BACKGROUND: In September 2021, Eswatini began optimizing children under 20kg to pediatric dolutegravir (pDTG)-based Antiretroviral Treatment (ART). All children on first line ART optimized either to ABC/3TC/DTG if viral load (VL) =400copies/mL; or if VL =1000copies/mL, genotype results were used to inform an optimized NRTI backbone with pDTG. All children with VL 401-999 went through adherence counseling. This is a description of early viral load outcomes for these children.
METHODS: This is a retrospective review of routinely collected data from all children on first line ART optimized to pDTG based ART from August 2021 until January 2023 at Baylor College of Medicine Children’s Foundation-Eswatini. Data were extracted from electronic medical records and imported into STATA 17 for analysis. McNemar’s Test using 95% confidence intervals (p<0.05) was used to determine significance in viral suppression (=400 copies/mL) before and after optimization.
RESULTS: Since optimization, 369 children have accessed pDTG; 57 as new initiations and 312 through optimizations. Of the 57 newly initiated, 46% were (26/57) male and 54% (31/57) female with an average age of 17 months (0-83months). The suppression rate for this group was 78% (21/27) at an average of 7 months post pDTG initiation (4-14 months).
Of the 312 children optimized to pDTG, 224 had VL results both before and after optimization. These children were 42% male (95/224) and 58% female (129/224) with an average age of 55 months (7-206months). Before optimization, 95% were on ABC/3TC/LPV/r (212/224); after optimization, 97% were on ABC/3TC/DTG (219/224). There was a significant increase in the VL suppression rate (89% pre-optimization to 95% post-optimization; p<0.05) at an average of 7.6 months post pDTG optimization (0.03-16 months). Stratified by age in 12-month increments, suppression rates for all groups increased to >90% after optimization except for with children between 12-23 months who increased to only 77% (10/13).
CONCLUSIONS: Children have benefited from introduction of pDTG. All children have seen improved viral suppression, but the 12-23 months age group and new initiations still struggle to meet national targets. Pending viral load data will continue to be tracked and evidence generated will be shared over the coming years.