BACKGROUND: Pediatric treatment optimization has improved HIV outcomes for children worldwide. However, for children living with HIV (CLHIV) below 20kg, poor palatability of the pediatric formulation of lopinavir and ritonavir (LPV/r) can lead to poor health outcomes, and by the end of 2021, only 68% of CLHIV aged 0-4 years had viral load (VL) suppression in Nampula Province in Mozambique. The introduction of pediatric formulation of dolutegravir (pDTG) by the Mozambique Ministry of Health (MOH) in late February 2022 presented an opportunity to overcome this challenge.
DESCRIPTION: ICAP at Columbia University worked in collaboration with MOH at national and subnational level to support pDTG roll-out to CLHIV below 20kg at 59 health facilities (HF) in Nampula Province, including data review to inform the provincial distribution plan, training and mentoring of providers, weekly monitoring of transition among CLHIV attending each HF and monthly monitoring of pediatric formulations and regimen consumption per HF. Intensive monitoring enabled timely feedback to HF teams on missed opportunities, to readjust stocks and provide targeted technical assistance for HF with slow transition. We present VL data for the pre- and post-implementation periods to assess preliminary results among CLHIV age 0 to 4 years.
LESSONS LEARNED: By March 2022, 64% of CLHIV had already transitioned to pDTG and by May 2022 virtually all CLHIV (99.2%) were on a pDTG-based regimen. Data from the pre-implementation phase (Dec 2021-Jan 2022) showed that of the 5,179 CLHIV with a VL result, 3,547 (68%) had VL suppression, while post-implementation data (Oct-Nov 2022) indicated 83% (4,922/5,937) had VL suppression, an increase of 22.1%.
CONCLUSIONS: Close monitoring, timely support for supply chain issues and technical assistance enabled rapid transition to optimized regimens among this vulnerable population, leading to early changes in viral suppression among young CLHIV.