BACKGROUND: Dolutegravir (DTG) is an anti-retroviral medicine proven to significantly reduce viral load (VL) among people living with HIV (PLHIV). Zimbabwe Health Interventions (ZHI) is supporting government to roll out DTG based regimens in children living with HIV (CLHIV) on antiretroviral therapy (ART). Transition to DTG based regimens for children with weight below 20kgs was started in June 2021. There is paucity of data in Zimbabwe on VL suppression rates and clinical outcomes of CLHIV transitioned to DTG based regimens. We assessed outcomes of CLHIV before and after DTG transition in Manicaland and Midlands provinces between June and July 2022.
METHODS: We conducted an analytic cross-sectional study focusing on client outcomes before and after DTG transition across 34 sites with at least 1000 ART clients. The study focused on client status before and after transition to a DTG regimen. All children on ART in these facilities were included. Client clinical charts were reviewed, and data were abstracted and captured into Kobo Toolbox. Data were analyzed using Stata 15 and study was covered by the Medical Research of Zimbabwe approved protocol (MRCZ/E/159).
RESULTS: Data for 1,003 children were collected and 811 (80.9%) were initiated on a non-DTG based ART regimen when they started ART. Of the 811 children, 635 (72.3%) were transitioned to a DTG based containing regimen. Of the 220 children who had a documented viral load below 1000 before DTG transition, 216 (98.1%) of them had a viral load remaining below 1000 and four had a viral load above 1000. Of the 56 children who had a viral load above 1000, 85% (48) had suppressed after transition to DTG based regimen and 8 remained unsuppressed. Children who remained on a non-DTG containing regimen were 8 times more likely to have unsuppressed VL compared to those who switched to DTG (RR 7.86, 95% CI 2.4-25.2).
CONCLUSIONS: A significant proportion of children were transitioned to a DTG containing regimen and had better VL suppression compared to those on a non DTG regimen. We recommend transitioning all children to a DTG regimen to improve virological outcomes in children.