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Published on: October 31, 2010
Targeted solutions to increase dolutegravir coverage, viral load testing coverage, and viral suppression among
Caterina Casalini1, Yema D'Almeida2, Moussa Ariziki Nassam2
1HIV Programs, FHI 360, Hilversum, Netherlands.
Insights
Root-cause solutions improved dolutegravir (DTG) use and viral load suppression in children with HIV in Togo. These interventions increased ART coverage and testing, leading to better health outcomes for pediatric HIV patients.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Interventions
- HIV/AIDS Management
Background:
- Togo has reduced AIDS deaths in children, but faces challenges with dolutegravir (DTG)-containing antiretroviral therapy (ART) coverage and viral load suppression (VLS) among children living with HIV (CLHIV).
- Routine data indicated suboptimal uptake of DTG-based ART and low VLS rates in CLHIV.
- Addressing these gaps is crucial for improving pediatric HIV care outcomes.
Purpose of the Study:
- To analyze the impact of implementing root-cause-based solutions on DTG coverage, viral load (VL) testing, and VLS among CLHIV in Togo.
- To evaluate the effectiveness of targeted interventions in improving key indicators of pediatric HIV treatment.
- To identify strategies for enhancing ART adherence and monitoring treatment efficacy in children.
Main Methods:
- Analysis of routine facility data for children aged ≤14 years from October 2019 to September 2022.
- Assessment of DTG regimen uptake, VL testing coverage, and VLS rates before and after intervention implementation.
- Root-cause analysis to identify barriers, followed by implementation of solutions including line listing, adherence support, stock monitoring, and timely feedback.
Main Results:
- Dolutegravir (DTG) coverage increased from 52% to 71% among children on ART.
- Viral load (VL) testing coverage significantly improved from 48% to 90%.
- Viral load suppression (VLS) rates rose from 64% to 82% among tested children.
Conclusions:
- Root-cause-based solutions, coupled with granular data utilization, effectively enhanced DTG coverage, VL testing, and VLS in children living with HIV.
- These successful interventions demonstrate the potential for scaling up and establishing them as the national standard of care in Togo.
- The findings underscore the importance of data-driven approaches and targeted strategies in optimizing pediatric HIV treatment programs.
Background:
According to UNAIDS, Togo halved AIDS-related deaths among children ages 0-14 from 2010 to 2020. However, available data show low dolutegravir (DTG)-containing antiretroviral therapy (ART) coverage and low viral load suppression (VLS) among children living with HIV (CLHIV). We analyzed routine facility data before and after implementation of root-cause-based solutions for improving DTG coverage, viral load (VL) testing coverage, and VLS among CLHIV.
Description:
We analyzed routine data for CLHIV ≤14 years from October 2019 through September 2022. We assessed proportion of CLHIV on ART receiving DTG, VL testing coverage (CLHIV on ART with documented VL test result), and VLS (CLHIV with documented VL test result of <1,000 copies among those with test result). From October 2019 to September 2020, 52% were on a DTG-containing regimen, 48% had documented VL test results, and 64% had VLS. Site-level teams conducted a root-cause analysis and designed corresponding solutions implemented beginning October 2020: line listing and contacting eligible CLHIV to start/transition to DTG-containing regimen and collect VL samples; ART adherence support; monthly DTG stock monitoring; tracking pending VL test results through laboratory focal persons; documenting VL test results; and informing caregivers within one week if CLHIV not virally suppressed. Granular data were used to prioritize technical assistance to sites with lowest DTG coverage, VL testing coverage, and VLS.
Results:
From baseline (October 2019-September 2020) to endline (October 2021-September 2022), increases were observed for DTG coverage (52% to 71%), VL testing coverage (48% to 90%), and VLS (64% to 82%). Age-disaggregated data showed positive trends.
Conclusions:
Root-cause-based solutions and granular data use increased DTG coverage, resulting in increased VL testing and VLS among CLHIV. These interventions should be scaled and become the national standard of care.
