Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study

Abstract

Background The World Health Organization recommends dolutegravir (DTG) as the for first-line and second-line antiretroviral therapy (ART) worldwide. However, little is known about the acceptability and tolerability of DTG-based ART at routine points-of-care in Uganda. We set out to explore the perceptions of clinicians in ART clinics regarding the acceptability and tolerability of DTG-based ART since national roll-out in March 2018 in Uganda. Methods We adopted a qualitative exploratory design involving 49 participants. Between September 2020 and February 2021, we conducted 22 in-depth interviews with clinicians in the ART clinics of 12 purposively selected health facilities across Uganda. The selection of study sites ensured diversity in facility ownership-type (public/private), level of service delivery (tertiary/secondary/primary) and the four major geographic sub-regions of Uganda. We conducted three focus group discussions with 27 clinicians in the participating facilities. Data were analyzed by thematic approach. Results Clinicians in ART clinics acknowledged that DTG-based ART is well tolerated by the majority of their patients who appreciate the reduced pill burden, perceived less side effects and superior viral load suppression. However, they reported that a number of their patients experience adverse drug reactions (ADRs) after being transitioned to DTG. Hyperglycemia is, by far, the most commonly reported suspected ADR associated with DTG-based regimens and was cited in all but two participating facilities. Insomnia, weight gain and reduced libido are among the other frequently cited suspected ADRs. In addition, clinicians in ART clinics perceived some of the suspected ADRs as resulting from drug interactions between dolutegravir and isoniazid. Weak diagnostic capacities and shortage of associated commodities (e.g. glucometers and test kits) were reported as impediments to understanding the full extent of ADRs associated DTG-based ART. Conclusion While DTG-based regimens were perceived by clinicians in ART clinics to be well tolerated by the majority of their patients, they also reported that a number of patients experience suspected ADRs key among which were hyperglycemia, insomnia and reduced libido. Based on the perspectives of clinicians, we recommend that future studies examine the prevalence of dolutegravir-induced hyperglycemia in patients in Uganda.

Patient experiences of sexual dysfunction after transition to dolutegravir-based HIV treatment in mid-Western Uganda: a qualitative study

“…Many countries in sub-Saharan Africa (SSA) are transitioning to DTG-based regimens, with some providers reporting as high as 80% of their HIV client loads transitioned [ 3 ]. Therefore, DTG-based ART will be a primary treatment option for the majority of the nearly 38 million people living with HIV globally [ 4 ].…”

“…DTG-based ART is rapidly becoming the dominant option in HIV treatment in Uganda [ 3 ]. Despite the increasing complaints from patients in Uganda around suspected ADRs arising from dolutegravir-based ART [ 3 ], there is little research exploring patient safety in the context of the aggressive roll-out of DTG-based regimens. The findings reported here are derived from a larger study, aimed at promoting patient-centred pharmacovigilance, in the context of the concurrent roll-out of newer HIV medications such as DTG-based ART and community-based ART delivery models in Uganda [ 3 ].…”

“…Despite the increasing complaints from patients in Uganda around suspected ADRs arising from dolutegravir-based ART [ 3 ], there is little research exploring patient safety in the context of the aggressive roll-out of DTG-based regimens. The findings reported here are derived from a larger study, aimed at promoting patient-centred pharmacovigilance, in the context of the concurrent roll-out of newer HIV medications such as DTG-based ART and community-based ART delivery models in Uganda [ 3 ]. The first phase involved interviews with clinicians in HIV clinics to understand provider perspectives on the acceptability and tolerability of DTG-based ART [ 3 ].…”

“…The findings reported here are derived from a larger study, aimed at promoting patient-centred pharmacovigilance, in the context of the concurrent roll-out of newer HIV medications such as DTG-based ART and community-based ART delivery models in Uganda [ 3 ]. The first phase involved interviews with clinicians in HIV clinics to understand provider perspectives on the acceptability and tolerability of DTG-based ART [ 3 ].…”

“…In this study we sought to understand the lived experience of chronic illness by patients [ 24 ]. Therefore, we aimed to elicit the experiences of patients with self-reported constraints in sexual functioning directly from the subjects through first-hand narrative discourse as opposed to hearing from attending clinicians whose perspectives on medication safety of DTG-based ART we reported elsewhere [ 3 ].…”