Uptake of Dolutegravirbased Art in Children and Adolescents Living With Hiv at Kenyatta National Hospita

Abstract

ackground: The World Health Organization (WHO) in 2018 recommended the use of dolutegravir (DTG) containing antiretroviral regimens in all populations including children. DTG has been a major component of Antiretroviral Therapy (ART) treatment for adults in low-resource settings. However, its application in children and experiences of switching to DTG-based ART have not been fully investigated. Objectives: The primary objective was to evaluate the level of viral suppression following a switch to DTG-containing ART regimens at Kenyatta National Hospital. The secondary objectives were to determine the proportion of children and adolescents living with Human Immunodeficiency Virus (CALHIV) who switched from non-DTG to DTG- containing ART regimens over the past 12 months and short-term caregiver experiences. Methods: This was a mixed-method study conducted at the Kenyatta National Hospital. A census approach was used to recruit patients who met the inclusion criteria. An interviewer-administered questionnaire was used to collect data on patients’ experiences after being initiated on DTG-based ART. The responses were written down by the principal investigator and the research assistant. Data analysis and presentation: Data analysis was done using R version 4.1.2. Categorical variables e.g., gender and adverse effects were analysed using frequencies and proportions and presented in graphs and charts. Continuous data e.g., age was analysed using Median and Interquartile ranges (IQR) and presented using density plots. The inferential analysis utilized McNemar’s test for correlated categorical data to compare differences in viral load before and after initiation of DTG. Tests were interpreted at 5% significance level and p-values less than 0.05 were considered significant. Results: Of the 495 children from the CCC records, 52.8% (258 out of 495) were males. Before the switch to DTG-based ART, 41%, 19%, 33% and 7% of the children were in WHO stage 1,2,3 and 4 respectively. After the switch to DTG-based ART, there was a shift in WHO stages with 98.7%, 0.2%, 0.9% and 0.2% in WHO stages 1,2,3 and 4 respectively. The proportion of children with viral load < 500 copies/ml increased from 54% before switch to 85% after switch to DTG. xiii Four hundred and seventy five of the 495 children switched from 1st line non-DTG to DTG containing regimens over the period of study (96% (95% CI 93.7%, 97.4%). We used McNemar’s test for correlated categorical data to compare viral load suppression before and after initiation of DTG-based ART which showed a significant change in viral suppression one year after starting the DTG-based ART regimen (p < 0.001). Experiences from caregivers revealed that appetite had improved and there was an increase in weight for those who previously had challenges with low weight. Scheduling of the drug was reported as a difficulty since it was supposed to be taken at a specific time thus interfering with school. Reduction of episodes of illness, admissions and improvement in health were also reported. There was a reduction of adverse effects compared to previous regimen, others reported no adverse effects while others reported abdominal pain and nausea. Conclusion: Uptake of DTG optimisation/based ART was high with 96% of participants switching to DTG during the five-year period. Viral suppression improved from 54% to 85% due to switch to DTG in the five-year period under study. Dolutegravir-based ART regimen was associated with fewer adverse effects, there was improvement in appetite and, a reduction in episodes of sickness and admissions. Utility: The findings of this study will play a critical role in the use of dolutegravir. The results have demonstrated that dolutegravir is an effective drug in viral suppression after its initiation. This study, therefore, supports the WHO recommendations of using dolutegravir as a first-line drug in combination with other drugs to prevent the progression of HIV to AIDS