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TLD turnaround: increasing rates of Dolutegravir-based regimens among women of childbearing age in Zimbabwe
Abstract Content:
BACKGROUND: Zimbabwe has an HIV prevalence among women of childbearing age (WOCBA) of 15.3%. Initial public health messaging around Dolutegravir (DTG)-based Anti-retroviral medicines emphasized educating WOCBA on the possible increased risk of neural tube defects in pregnant women. Zimbabwe Ministry of Health released new guidance emphasizing the safety and efficacy of DTG-based regimens among WOCBA in December 2019. The objective of this assessment was to evaluate the initiation rates of Tenofovir-Lamivudine-Dolutegravir (TLD) regimen among females newly identified as HIV positive, one year on from the release of the revised guidelines.
METHODS: A retrospective cross-sectional assessment of routine program data for females 10 years and older testing HIV positive from 151 purposively sampled OPHID supported health facilities was conducted. The period under review was January' December 2020. Data was analyzed descriptively using MS-Excel.
RESULTS:
From January to December 2020, 8233 females >10years of age were newly identified as HIV positive, with 8024 (97.5%) newly initiated on Anti-Retroviral Therapy (ART). Overall, 6356 (79.2%) were initiated on TLD. There was a gradual month on month increase in the proportion of WOCBA initiated on TLD, from 51% in January 2020 to as high as 90% in November 2020). Older women had higher TLD initiation rates compared with younger age groups representing clients on ART being switched to TLD.
CONCLUSIONS: We demonstrate a gradual temporal shift in TLD initiation rates among WOCBA newly diagnosed HIV positive despite guidance on its safety. Targeted program remediation to increase TLD initiation rates among adolescent girls and young women is required. Revision of HIV treatment guidance should be accompanied by information, education, and communication material for recipients of care and health workers to dispel myths and misconceptions and prevent delays in policy to practice.
METHODS: A retrospective cross-sectional assessment of routine program data for females 10 years and older testing HIV positive from 151 purposively sampled OPHID supported health facilities was conducted. The period under review was January' December 2020. Data was analyzed descriptively using MS-Excel.
RESULTS:
From January to December 2020, 8233 females >10years of age were newly identified as HIV positive, with 8024 (97.5%) newly initiated on Anti-Retroviral Therapy (ART). Overall, 6356 (79.2%) were initiated on TLD. There was a gradual month on month increase in the proportion of WOCBA initiated on TLD, from 51% in January 2020 to as high as 90% in November 2020). Older women had higher TLD initiation rates compared with younger age groups representing clients on ART being switched to TLD.
CONCLUSIONS: We demonstrate a gradual temporal shift in TLD initiation rates among WOCBA newly diagnosed HIV positive despite guidance on its safety. Targeted program remediation to increase TLD initiation rates among adolescent girls and young women is required. Revision of HIV treatment guidance should be accompanied by information, education, and communication material for recipients of care and health workers to dispel myths and misconceptions and prevent delays in policy to practice.