By Onche Odeh
Six states in Nigeria have commenced the use of the paediatric version of Dolutegravir (DTG), the World Health Organisation’s (WHO) recommended first-line drug for the treatment of HIV,
Dolutegravir (DTG), sold under the brand name Tivicay, is an antiretroviral medication used, together with other medication, to treat HIV/AIDS. It may also be used, as part of post exposure prophylaxis, to prevent HIV infection following potential exposure.
In the pilot subsumed under Nigeria’s National HIV Treatment Plan commenced over one month ago across selected hospital facilities including the Federal Medical Centre(FMC) in Makurdi, Benue State, University of Calabar Teaching Hospital (UCTH) in Cross River State, Uthman Dan Fodio University Teaching Hospital in Sokoto State and other locations in Akwa Ibom, Rivers and Lagos states.
The new DTG 10 mg strawberry-flavored, dispersible tablet has been formulated to be more inviting to children, as a way of enabling them to successfully remain on medication and prevent thousands of premature deaths each year. This could potentially transform pediatric HIV treatment in low and middle-income countries.
Dr. Olugbenga Ijaodola, Assistant Director at Nigeria’s Federal Ministry of Health, National PMTCT Lead at National AIDS and STIs Control Program (NASCP) who confirmed this development to Africasti during the UNICEF supported meeting of Journalists Alliance for Prevention of Mother-To-Child Transmission (JAPiN) held in Calabar, Cross River State, said the pilot of pDTG across Nigeria is aimed at achieving zero transmission of HIV from the mother to the child.
“The Federal Ministry of Health (FMOH) in line with her mandate is committed to the attainment of the global goal of Elimination of Mother to Child Transmission of HIV (e-MTCT) and Zero new HIV infections. It is anticipated that the adoption of pDTG in treatment of children living with HIV would increase Antiretroviral Treatment (ART) coverage among children and reduce the AIDS burden on them and caregivers,” Ijaodola said.
He listed some of the issues that have limited the uptake of ART among children in Nigeria to include low Ante natal care service uptake, low rates of facility deliveries, low uptake of Early Infant Diagnosis (EID) services, low ART coverage for HIV positive pregnant women among other factors.
Records from Nigeria’s Federal Ministry of Health show that an estimated 63 percent of HIV positive women do not access Prevention of Mother-To-Child Transmission (PMTCT) of HIV services, just as 3 in 4 Pregnant women in Nigeria are not captured at antenatal care. According to the recent sentinel survey, about 22,000 new HIV infections among children are recorded in Nigeria.
Dr Atana Ewa, an Associate Professor of Paediatric Respiratory/Infectious Diseases who is the PMTCT Focal Person at the University of Calabar Teaching Hospital, whom spoke about the ART in children said combination ART therapy is recommended.
“Combination ART therapy is recommended for children because it slows down disease progression, improves their chances of survival and results in greater and more sustained virological and immunological response, just as it delays development of drug resistant strains,” Dr Ewa said in her presentation.
In 2018, WHO published up-to-date recommendations for the use of antiretroviral (ARV) drug regimens to treat and prevent HIV infection. These guidelines recommended a dolutegravir-based regimen as the preferred first-line and second-line regimen for children for whom approved DTG dosing is available.
Sequel to this, the U.S. Food and Drug Administration (FDA) approved a dispersible 5mg formulation of dolutegravir (DTG) for use in combination with other antiretroviral treatments among infants from four weeks of age weighing at least 3 kg that are living with HIV type 1 (HIV-1), a decision that was hailed by the WHO in a statement in June 2020.
The approval followed a trial that included 75 infants and children infected with HIV-1 with an average age of 27 months. According to the FDA press release, 62% of pediatric patients taking the 5 mg formulation had an undetectable HIV viral load at 24 weeks and, at 48 weeks, 69% had an undetectable viral load. On average, the patients had higher levels of CD4 cells that help the body fight off infection.
Meanwhile, Nigeria could benefit from an agreement that will significantly lower the total annual cost of pediatric HIV treatment from $480 per child to less than $120. With global health budgets more constrained than ever, analysts suggest that such significant savings, in the range of US$60-260 million over five years will be a game-changer.