medRxiv : the preprint server for health sciences · 2025
Lingering sex and age disparities in dolutegravir uptake among adults with HIV: A multi-country observational cohort study.
СтатьяПрепринтНазвание и аннотация: Перевод в очереди
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Brazier Ellen, Romo Matthew L, Ciaranello Andrea, Odhiambo Francesca, Pujari Sanjay, Murenzi Gad, Kasozi Charles, Kiertiburanakul Sasisopin, Nsonde Dominique Mahambou, Muyindike Winnie R, Khol Vohith, Lelo Patricia, Lyamuya Rita, Lee Man Po, Nash Denis
Аннотация
INTRODUCTION: Since July 2019, the World Health Organization (WHO) has recommended dolutegravir (DTG)-based regimens as preferred first-line antiretroviral therapy (ART) for adults and adolescents living with HIV (DTG-for-All), a reversal of a 2018 safety alert on use of DTG-based regimens by women of reproductive age (WRA). We examined sex and age disparities in DTG uptake before and after DTG-for-All in the International epidemiology Databases to Evaluate AIDS (IeDEA).
METHODS: We included patients ≥16 years on or initiating treatment between January 2017 and July 2021 in 14 low- and middle-income countries where initial guidelines on DTG-based regimens for first-line ART either restricted use by WRA or had no such restrictions. We estimated the cumulative incidence of DTG uptake (CI-DTG) by sex and age group (aged 16-49 years vs. 50+ years), stratified by patient, clinic and setting characteristics.
RESULTS: Among 177,706 patients on ART during the study period, 51% were females aged 16-49 years, with 25% males aged 16-49, and 13% and 11%, respectively, females and males aged 50+. At the time of DTG-for-All, overall CI-DTG was 29.6% (95%CI: 29.4, 29.8); it was lower among females aged 16-49 (16.2%; 95%CI: 16.0-16.5) than males (41.1%; 95%CI: 40.6, 41.5), with no sex disparities among patients aged 50+ (females: 46.0%; males: 47.0%). While DTG uptake subsequently increased among all groups, by July 2021, it remained substantially lower among females 16-49 (66.4%; 95%CI: 66.1, 66.7), compared with males 16-49 and older females and males (75.8% to 77.5%). Concentrated in countries where initial guidelines on DTG restricted use by WRA, disparities in DTG uptake persisted at all health system levels and in both low-income and lower-middle income countries.
CONCLUSIONS: While sex-age differentials in DTG uptake narrowed after WHO's DTG-for-All recommendation, lingering disparities uptake underscore the challenges of policy de-implementation when new evidence emerges.
METHODS: We included patients ≥16 years on or initiating treatment between January 2017 and July 2021 in 14 low- and middle-income countries where initial guidelines on DTG-based regimens for first-line ART either restricted use by WRA or had no such restrictions. We estimated the cumulative incidence of DTG uptake (CI-DTG) by sex and age group (aged 16-49 years vs. 50+ years), stratified by patient, clinic and setting characteristics.
RESULTS: Among 177,706 patients on ART during the study period, 51% were females aged 16-49 years, with 25% males aged 16-49, and 13% and 11%, respectively, females and males aged 50+. At the time of DTG-for-All, overall CI-DTG was 29.6% (95%CI: 29.4, 29.8); it was lower among females aged 16-49 (16.2%; 95%CI: 16.0-16.5) than males (41.1%; 95%CI: 40.6, 41.5), with no sex disparities among patients aged 50+ (females: 46.0%; males: 47.0%). While DTG uptake subsequently increased among all groups, by July 2021, it remained substantially lower among females 16-49 (66.4%; 95%CI: 66.1, 66.7), compared with males 16-49 and older females and males (75.8% to 77.5%). Concentrated in countries where initial guidelines on DTG restricted use by WRA, disparities in DTG uptake persisted at all health system levels and in both low-income and lower-middle income countries.
CONCLUSIONS: While sex-age differentials in DTG uptake narrowed after WHO's DTG-for-All recommendation, lingering disparities uptake underscore the challenges of policy de-implementation when new evidence emerges.