEDO) study at 6 months in Benin, Nigeria, and Uganda

Presenter

Jennifer Campbell

Authors

J. Campbell¹, D. Rathakrishnan², B. Ngwatu², J. Bropy^2,3, C. Amole², T TORPEDO Study Group Benin^4,5, T TORPEDO Study Group Nigeria^{6,7,8,9,10,11}, T TORPEDO Study Group Uganda^12,13

Institutions

¹Clinton Health Access Initiative, Analytics and Implementation Research, Boston, United States, ²Clinton Health Access Initiative, Boston, United States, ³Children’s Hospital of Eastern Ontario, Ottowa, Canada, ⁴Clinton Health Access Initiative, Porto-Novo, Benin, ⁵Ministry of Health, Porto-Novo, Benin, ⁶Ministry of Health, National AIDS and STIs Control Program, Abuja, Nigeria, ⁷Clinton Health Access Initiative, Abuja, Nigeria, ⁸Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, ⁹Jos University Teaching Hospital, Jos, Nigeria, ¹⁰Lagos University Teaching Hospital, Lagos, Nigeria, ¹¹University of Calabar Teaching Hospital, Calabar, Nigeria, ¹²Ministry of Health, STD/AIDS Control Program, Kampala, Uganda, ¹³Clinton Health Access Initiative, Kampala, Uganda

BACKGROUND: Following the successful global rollout of dolutegravir for antiretroviral treatment of adults and children over 20kg, a pediatric dolutegravir formulation (pDTG) became available in late 2021. This dispersible tablet is administered once daily, and with better taste and potency is expected to improve pediatric outcomes. To inform the introduction of this optimal treatment for children living with HIV (CLWH), we systematically monitored health care workers’ (HCWs) experiences prescribing pDTG as well as health outcomes of pDTG initiates.
METHODS: TORPEDO is a mixed-methods, prospective cohort study of CLWH initiating pDTG at 19 pediatric HIV treatment sites in 3 countries with early access to pDTG: Benin (6 sites), Nigeria (7 sites), and Uganda (6 sites). 510 CLWH were enrolled from October 2021–June 2022. Six-months following introduction, individually administered surveys were collected from study facility HCWs. Surveys included questions on HCWs’ experiences prescribing pDTG. Viral load (VL) test results at baseline and 6 months following pDTG initiation were analyzed; undetectable VL was defined as <50 copies/mL and viremia was defined as greater than 1,000 copies/mL.
RESULTS: 89 HCWs [54% physicians, 17% nurses, 11% clinical officers] were surveyed between April 2022-November 2022.Over 90% had more than 5 years health care experience, and almost 80% had more than 5 years of experience treating HIV. All respondents (100%) believed that clients preferred pDTG over previous drugs. Nearly all HCWs (n=86, 97%) observed better client adherence; 72 (81%) observed fewer side effects compared to lopinavir/ritonavir. 87 respondents (98%) reported increased confidence in prescribing pDTG; reasons for this included “better tolerated” as the most frequent response and “improved side effects or outcomes” as the second most frequent. When asked to share observations on prescribing pDTG, almost three-quarters said “appropriate or better weight gain.” At baseline, 69% of VL tests were “undetectable”, and 16% had viremia (n=357); at 6-months, 85% were undetectable and 6% had viremia (n=310).
CONCLUSIONS: Improved tolerability and adherence as reported by prescribers of pDTG was supported by improved viral suppression amongst study participants. Further analysis of long-term client VL results, as well as weight and body-mass index trends, will provide more evidence of pDTG’s impact.

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