Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study
Issued Date
2026-03-01
Resource Type
eISSN
20597908
Scopus ID
2-s2.0-105034308542
Journal Title
BMJ Global Health
Volume
11
Issue
3
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMJ Global Health Vol.11 No.3 (2026)
Suggested Citation
Brazier E., Romo M.L., Ciaranello A.L., Odhiambo F., Pujari S., Murenzi G., Kasozi C., Kiertiburanakul S., Nsonde D.M., Muyindike W., Khol V., Lelo P., Lyamuya R., Lee M.P., Nash D. Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study. BMJ Global Health Vol.11 No.3 (2026). doi:10.1136/bmjgh-2025-020159 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116058
Title
Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study
Author's Affiliation
Massachusetts General Hospital
The City University of New York
Kenya Medical Research Institute
University of Rwanda
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
Mbarara University of Science and Technology
Mbarara Regional Referral Hospital
Institute of Infectious Diseases
National Center for HIV/AIDS
Masaka Regional Referral Hospital
Morogoro Regional Hospital
Centre de Traitement Ambulatoire
Kalembelembe Pediatric Hospital
Goodlife Access
The City University of New York
Kenya Medical Research Institute
University of Rwanda
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
Mbarara University of Science and Technology
Mbarara Regional Referral Hospital
Institute of Infectious Diseases
National Center for HIV/AIDS
Masaka Regional Referral Hospital
Morogoro Regional Hospital
Centre de Traitement Ambulatoire
Kalembelembe Pediatric Hospital
Goodlife Access
Corresponding Author(s)
Other Contributor(s)
Abstract
IntroductionSince July 2019, the WHO has recommended dolutegravir (DTG)-based regimens as preferred first-line antiretroviral therapy (ART) for adults and adolescents living with HIV (DTG-for-All), a reversal of a 2018 safety alert on use of DTG-based regimens by women of reproductive age (WRA). We examined sex and age disparities in DTG uptake before and after DTG-for-All in the International epidemiology Databases to Evaluate AIDS.MethodsWe included patients ≥16 years on or initiating treatment between January 2017 and July 2021 in 14 low- and middle-income countries where initial guidelines on DTG-based regimens for first-line ART either restricted use by WRA or had no such restrictions. We estimated the cumulative incidence of DTG uptake (CI-DTG) by sex and age group (aged 16–49 years vs 50+ years), stratified by patient, clinic and setting characteristics.ResultsAmong 177 706 patients on ART during the study period, 51% were females aged 16–49 years, with 25% males aged 16–49 and 13% and 11%, respectively, females and males aged 50+. At the time of DTG-for-All, overall CI-DTG was 29.6% (95% CI 29.4% to 29.8%); it was lower among females aged 16–49 (16.2%; 95% CI 16.0% to 16.5%) than males (41.1%; 95% CI 40.6% to 41.5%), with no sex disparities among patients aged 50+ (females: 46.0%; males: 47.0%). While DTG uptake subsequently increased among all groups, by July 2021, it remained substantially lower among females 16–49 (66.4%; 95% CI 66.1% to 66.7%), compared with males 16–49 and older females and males (75.8% to 77.5%). Concentrated in countries where initial guidelines on DTG restricted use by WRA, disparities in DTG uptake persisted at all health system levels and in both low-income and lower-middle-income countries.ConclusionsWhile sex-age differentials in DTG uptake narrowed after WHO’s DTG-for-All recommendation, lingering disparities in uptake underscore the difficulty of policy de-implementation when new evidence emerges.