Comparative assessment on the adherence and effectiveness of Dolutegravir versus Lopinavir-based regimens among children with HIV infection in Tanzania and associated factors: a retrospective cohort study

Abstract

ABSTRACT Background: Tanzania bears a significant HIV burden, with around 85,000 children living with the virus as of 2021, according to the United Nations Programme on HIV/AIDS (UNAIDS). The global HIV 95-95-95 targets aim for 95% of people with HIV to be diagnosed, 95% of those diagnosed to be on antiretroviral therapy (ART), and 95% of those on ART to achieve viral load suppression by 2030. Tanzania has achieved significant advancements: 60.6% of individuals with HIV are aware of their status, 93.6% of those who know their status are receiving antiretroviral therapy (ART) and 87% of those on ART have attained viral load suppression. Adhering well to ART is crucial for meeting these goals, particularly for pediatric patients who not only needs safe and effective but also medications tailored for children. Objective: To compare the adherence and effectiveness of a dolutegravir (DTG) tablet 10mg-versus Lopinavir (LPV/r) based regimens among HIV-infected children in Tanzania and associated factors. Methodology: This retrospective cohort study was conducted from January 2021 to November 2023 at three selected CTC clinics in Tanzania: Muhimbili National Hospital, Mbeya Zonal Referral Hospital, and Baylor College of Medicine Bugando- Mwanza. The study included children who had been on the DTG and Lopinavir-based regimen for at least six months to one year without prior exposure to other HIV treatment regimens. Adherence was measured by assessing the patients’ refilling schedule of medicine and effectiveness was assessed by viral load suppression (HVL < 50 copies/ml). Data were collected using a structured case report forms and then analyzed using SPSS version 23. Descriptive statistics summarized the data, and associations between regimens adherence and effectiveness were evaluated using modified poison regression. Results: The study included 340 participants. Adherence rates were significantly higher among those on the DTG regimen (95.9%) compared to those on the Lopinavir/ritonavir (LPV/r) regimen (85.1%) (P < 0.001) 95 % CI. Adverse drug events (ADEs) were significantly lower in the DTG group (8.7%) compared to the LPV/r group (22.0%) (p < 0.001). Factors which were significantly associated with good adherence included being aged ≥ 5 years (aRR = 1.08, p = 0.04) 95 % CI, the presence of an active caregiver (aRR = 1.40, p = 0.006) 95 % CI, and the absence of ADEs (aRR = 1.28, p = 0.008) 95 % CI. Viral load suppression rates were higher in the DTG group at both at 6 and 12 months compared to the LPV/r group. Conclusion and Recommendation: The DTG regimen is associated with higher adherence and better effectiveness in achieving viral load suppression among pediatric patients compared to the LPV/r regimen. These findings support the use of DTG as a preferred treatment option for children with HIV. Ongoing monitoring and support for caregivers are recommended to enhance adherence and improve treatment outcomes. Further research with longer follow-up periods and diverse populations is needed to confirm these findings and assess long-term outcomes.