Population Effectiveness of Dolutegravir Implementation in Uganda: A Prospective Observational Cohort Study (DISCO), 48-Week Results

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2024 May 15

PMID 38748986

Authors

Suzanne M McCluskey

Winnie R Muyindike

Victoria Nanfuka

Daniel Omoding

Nimusiima Komukama

Ian T Barigye

Lydia Kansiime

Justus Tumusiime

Taing N Aung

Ashley Stuckwisch

Bethany Hedt-Gauthier

Vincent C Marconi

Mahomed-Yunus S Moosa

Deenan Pillay

Jennifer Giandhari

Richard Lessells

Ravindra K Gupta

Mark J Siedner

Affiliations

Soon will be listed here.

Abstract

Background: Tenofovir/lamivudine/dolutegravir (TLD) is the preferred first-line antiretroviral therapy (ART) regimen for people with HIV (PWH), including those who were previously virologically suppressed on nonnucleoside reverse transcriptase inhibitors (NNRTIs). We sought to estimate the real-world effectiveness of the TLD transition in Ugandan public-sector clinics.

Methods: We conducted a prospective cohort study of PWH aged ≥18 years who were transitioned from NNRTI-based ART to TLD. Study visits were conducted on the day of TLD transition and 24 and 48 weeks later. The primary end point was viral suppression (<200 copies/mL) at 48 weeks. We collected blood for retrospective viral load (VL) assessment and conducted genotypic resistance tests for specimens with VL >500 copies/mL.

Results: We enrolled 500 participants (median age 47 years; 41% women). At 48 weeks after TLD transition, 94% of participants were in care with a VL <200 copies/mL (n = 469/500); 2% (n = 11/500) were lost from care or died; and only 2% (n = 9/500) had a VL >500 copies/mL. No incident resistance to DTG was identified. Few participants (2%, n = 9/500) discontinued TLD due to adverse events.

Conclusions: High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region.

Clinical Trials Registration: NCT04066036.

Citing Articles

HIV Drug Resistance Profile in Clients Experiencing Treatment Failure After the Transition to a Dolutegravir-Based First-Line Antiretroviral Treatment Regimen in Mozambique.

Ismael N, Hussein C, Magul C, Inguane H, Couto A, Nhangave A Pathogens. 2025; 14(1).

PMID: 39861009 PMC: 11769524. DOI: 10.3390/pathogens14010048.

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