Disparities in Dolutegravir Uptake Affecting Females of Reproductive Age With HIV in Low- and Middle-Income Countries After Initial Concerns About Teratogenicity An Observational Study
Issued Date
2022-01-01
Resource Type
ISSN
00034819
eISSN
15393704
DOI
Scopus ID
2-s2.0-85123814148
Pubmed ID
34843382
Journal Title
Annals of Internal Medicine
Volume
175
Issue
1
Start Page
84
End Page
94
Rights Holder(s)
SCOPUS
Bibliographic Citation
Annals of Internal Medicine Vol.175 No.1 (2022) , 84-94
Suggested Citation
Romo M.L. Disparities in Dolutegravir Uptake Affecting Females of Reproductive Age With HIV in Low- and Middle-Income Countries After Initial Concerns About Teratogenicity An Observational Study. Annals of Internal Medicine Vol.175 No.1 (2022) , 84-94. 94. doi:10.7326/M21-3037 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86682
Title
Disparities in Dolutegravir Uptake Affecting Females of Reproductive Age With HIV in Low- and Middle-Income Countries After Initial Concerns About Teratogenicity An Observational Study
Author(s)
Author's Affiliation
Makerere University College of Health Sciences
Institute of Social and Preventive Medicine
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
VHS Medical Centre India
Ministry of Health Cambodia
Gokila
Bach Mai Hospital
Moi Teaching and Referral Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
Fundacion Huesped
University of Washington School of Medicine
The Kirby Institute
Fundacao Oswaldo Cruz
The University of North Carolina at Chapel Hill
Instituto Nacional de Infectologia Evandro Chagas (INI)
National Center for Global Health and Medicine
Indiana University School of Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Universidad de Chile
The University of British Columbia
City University of New York
Tan Tock Seng Hospital
Infectious Diseases Institute (IDI)
Family AIDS Care and Education Services
SolidarMed
National Hospital for Tropical Diseases
National Center for HIV/AIDS
amfAR - The Foundation for AIDS Research
Research Institute for Health Sciences
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Fundación Arriarán
Institute of Social and Preventive Medicine
Hospital Sungai Buloh
Beijing Ditan Hospital Capital Medical University
VHS Medical Centre India
Ministry of Health Cambodia
Gokila
Bach Mai Hospital
Moi Teaching and Referral Hospital
Universitas Udayana
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Thai Red Cross Agency
Fundacion Huesped
University of Washington School of Medicine
The Kirby Institute
Fundacao Oswaldo Cruz
The University of North Carolina at Chapel Hill
Instituto Nacional de Infectologia Evandro Chagas (INI)
National Center for Global Health and Medicine
Indiana University School of Medicine
Yonsei University College of Medicine
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Queen Elizabeth Hospital Hong Kong
University of Malaya Medical Centre
Veterans General Hospital-Taipei
Universidad de Chile
The University of British Columbia
City University of New York
Tan Tock Seng Hospital
Infectious Diseases Institute (IDI)
Family AIDS Care and Education Services
SolidarMed
National Hospital for Tropical Diseases
National Center for HIV/AIDS
amfAR - The Foundation for AIDS Research
Research Institute for Health Sciences
Institute of Infectious Diseases
Chiangrai Prachanukroh Hospital
Fundación Arriarán
Other Contributor(s)
Abstract
Background: The transition to dolutegravir-containing antiretroviral therapy (ART) in low- and middle-income countries (LMICs) was complicated by an initial safety signal in May 2018 suggesting that exposure to dolutegravir at conception was possibly associated with infant neural tube defects. On the basis of additional evidence, in July 2019, the World Health Organization recommended dolutegravir for all adults and adolescents living with HIV. Objective: To describe dolutegravir uptake and disparities by sex and age group in LMICs. Design: Observational cohort study. Setting: 87 sites that began using dolutegravir in 11 LMICs in the Asia-Pacific; Caribbean, Central and South America network for HIV epidemiology (CCASAnet); and sub-Saharan African regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Patients: 134 672 patients aged 16 years or older who received HIV care from January 2017 through March 2020. Measurements: Sex, age group, and dolutegravir uptake (that is, newly initiating ART with dolutegravir or switching to dolutegravir from another regimen). Results: Differences in dolutegravir uptake among females of reproductive age (16 to 49 years) emerged after the safety signal. By the end of follow-up, the cumulative incidence of dolutegravir uptake among females 16 to 49 years old was 29.4% (95% CI, 29.0% to 29.7%) compared with 57.7% (CI, 57.2% to 58.3%) among males 16 to 49 years old. This disparity was greater in countries that began implementing dolutegravir before the safety signal and initially had highly restrictive policies versus countries with a later rollout. Dolutegravir uptake was similar among females and males aged 50 years or older. Limitation: Follow-up was limited to 6 to 8 months after international guidelines recommended expanding access to dolutegravir. Conclusion: Substantial disparities in dolutegravir uptake affecting females of reproductive age through early 2020 are documented. Although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence.