Role of Dolutegravir-based antiretroviral treatment in achieving an undetectable HIV-1 viral load among women attending prevention of mother-to-child transmission clinics in Addis Ababa, Ethiopia.

Abstract

Objectives: This study aimed to determine the prevalence of detectable HIV-1 viral load and associated factors among pregnant and lactating women on Dolutegravir-based and non-Dolutegravir-based regimens.

Methods: HIV-positive pregnant and breastfeeding women enrolled in a cross-sectional study design incorporating Dolutegravir versus non-Dolutegravir group for comparison purposes, and the study was conducted from September 2022 to March 2023. In total, 684 women receiving antiretroviral treatment (456 on Dolutegravir-based and 228 on non-Dolutegravir-based regimens) were enrolled across 16 prevention of mother-to-child transmission clinics. An undetectable viral load was defined as <20 RNA copies/mL. Univariable and multivariable regression models were used to determine the associations of the detectable viral load with factors such as sociodemographic, clinical, obstetric, and laboratory parameters.

Results: The prevalence of detectable viral load on a non-Dolutegravir-based regimen was 32.9% and on a Dolutegravir-based regimen group was 19.7%. The overall prevalence was 24.1% (95% CI: 20.9-27.6). Compared with non-Dolutegravir-based regimens, Dolutegravir-based regimens were associated with 69% (AOR: 0.31; 95% CI: 0.16-0.61) lower risk of having a detectable viral load. The median viral load was significantly lower in women on a Dolutegravir-based regimen (1.66 log copies/mL) compared to those on a non-Dolutegravir-based regimen (2.11 log copies/mL; p < 0.001). A lower level of adherence was associated with 2.33 times (AOR: 2.33; 95% CI: 1.06-5.12) higher odds of having a detectable viral load and women who had a WHO clinical stage II and above were 2.71 times (AOR: 2.71: 95% CI: 1.30-5.64) more vulnerable to developing a detectable viremia than their counterparts.

Conclusion: Despite the scale-up of Dolutegravir-based regimens, the overall prevalence of detectable viremia was 24.1%, with a higher prevalence of 32.9% among women on non-Dolutegravir-based regimens indicating a programmatic challenge that could affect mother-to-child transmission outcomes. Strengthening adherence monitoring and maintaining World Health Organization clinical stage I is crucial for achieving undetectable viral load levels in pregnant and breastfeeding women.