Meque Ivete, Herrera Nicole, Nhangave Amâncio, Mandlate Dórcia, Guilaze Rui, Tambo Ana, Mussa Abdul, Bhatt Nilesh, Gill Michelle M
Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique.
Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America.
South Afr J HIV Med. 2024 Jul 31;25(1):1578. doi: 10.4102/sajhivmed.v25i1.1578. eCollection 2024.
In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings.
We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV.
We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors.
Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% ( = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% ( = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]).
Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.
2022年，莫桑比克引入了10毫克度鲁特韦（pDTG），作为体重<20千克儿童抗逆转录病毒治疗的一部分。了解全国推广过程中的实际挑战可以加强资源有限环境下的卫生系统。
我们描述了pDTG的转换率和新开始使用情况、pDTG治疗后的病毒载量抑制（VLS），以及与感染艾滋病毒儿童的VLS相关的因素。
我们进行了一项回顾性队列研究，纳入了9岁以下儿童，并从临床资料中提取数据。我们使用逻辑回归来评估VLS和pDTG开始使用的预测因素。
在1353名儿童中，1146名开始使用pDTG；196名（14.5%）没有记录体重。在改用pDTG后，98.9%（950/961）的儿童维持了相同的核苷类逆转录酶抑制剂主干治疗方案。开始使用阿巴卡韦/拉米夫定+pDTG后，834名（72.8%）儿童继续使用该方案，156名（13.6%）改用其他方案（大多数改用50毫克度鲁特韦），22名（1.9%）有≥2次锚定药物转换；134名（11.7%）没有记录后续治疗方案。与开始使用或转换pDTG相关的因素包括年龄较小（调整后的优势比[AOR]=0.71[0.63-0.80]）和有记录的体重（AOR=55.58[33.88-91.18]）。在pDTG治疗≥5个月后进行病毒载量（VL）检测的294名儿童中，VLS率为75.5%（=222/294）。有治疗经验的儿童在使用pDTG前的VLS率为56.5%（=130/230）。与VLS相关的因素包括年龄较大（AOR=1.18[1.03-1.34]）和之前的VLS（AOR=2.27[1.27-4.06]）。
大多数符合条件的儿童按照指南开始使用pDTG，改善了pDTG治疗后的VLS。挑战包括开始使用pDTG后不明原因的改用其他方案、VL检测覆盖率低以及临床记录中的记录不充分。
