Clinton Health Access Initiative, Abuja, Nigeria.
Department of Family Medicine, Federal Medical Centre Makurdi, Makurdi, Benue state, Nigeria.
PLoS One. 2023 May 17;18(5):e0284767. doi: 10.1371/journal.pone.0284767. eCollection 2023.
Nigeria adopted dolutegravir (DTG) as part of first line (1L) antiretroviral therapy (ART) in 2017. However, there is limited documented experience using DTG in sub-Saharan Africa. Our study assessed DTG acceptability from the patient's perspective as well as treatment outcomes at 3 high-volume facilities in Nigeria. This is a mixed method prospective cohort study with 12 months of follow-up between July 2017 and January 2019. Patients who had intolerance or contraindications to non-nucleoside reverse-transcriptase inhibitors were included. Patient acceptability was assessed through one-on-one interviews at 2, 6, and 12 months following DTG initiation. ART-experienced participants were asked about side effects and regimen preference compared to their previous regimen. Viral load (VL) and CD4+ cell count tests were assessed according to the national schedule. Data were analysed in MS Excel and SAS 9.4. A total of 271 participants were enrolled on the study, the median age of participants was 45 years, 62% were female. 229 (206 ART-experienced, 23 ART-naive) of enrolled participants were interviewed at 12 months. 99.5% of ART-experienced study participants preferred DTG to their previous regimen. 32% of particpants reported at least one side effect. "Increase in appetite" was most frequently reported (15%), followed by insomnia (10%) and bad dreams (10%). Average adherence as measured by drug pick-up was 99% and 3% reported a missed dose in the 3 days preceding their interview. Among participants with VL results (n = 199), 99% were virally suppressed (<1000 copies/ml), and 94% had VL <50 copies/ml at 12 months. This study is among the first to document self-reported patient experiences with DTG in sub-Saharan Africa and demonstrated high acceptability of DTG-based regimens among patients. The viral suppression rate was higher than the national average of 82%. Our findings support the recommendation of DTG-based regimen as the preferred 1L ART.
尼日利亚于 2017 年将多替拉韦（DTG）纳入一线抗逆转录病毒治疗（ART）。然而，在撒哈拉以南非洲，使用 DTG 的经验有限。我们的研究从患者的角度评估了 DTG 的可接受性，以及在尼日利亚的 3 个大容量机构的治疗结果。这是一项混合方法前瞻性队列研究，从 2017 年 7 月到 2019 年 1 月进行了 12 个月的随访。纳入对非核苷类逆转录酶抑制剂不耐受或有禁忌症的患者。通过在 DTG 开始后 2、6 和 12 个月进行一对一访谈来评估患者的可接受性。曾接受过 ART 的参与者被问及与之前的方案相比，副作用和方案偏好。根据国家时间表评估病毒载量（VL）和 CD4+细胞计数测试。数据在 MS Excel 和 SAS 9.4 中进行分析。共有 271 名参与者入组本研究，参与者的中位年龄为 45 岁，62%为女性。入组的 229 名（206 名 ART 经验丰富，23 名 ART 初治）参与者在 12 个月时接受了访谈。99.5%的 ART 经验丰富的研究参与者更喜欢 DTG 而不是他们之前的方案。32%的参与者报告至少有一种副作用。“食欲增加”是最常报告的（15%），其次是失眠（10%）和噩梦（10%）。药物采集的平均依从性为 99%，3%的参与者在接受访谈前 3 天漏服一剂。在有 VL 结果的参与者中（n=199），99%的病毒被抑制（<1000 拷贝/ml），94%的病毒在 12 个月时 VL<50 拷贝/ml。这项研究是首批记录撒哈拉以南非洲 DTG 自我报告患者经验的研究之一，表明 DTG 为基础的方案在患者中具有很高的可接受性。病毒抑制率高于全国平均水平 82%。我们的研究结果支持将 DTG 为基础的方案作为首选一线 ART 的建议。
