Longitudinal monitoring of HIV virologic suppression among people who inject drugs and on Dolutegravir-containing antiretroviral therapy in Kenya. Open Access
Mbogo, Loice Wangari (Spring 2024)
Abstract
Background: Globally, there has been a transition to newer integrase strand transfer inhibitor (InSTI) included in first-line antiretroviral treatment (ART) regimens for people with HIV, consisting of tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + dolutegravir (DTG). This regimen (TLD) has become a global standard, as recommended by the World Health Organization. There are limited longitudinal data on effectiveness of DTG-based regimens among people who inject drugs (PWID) in Sub-Saharan Africa. The purpose of this study was to longitudinally monitor survival trends and virologic suppression patterns of DTG-containing first-line ART among PWID in Kenya and to evaluate the social and demographic factors associated with viral suppression over time.
Methods: We selected participants who were on first-line ART treatment regimen of TLD for 6 months prior to study enrollment and then monitored the HIV-1 plasma RNA viral load (VL) every 6 months within the 2 years of follow-up. Study enrollment and data collection occurred between May 2021 and September 2023. The study population was recruited from drop-in centers in Nairobi and coastal region in Kenya. We employed Kaplan-Meier estimators and Cox regression models to ascertain factors associated with time from viral suppression to viremia.
Results: Among 250 enrolled participants, 125 (50%) were taking methadone, and most (70%) were male. Median age was 39 years (interquartile range: 33-44). At baseline, 213 (85%) were virally suppressed (<1000 copies/ml), and over time that proportion remained constant with 177 (86%) suppressed at 24 months. Nevertheless, 13% to 16% of individuals were viremic across various time points. Older age was associated with a longer time until viremia (HR = 0.95, 95% CI: 0.92, 0.99). Additionally, males, secondary education, injecting for >5 years, and methadone use were associated with a longer time to viremia though not statistically significant.
Conclusion: This is the first longitudinal study of HIV viral suppression among PWID in Kenya. This study showed that most individuals on DTG-containing ART were consistently virally suppressed over time. Nevertheless, several individuals became viremic, which indicates the need to continue evaluating the effectiveness of DTG over time to guide optimal HIV treatment strategies for PWIDs in Kenya.
Keywords: Dolutegravir-containing ART, viral suppression, longitudinal
Table of Contents
Contents
Introduction. 1
Chapter 1. Literature. 2
Chapter 2. Methods. 3
2.1 Introduction. 3
2.2 Population and sample. 3
2.3 Research design. 4
2.4 Procedures. 4
2.5 Laboratory Samples Analysis. 4
2.6 Instruments. 4
2.7 Ethical Consideration. 5
2.8 Limitations and delimitations. 5
Chapter 3. Data analysis. 5
Chapter 4. Results. 6
4.1 Participants characteristics. 6
4.2 Patterns of Viral Suppression. 12
4.3 Factors associated with time to being viremic. 12
Chapter 5. Discussion/conclusion. 15
5.1 Limitations and recommendations. 16
Reference. 17
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