BMJ Global Health (Jan 2025)

Disparities in dolutegravir utilisation in children, adolescents and young adults (0–24 years) living with HIV. An analysis of the IeDEA Pediatric West African cohort

  • ,
  • Valériane Leroy,
  • Anandi Sheth,
  • Julie Jesson,
  • Jean Jacques Koffi,
  • Antoine Jaquet,
  • François Dabis,
  • Didier Koumavi Ekouevi,
  • Karen Malateste,
  • Olivia Keiser,
  • Lehila Bagnan,
  • Simon Boni,
  • Madeleine Amorissani Folquet,
  • Mariam Sylla,
  • Olivier Marcy,
  • Raoul Moh,
  • Gildas Boris Hedible,
  • Sophie Desmonde,
  • Joycelyn Dame,
  • Agatha David,
  • Madeleine Amorissani-Folquet,
  • Sylvie N'Gbeche,
  • Elom Takassi,
  • François Tanoh Eboua,
  • Kouadio Kouakou,
  • Lehila Bagnan Tossa,
  • Caroline Yonaba,
  • Jocelyn Dame,
  • Sylvie Marie N’Gbeche,
  • Fatoumata Dicko Traore,
  • Oliver Ezchechi,
  • Rosemary Audu,
  • Charlotte Bernard,
  • Caroline Couturier,
  • Marie Kerbie Plaisy,
  • Elodie Rabourdin,
  • Thierry Tiendrebeogo,
  • Désiré Dahourou,
  • Emile Sodinyessi,
  • Jean-Claude Azani,
  • Kadidja Diarra,
  • Maika Bengali,
  • Abdoulaye Cissé,
  • Guy Gnepa,
  • Eric Komena,
  • Séverin Lenaud,
  • Eulalie Kangah,
  • Igho Ofotokun,
  • Cecile Delille Lahiri,
  • Noëlle Benzekri,
  • Geoffrey Gottlieb

DOI
https://doi.org/10.1136/bmjgh-2024-016512
Journal volume & issue
Vol. 10, no. 1

Abstract

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Introduction We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa.Methods We included all patients aged 0–24 years on ART from nine clinics in Côte d’Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit ≥7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity.Results Since 2019, 3350 patients were included; 47.2% were female; 78.9% had been on ART ≥12 months. Median baseline age was 12.5 years (IQR 8.4–15.8). Median follow-up was 14 months (IQR 7–22). The overall cumulative incidence of DTG initiation reached 22.7% (95% CI 21.3 to 24.2) and 56.4% (95% CI 54.4 to 58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and female were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females aged >10 years were less likely to initiate DTG compared with males of the same age (adjusted HR among 10–14 years: 0.62, 95% CI 0.54 to 0.72; among ≥15 years: 0.43, 95% CI 0.36 to 0.50), as were those with detectable VL (>50 copies/mL) compared with those in viral suppression (aHR 0.86, 95% CI 0.77 to 0.97) and those on PIs compared with those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI 0.65 to 0.86).Conclusion Paediatric DTG uptake was incomplete and unequitable in west African settings: DTG use was least likely in children <5 years, females ≥10 years and those with detectable VL. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake.