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HIV drug resistance among adults initiating antiretroviral therapy in Uganda

Watera, Christine ; Ssemwanga, Deogratius ; Namayanja, Grace ; Asio, Juliet ; Lutalo, Tom ; Namale, Alice ; Sanyu, Grace ; Ssewanyana, Isaac ; Gonzalez-Salazar, Jesus Fidel and Nazziwa, Jamirah LU orcid , et al. (2021) In The Journal of antimicrobial chemotherapy 76(9). p.2407-2414
Abstract

BACKGROUND: WHO revised their HIV drug resistance (HIVDR) monitoring strategy in 2014, enabling countries to generate nationally representative HIVDR prevalence estimates from surveys conducted using this methodology. In 2016, we adopted this strategy in Uganda and conducted an HIVDR survey among adults initiating or reinitiating ART.

METHODS: A cross-sectional survey of adults aged ≥18 years initiating or reinitiating ART was conducted at 23 sites using a two-stage cluster design sampling method. Participants provided written informed consent prior to enrolment. Whole blood collected in EDTA vacutainer tubes was used for preparation of dried blood spot (DBS) specimens or plasma. Samples were shipped from the sites to the Central... (More)

BACKGROUND: WHO revised their HIV drug resistance (HIVDR) monitoring strategy in 2014, enabling countries to generate nationally representative HIVDR prevalence estimates from surveys conducted using this methodology. In 2016, we adopted this strategy in Uganda and conducted an HIVDR survey among adults initiating or reinitiating ART.

METHODS: A cross-sectional survey of adults aged ≥18 years initiating or reinitiating ART was conducted at 23 sites using a two-stage cluster design sampling method. Participants provided written informed consent prior to enrolment. Whole blood collected in EDTA vacutainer tubes was used for preparation of dried blood spot (DBS) specimens or plasma. Samples were shipped from the sites to the Central Public Health Laboratory (CPHL) for temporary storage before transfer to the Uganda Virus Research Institute (UVRI) for genotyping. Prevalence of HIVDR among adults initiating or reinitiating ART was determined.

RESULTS: Specimens from 491 participants (median age 32 years and 61.5% female) were collected between August and December 2016. Specimens from 351 participants were successfully genotyped. Forty-nine had drug resistance mutations, yielding an overall weighted HIVDR prevalence of 18.2% with the highest noted for NNRTIs at 14.1%.

CONCLUSIONS: We observed a high HIVDR prevalence for NNRTIs among adults prior to initiating or reinitiating ART in Uganda. This is above WHO's recommended threshold of 10% when countries should consider changing from NNRTI- to dolutegravir-based first-line regimens. This recommendation was adopted in the revised Ugandan ART guidelines. Dolutegravir-containing ART regimens are preferred for first- and second-line ART regimens.

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publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of antimicrobial chemotherapy
volume
76
issue
9
pages
2407 - 2414
publisher
Oxford University Press
external identifiers
  • pmid:33993252
  • scopus:85114369131
ISSN
1460-2091
DOI
10.1093/jac/dkab159
language
English
LU publication?
no
additional info
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
id
853e4151-3c00-4569-a7d5-a1cb9737f510
date added to LUP
2021-10-26 12:20:29
date last changed
2024-06-01 18:36:23
@article{853e4151-3c00-4569-a7d5-a1cb9737f510,
  abstract     = {{<p>BACKGROUND: WHO revised their HIV drug resistance (HIVDR) monitoring strategy in 2014, enabling countries to generate nationally representative HIVDR prevalence estimates from surveys conducted using this methodology. In 2016, we adopted this strategy in Uganda and conducted an HIVDR survey among adults initiating or reinitiating ART.</p><p>METHODS: A cross-sectional survey of adults aged ≥18 years initiating or reinitiating ART was conducted at 23 sites using a two-stage cluster design sampling method. Participants provided written informed consent prior to enrolment. Whole blood collected in EDTA vacutainer tubes was used for preparation of dried blood spot (DBS) specimens or plasma. Samples were shipped from the sites to the Central Public Health Laboratory (CPHL) for temporary storage before transfer to the Uganda Virus Research Institute (UVRI) for genotyping. Prevalence of HIVDR among adults initiating or reinitiating ART was determined.</p><p>RESULTS: Specimens from 491 participants (median age 32 years and 61.5% female) were collected between August and December 2016. Specimens from 351 participants were successfully genotyped. Forty-nine had drug resistance mutations, yielding an overall weighted HIVDR prevalence of 18.2% with the highest noted for NNRTIs at 14.1%.</p><p>CONCLUSIONS: We observed a high HIVDR prevalence for NNRTIs among adults prior to initiating or reinitiating ART in Uganda. This is above WHO's recommended threshold of 10% when countries should consider changing from NNRTI- to dolutegravir-based first-line regimens. This recommendation was adopted in the revised Ugandan ART guidelines. Dolutegravir-containing ART regimens are preferred for first- and second-line ART regimens.</p>}},
  author       = {{Watera, Christine and Ssemwanga, Deogratius and Namayanja, Grace and Asio, Juliet and Lutalo, Tom and Namale, Alice and Sanyu, Grace and Ssewanyana, Isaac and Gonzalez-Salazar, Jesus Fidel and Nazziwa, Jamirah and Nanyonjo, Maria and Raizes, Elliot and Kabuga, Usher and Mwangi, Christina and Kirungi, Wilford and Musinguzi, Joshua and Mugagga, Kaggwa and Mbidde, Edward Katongole and Kaleebu, Pontiano}},
  issn         = {{1460-2091}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{9}},
  pages        = {{2407--2414}},
  publisher    = {{Oxford University Press}},
  series       = {{The Journal of antimicrobial chemotherapy}},
  title        = {{HIV drug resistance among adults initiating antiretroviral therapy in Uganda}},
  url          = {{http://dx.doi.org/10.1093/jac/dkab159}},
  doi          = {{10.1093/jac/dkab159}},
  volume       = {{76}},
  year         = {{2021}},
}