Viral Response with Transition to Dolutegravir-Based Treatment, 2018–2020, Homa Bay, Kenya

Overview

Dolutegravir (DTG) is an integrase inhibitor that has been shown to have safety and efficacy benefits compared to the current efavirenz (EFV)-based first-line antiretroviral therapy (ART) and to have a high barrier to resistance. The World Health Organization (WHO) recommends that if countries adopt transition from current ART regimens to DTG-based ART by substituting DTG as the core ART drug in the absence of viral load testing, close monitoring of outcomes and assessing viral load levels and drug resistance needs to be done. Standardized prospective studies and cross-sectional national HIV drug resistance surveys are encouraged to generate critical data on the safety and efficacy of this approach. In Kenya, the transition to DTG for first- and second-line treatment, in accordance with international guidelines, began in late 2017 and has been rolled out to most health facilities in the country, including 163 facilities supported by Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Homa Bay County.

Key Takeaways

• Consider accelerating transition to DTG-ART, including provision of pediatric DTG formulations based on the revised national HIV prevention and treatment guidelines.
• High viral suppression rates of clients on DTG-ART were observed at six and 12 months (>90%). among ART-experienced patients who did not switch their NRTI backbone at the time of DTG transition, viral suppression was similar to those who switched NRTI backbone. Longer-term follow-up is needed to determine sustainability of suppression over time.