Experience of a Nationwide implementation of single-tablet second-generation integrase inhibitors-based treatment in Mexico

Objectives

In Mexico, until 2018, antiretroviral therapy (ART) primarily relied on efavirenz-containing regimens or other options suitable for optimization, with ART costs among the highest in the region. This study evaluated the impact of a national strategy using single-tablet, second-generation integrase inhibitors (STSGII)—either bictegravir, emtricitabine, and tenofovir alafenamide or abacavir/lamivudine/dolutegravir—for ART initiation or switch.

Methods

Adults initiating or switching to STSGII between June 1, 2019, and June 30, 2021, at clinics for individuals without social security, were categorized into three groups: G1 (initiated with STSGII), G2 (initiated with non-STSGII), and G3 (switched to STSGII). The switch was defined as individuals changing ART in the presence of virological suppression. Viral suppression (VS) at 6 months post-initiation or switch was reported. A Cox model evaluated VS and regimen durability, defined as maintaining VS without ART change, loss to follow-up, or death.

Results

A total of 70,732 individuals were included; 24,133 (34.1%) on G1, 4605 (6.5%) on G2, and 41,994 (59.4%) on G3. VS was achieved in 85.7%, 52.7%, and 82.7% of individuals in G1, G2, and G3, respectively. Durability was met in 85.1%, 41.3%, and 90.8% of individuals in G1, G2, and G3.

Conclusions

Second-generation INSTIs are effective and durable in this 2-year follow-up analysis, both for ART initiation and optimization in Mexico's population, offering a valuable strategy for improving ART outcomes.