Transition to dolutegravir-based ART in 35 low- and middle-income countries: a global survey of HIV care clinics.

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-09-05 DOI:10.1097/QAD.0000000000004007
Elizabeth Zaniewski, Veronika Whitesell Skrivankova, Ellen Brazier, Anchalee Avihingsanon, Sandra Wagner Cardoso, Carina Cesar, Henri Chenal, Brenda E Crabtree-Ramírez, Rossana A Ditangco, Peter Vanes Ebasone, Brian Eley, Jonathan George Euvrard, Geoffrey Fatti, Jacqueline Madalitso Huwa, Patricia Lelo, Daisy Maria Machado, Eugene Kouassi Messou, Albert Kla Minga, Joseph Muleebwa, Sanjay Mundhe, Gad Murenzi, Winnie R Muyindike, Dominique Mahambou Nsonde, Sarah M Obatsa, Joseph Odhiambo, Hans Walter Prozesky, Supattra Rungmaitree, Aggrey Semwendero Semeere, Moussa Seydi, Nosisa Sipambo, Tavitiya Sudjaritruk, Karl-Günter Technau, Thierry Tiendrebeogo, Christelle Twizere, Marie Ballif
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Abstract

Objective: We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA).

Design: Site-level survey conducted in 2020-2021 among HIV clinics in low- and middle-income countries (LMICs).

Methods: We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for patients on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors.

Results: Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level (aOR 4.00; 95% CI 1.39 to 11.47) and secondary-level clinics (aOR 3.66; 95% CI 2.19 to 6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch.

Conclusions: Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched patients to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among patient switching to dolutegravir may go undetected.

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35 个中低收入国家向基于多罗替拉韦的抗逆转录病毒疗法的过渡:对艾滋病毒护理诊所的全球调查。
目的我们研究了国际艾滋病流行病学评估数据库(IeDEA)中的艾滋病治疗诊所向含多罗替韦的抗逆转录病毒疗法(ART)过渡的情况:设计:2020-2021 年在中低收入国家(LMICs)的 HIV 诊所进行的现场调查:我们评估了多罗替拉韦的推广情况以及接受抗逆转录病毒疗法的患者转用多罗替拉韦治疗方案后的病毒载量和耐药性检测情况。我们使用了广义估计方程来评估诊所同时推广基于多鲁特韦的一线和二线抗逆转录病毒疗法(双线推广)与地点水平因素之间的关联:在 179 家接受调查的诊所中,175 家(98%)参与了调查;其中 137 家(78%)来自非洲,30 家(17%)来自亚太地区,8 家(5%)来自拉丁美洲。大多数诊所(80%)位于低收入或中低收入国家,其中包括初级、二级和三级诊所。90%的诊所报告推出了一线多鲁曲韦,59%的诊所推出了二线多鲁曲韦,94%的诊所推出了一线或二线多鲁曲韦,55%的诊所推出了双线多鲁曲韦。三级诊所(aOR 4.00;95% CI 1.39 至 11.47)和二级诊所(aOR 3.66;95% CI 2.19 至 6.11)的调整后双线推广几率高于一级诊所。在引入基于多鲁曲韦的一线或二线抗逆转录病毒疗法的诊所中,超过一半(59%)的诊所要求在转用多鲁曲韦之前进行近期病毒载量检测,15%的诊所在转用时进行了基因型耐药性检测:结论:在低收入发展中国家,几乎所有的 IeDEA 诊所都推出了基于多鲁曲韦的抗逆转录病毒疗法,但许多诊所在未进行近期病毒载量检测的情况下就将患者转为使用多鲁曲韦,而且很少进行耐药性检测。如果不进行此类检测,转用多鲁特韦的患者的耐药性可能不会被发现。
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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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