Three Year Outcomes after Programmatic Transitioning to Dolutegravir in the Context of Severe Civil Unrest in Haiti

BackgroundDolutegravir (DTG) has been widely scaled-up worldwide. Data on long-term outcomes are limited. MethodsWe included all persons living with HIV (PLWH) [&ge;]15 years of age who initiated or switched to DTG in Port-au-Prince, Haiti. We described treatment outcomes by pre-switch viral load and assessed predictors of virologic failure using multivariable logistic regression. FindingsA total of 10,354 PLWH initiated or switched to DTG from November 5, 2018 to March 21, 2021, and were included in the analyses. Of these, 2217 (21.4%) were ART-naive and 8137 (78.6%) switched from an NNTRI-based regimen. Median follow-up time on DTG was 2.8 years (IQR: 2.3, 3.1). Among PLWH with [&ge;]2 tests on DTG, 83.5% of ART-naive, 93.1% with pre-switch suppression, 64.8% with pre-switch failure, and 90.2% without pre-switch viral load had <1000 copies/mL at latest test. Among treatment-experienced patients, predictors of HIV-1 RNA [&ge;]1000 copies/mL at latest test included younger age (adjusted odds ratio [aOR]: 2.33 for [&le;]30 vs. [&ge;]50 years), shorter pre-switch time on ART (aOR: 0.91; 95% CI: 0.89, 0.94/year), lower education (aOR: 1.31; 95% CI: 1.10, 1.55), and higher pre-switch viral load: (aOR: 7.00; 95% CI; 5.74, 8.54 for [&ge;]10,000 vs. <1000 copies/mL). InterpretationVirologic outcomes on DTG-based regimens are outstanding for PLWH with pre-switch suppression, even in the context of severe civil unrest in Haiti. However, rates of persistent viremia are high among PLWH who experienced pre-switch failure; additional interventions are critically needed, including access to genotypic resistance testing and provision of alternative regimens as clinically-indicated. FundingNone