{
  "abstract": "Introduction Since July 2019, the WHO has recommended dolutegravir (DTG)-based regimens as preferred first-line antiretroviral therapy (ART) for adults and adolescents living with HIV (DTG-for-All), a reversal of a 2018 safety alert on use of DTG-based regimens by women of reproductive age (WRA). We examined sex and age disparities in DTG uptake before and after DTG-for-All in the International epidemiology Databases to Evaluate AIDS.Methods We included patients ≥16 years on or initiating treatment between January 2017 and July 2021 in 14 low- and middle-income countries where initial guidelines on DTG-based regimens for first-line ART either restricted use by WRA or had no such restrictions. We estimated the cumulative incidence of DTG uptake (CI-DTG) by sex and age group (aged 16–49 years vs 50+ years), stratified by patient, clinic and setting characteristics.Results Among 177 706 patients on ART during the study period, 51% were females aged 16–49 years, with 25% males aged 16–49 and 13% and 11%, respectively, females and males aged 50+. At the time of DTG-for-All, overall CI-DTG was 29.6% (95% CI 29.4% to 29.8%); it was lower among females aged 16–49 (16.2%; 95% CI 16.0% to 16.5%) than males (41.1%; 95% CI 40.6% to 41.5%), with no sex disparities among patients aged 50+ (females: 46.0%; males: 47.0%). While DTG uptake subsequently increased among all groups, by July 2021, it remained substantially lower among females 16–49 (66.4%; 95% CI 66.1% to 66.7%), compared with males 16–49 and older females and males (75.8% to 77.5%). Concentrated in countries where initial guidelines on DTG restricted use by WRA, disparities in DTG uptake persisted at all health system levels and in both low-income and lower-middle-income countries.Conclusions While sex-age differentials in DTG uptake narrowed after WHO’s DTG-for-All recommendation, lingering disparities in uptake underscore the difficulty of policy de-implementation when new evidence emerges.",
  "authors": [
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA"
      ],
      "name": "Ellen Brazier"
    },
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA"
      ],
      "name": "Matthew L Romo"
    },
    {
      "affiliations": [
        "Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA",
        "Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Andrea L Ciaranello"
    },
    {
      "affiliations": [
        "Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya"
      ],
      "name": "Francesca Odhiambo"
    },
    {
      "affiliations": [
        "Institute of Infectious Diseases, Pune, India"
      ],
      "name": "Sanjay Pujari"
    },
    {
      "affiliations": [
        "School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda",
        "Goodlife Access, Kigali, Rwanda"
      ],
      "name": "Gad Murenzi"
    },
    {
      "affiliations": [
        "Department of Public Health, Masaka Regional Referral Hospital, Masaka, Uganda"
      ],
      "name": "Charles Kasozi"
    },
    {
      "affiliations": [
        "Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"
      ],
      "name": "Sasisopin Kiertiburanakul"
    },
    {
      "affiliations": [
        "Centre de Traitement Ambulatoire Brazzaville, Brazzaville, Congo"
      ],
      "name": "Dominique Mahambu Nsonde"
    },
    {
      "affiliations": [
        "Mbarara National Referral Hospital, Mbarara, Mbarara, Uganda",
        "Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda"
      ],
      "name": "Winnie Muyindike"
    },
    {
      "affiliations": [
        "National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia"
      ],
      "name": "Vohith Khol"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Kalembelembe Pediatric Hospital, Kinshasa, Congo (the Democratic Republic of the)"
      ],
      "name": "Patricia Lelo"
    },
    {
      "affiliations": [
        "Care and Treatment Centre, Morogoro Regional Hospital, Morogoro, Tanzania"
      ],
      "name": "Rita Lyamuya"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital, Hong Kong, SAR, China"
      ],
      "name": "Man Po Lee"
    },
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA",
        "City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA"
      ],
      "name": "Denis Nash"
    }
  ],
  "title": "Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study",
  "uid": "7fcb3793-c845-5fcb-906f-1b05ccc6f025"
}