BACKGROUND: Though a UNAIDS 2021 report shows that, between 2010 and 2020, Togo halved AIDS-related deaths in children ages 0–14, available data show low dolutegravir coverage (DTG-C) and viral load suppression (VLS) among children living with HIV (CLHIV). This analysis presents data and solutions to improve DTG-C, viral load coverage (VLC), and VLS among CLHIV at selected public health facilities. The work was supported by the PEPFAR- and USAID-funded EAWA project, which is implemented by FHI 360.
DESCRIPTION: Routinely collected data were analyzed for CLHIV ages 14 and younger from October 2019 through September 2022. We assessed the proportion of CLHIV on antiretroviral therapy (ART) who received a dolutegravir-based regimen; VLC, calculated as CLHIV with a documented viral load test result (VLTR) among those on ART; VLS, calculated as CLHIV with a documented VLTR below 1,000 copies among those with a VLTR. Between October 2019 and September 2020, only half were on a dolutegravir-based regimen, less than half had a documented VLTR, and 64% reached VLS. A team was tasked with implementing solutions based on roots cause analysis: Eligible CLHIV were line listed and contacted for starting/transitioning to dolutegravir and collecting viral load samples; ART adherence support was provided; monthly dolutegravir stock monitoring was conducted; pending test results were tracked through a laboratory focal person; VLTR were documented; and CLHIV were informed within one week from test result. Granular data were used to prioritize technical assistance to sites with lowest DTG-C, VLC, and VLS.
LESSONS LEARNED: From October 2019–September 2020, October 2020–September 2021, and October 2021–September 2022, an increase was observed in the following indicators among CLHIV: DTG-C from 52% to 64% to 71%, respectively; VLC from 48% to 85% to 90%, respectively; and VLS from 64% to 70% to 82%, respectively. A positive trend in indicators was observed when disaggregated by age (Table 1).

Table 1. Dolutegravir, viral load coverage, and viral load suppression by age band, by year, Togo

Oct 2019 - Sep 2020 Oct 2020 - Sep 2021 Oct 2021 - Sep 2022 0-4 5-9 10-14 total 0-14 0-4 5-9 10-14 total 0-14 0-4 5-9 10-14 total 0-14 Current on ART 406 600 717 1,723 428 693 807 1,928 510 841 1,046 2,397 Dolutegravir-based regimen 30% 91% 33% 52% 47% 99% 43% 64% 68% 97% 46% 71% Documented VLTR 115 (32%) 248 (40%) 432 (62%) 795 (48%) 272 (80%) 507 (87%) 620 (85%) 1,399 (85%) 372 (95%) 676 (87%) 834 (90%) 1,882 (90%) Virally suppressed 75 (65%) 156 (63%) 276 (64%) 507 (64%) 177 (65%) 353 (70%) 444 (72%) 974 (70%) 294 (79%) 542 (80%) 701 (84%) 1,537 (82%)

CONCLUSIONS: Solutions that address root causes and granular data use were successful in increasing DTG-C, which resulted in increased VLC and VLS among CLHIV. Such approaches should be scaled up and become national standard of care.

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