Factors linked to virological failure in people on a dolutegravir-based regimen in Mamelodi.

Abstract

Background: Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz.

Objectives: This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA).

Method: A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital's Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed (> 50 copies/mL) VLs.

Results: Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p < 0.05). Newly initiated patients had significantly lower suppression rates (p < 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p < 0.05).

Conclusion: The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD.

Contribution: Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.