PDF(Pubmed)
Abstract：
UNASSIGNED: In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings.
UNASSIGNED: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV.
UNASSIGNED: We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors.
UNASSIGNED: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]).
UNASSIGNED: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.
UNASSIGNED: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV.
UNASSIGNED: We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors.
UNASSIGNED: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]).
UNASSIGNED: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.
摘要：
■2022年，莫桑比克推出了Dolutegravir10mg（pDTG），作为儿童抗逆转录病毒治疗的一部分，体重<20公斤的儿童。在国家推广期间了解现实世界的挑战可以在资源有限的环境中加强卫生系统。
■我们描述了过渡率，和新的开始，pDTG,pDTG后的病毒载量抑制（VLS），以及感染艾滋病毒儿童中与VLS相关的因素。
■我们进行了一项涉及9岁以下儿童的回顾性队列研究，并从临床来源提取数据。我们使用逻辑回归来评估VLS和pDTG启动预测因子。
■在1353个孩子中，1146起始的pDTG;196(14.5%)没有记录体重。pDTG后开关,98.9%(950/961)的儿童维持相同的核苷逆转录酶抑制剂骨架。开始阿巴卡韦/拉米夫定+pDTG后，834名(72.8%)儿童仍在接受该方案，156（13.6％）关闭（大多数为Dolutegravir50mg），22（1.9％）有≥2种锚定药物转换；134（11.7％）没有记录的随访方案。与pDTG启动或转换相关的因素是年龄较小（调整比值比[AOR]=0.71[0.63-0.80]）和体重记录（AOR=55.58[33.88-91.18]）。在pDTG后≥5个月进行病毒载量（VL）测试的294名儿童中，VLS为75.5％（n=222/294）。有治疗经验的儿童pDTG前VLS率为56.5%(n=130/230)。与VLS相关的因素是年龄较大（AOR=1.18[1.03-1.34]）和既往VLS（AOR=2.27[1.27-4.06]）。
■大多数符合条件的儿童根据指南启动了pDTG，改进pDTG后VLS。挑战包括启动后无法解释的关闭pDTG，VL覆盖率低，临床记录中文件不足。
■我们描述了过渡率，和新的开始，pDTG,pDTG后的病毒载量抑制（VLS），以及感染艾滋病毒儿童中与VLS相关的因素。
■我们进行了一项涉及9岁以下儿童的回顾性队列研究，并从临床来源提取数据。我们使用逻辑回归来评估VLS和pDTG启动预测因子。
■在1353个孩子中，1146起始的pDTG;196(14.5%)没有记录体重。pDTG后开关,98.9%(950/961)的儿童维持相同的核苷逆转录酶抑制剂骨架。开始阿巴卡韦/拉米夫定+pDTG后，834名(72.8%)儿童仍在接受该方案，156（13.6％）关闭（大多数为Dolutegravir50mg），22（1.9％）有≥2种锚定药物转换；134（11.7％）没有记录的随访方案。与pDTG启动或转换相关的因素是年龄较小（调整比值比[AOR]=0.71[0.63-0.80]）和体重记录（AOR=55.58[33.88-91.18]）。在pDTG后≥5个月进行病毒载量（VL）测试的294名儿童中，VLS为75.5％（n=222/294）。有治疗经验的儿童pDTG前VLS率为56.5%(n=130/230)。与VLS相关的因素是年龄较大（AOR=1.18[1.03-1.34]）和既往VLS（AOR=2.27[1.27-4.06]）。
■大多数符合条件的儿童根据指南启动了pDTG，改进pDTG后VLS。挑战包括启动后无法解释的关闭pDTG，VL覆盖率低，临床记录中文件不足。
