{"doi":"10.1101/2024.05.24.24307900","title":"Disparities in dolutegravir utilisation in children, adolescents and young adults (0-24 years) living with HIV. An analysis of the IeDEA Paediatric West African cohort","abstract":"Introduction: We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa. Methods: We included all patients aged 0-24 years on ART from nine clinics in Côte d'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit ≥ 7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity. Results: Since 2019, 3,350 patients were included; 47.2% were female; 78.9% had been on ART ≥ 12 months. Median baseline age was 12.5 years (Interquartile range[IQR]: 8.4-15.8). Median follow-up was 14 months (IQR: 7-22). The overall cumulative incidence of DTG initiation reached 22.7% (95% Confidence Interval (CI): 21.3-24.2) and 56.4% (95% CI: 54.4-58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and females were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females >10 years were less likely to initiate DTG compared to males of the same age (adjusted Hazard Ratio [HR] among 10-14 years: 0.62, 95% CI: 0.54-0.72; among ≥15 years: 0.43, 95% CI: 0.36-0.50), as were those with detectable VL (> 50 copies/mL) compared to those in viral suppression (aHR: 0.86, 95% CI: 0.77-0.97) and those on protease inhibitors compared to those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI: 0.65-0.86). Conclusion: Paediatric DTG uptake was incomplete and unequitable in West African settings: DTG use was least likely in children <5years, females ≥ 10 years and those with detectable viral load. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake.","journal":"medRxiv","year":2024,"id":497893,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6257,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1344620,"name":"Joycelyn Assimeng Dame","orcid":"0000-0002-5197-023X","position":1,"is_corresponding":false},{"id":279946,"name":"Karen Malateste","orcid":null,"position":2,"is_corresponding":false},{"id":1006787,"name":"Agatha David","orcid":"0000-0002-7773-6206","position":3,"is_corresponding":false},{"id":692618,"name":"Madeleine Amorissani‐Folquet","orcid":"0000-0001-6101-5810","position":4,"is_corresponding":false},{"id":1344856,"name":"Sylvie N’Gbeche","orcid":null,"position":5,"is_corresponding":false},{"id":1065977,"name":"Mariam Sylla","orcid":"0000-0001-9967-9356","position":6,"is_corresponding":false},{"id":578653,"name":"Elom Takassi","orcid":"0000-0003-0726-5485","position":7,"is_corresponding":false},{"id":578654,"name":"François Tanoh Eboua","orcid":"0000-0001-6351-4170","position":8,"is_corresponding":false},{"id":1276356,"name":"Kouadio Kouakou","orcid":null,"position":9,"is_corresponding":false},{"id":1276353,"name":"Lehila Bagnan Tossa","orcid":null,"position":10,"is_corresponding":false},{"id":1275987,"name":"Caroline Yonaba","orcid":"0000-0002-2924-3538","position":11,"is_corresponding":false},{"id":445700,"name":"Valériane Leroy","orcid":"0000-0003-3542-8616","position":12,"is_corresponding":false},{"id":445696,"name":"Sophie Desmonde","orcid":"0000-0001-9372-2819","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-19T02:09:38.543544Z","pmid":"38826257","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}