Effect of the Scale-Up of Dolutegravir on Retention in Care, Risk of Developing Tuberculosis and Viral Load Suppression Among People Living With HIV: Analysis of Routine HIV Clinical Data in Rural KwaZulu-Natal, South Africa (2019-23).

BACKGROUND

There is limited evidence on how the rollout of dolutegravir (DTG) has affected retention in care, tuberculosis (TB) disease risk, and viral load suppression (VLS) among people living with HIV (PLHIV) in routine program settings. This study evaluated associations between DTG rollout and VLS, risk of developing TB disease, and retention in care in rural KwaZulu-Natal (KZN), South Africa.

METHODS

We employed a retrospective cohort study of PLHIV aged 15 and above, followed up from 1 October 2019 to 31 December 2023 in a rural sub-district of KZN. We grouped antiretroviral therapy (ART) regimens into DTG-containing and non-DTG-containing regimens. We classified PLHIV as virally suppressed or non-suppressed based on a VLS threshold of <400 copies/mL. We used Kaplan-Meier survival curves to describe the transition to DTG over time. We applied Cox proportional-hazards models to evaluate associations between DTG rollout and VLS, the risk of developing TB, and retention in care.

RESULTS

Of the 69 919 PLHIV included in the DTG rollout cohort, approximately 70% (n = 48 598) transitioned to DTG-containing regimens during the 4-year follow-up period. Compared with non-DTG regimens, DTG use was associated with a greater likelihood of VLS (aHR 1.24, 95% CI 1.10-1.29), retention in care (aHR 1.20, 95% CI 1.11-1.30), and lower risk of TB disease (aHR 0.68, 95% CI .54-.87).

CONCLUSIONS

These findings support the sustained rollout of DTG-based regimens and emphasize the importance of continuous monitoring to assess their long-term associations and programmatic performance in comparable settings.