Three-Year Outcomes After Programmatic Transitioning to Dolutegravir in the Context of Severe Civil Unrest in Haiti.

Abstract

Background: Tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) is widely prescribed in low and middle-income countries. Data on long-term outcomes are limited.

Methods: We included all persons with HIV (PWH) ≥15 years of age who initiated or switched to TLD in Port-au-Prince, Haiti. We described treatment outcomes by pre-switch viral load and assessed predictors of virologic failure using multivariable logistic regression.

Results: A total of 10 354 PWH initiated or switched to TLD from November 2018 to March 2021, and were included in the analyses. Of these, 2217 (21.4%) were ART-naïve and 8137 (78.6%) switched from an non-nucleoside reverse transcriptase inhibitor (NNTRI)-based regimen. Median follow-up time on TLD was 2.8 years (IQR: 2.3, 3.1). HIV-1 RNA <1000 copies/mL was achieved at the latest measurement in 92.7% of recipients of care (RoC) with pre-switch suppression, 88.5% without pre-switch viral load, 58.3% with pre-switch failure, and 81.8% of RoC ART-naïve at TLD initiation. Among treatment-experienced RoC, predictors of ≥1000 copies/mL at latest test included younger age (adjusted odds ratio [aOR]: 0.44; 95% CI: 0.34, 0.57 for age ≥50 vs <30 years), shorter time on ART (aOR: 0.91; 95% CI: 0.89, 0.93/year), lower education (aOR: 1.31; 95% CI: 1.13, 1.52), and higher pre-switch viral load: (aOR: 7.23; 95% CI: 6.06, 8.63 for ≥10 000 vs < 1000 copies/mL).

Conclusions: Virologic outcomes on TLD are outstanding for PWH with pre-switch suppression. However, rates of virologic suppression are suboptimal among PWH who were ART-naïve at TLD initiation, and among those with a history of pre-switch failure, additional interventions are necessary, including access to long-acting treatment regimens.