Implementation and outcomes of the dolutegravir rollout in South Africa
According to a collaborative team of researchers at CAPRISA, the eThekwini Municipality, the National Department of Health Health Informatics Directorate, and the University of Oxford the rollout of dolutegravir initially favoured men, but did lead to improved retention in care and viral suppression in KwaZulu-Natal, South Africa. The study “Implementation and outcomes of dolutegravir-based first-line antiretroviral therapy for people with HIV in South Africa: a retrospective cohort study”, was published in The Lancet HIV, along with a translated version of the abstract in isiZulu.
Using routine, de-identified data from 220,000 people with HIV in South African primary care, the researchers found that early in the rollout, women were less likely to receive dolutegravir. This was likely because of initial safety concerns around dolutegravir use in pregnancy, and once guidelines were updated to reflect new data confirming safety, the disparity between men and women disappeared.
Among people receiving dolutegravir, subsequent 12-month retention and viral suppression were better compared to those receiving the older drug, efavirenz. The benefits of dolutegravir were strongest among people receiving concurrent tuberculosis treatment when initiating ART, and among people transitioned to dolutegravir with most recent viral load at baseline ≥200 copies/mL. The analysis was part of the SHAPE project, which is led by Dr Dorward CAPRISA Honorary Associate and lead author on the study and Prof Nigel Garrett.