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

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dc.contributor.authorZakumumpa, Henry
dc.contributor.authorKitutu, Freddy Eric
dc.contributor.authorByomire Ndagije, Helen
dc.contributor.authorNakitto‑Kesi, Diana
dc.contributor.authorNambi Ssanyu, Jacquellyn
dc.contributor.authorKiguba, Ronald
dc.date.accessioned2023-01-27T16:29:10Z
dc.date.available2023-01-27T16:29:10Z
dc.date.issued2021
dc.description.abstractThe 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.en_US
dc.identifier.citationZakumumpa, H., Kitutu, F. E., Ndagije, H. B., Diana, N. K., Ssanyu, J. N., & Kiguba, R. (2021). Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study. BMC Infectious Diseases, 21, 1-13. https://doi.org/10.1186/s12879-021-06933-8en_US
dc.identifier.urihttps://doi.org/10.1186/s12879-021-06933-8
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7357
dc.language.isoenen_US
dc.publisherBMC Infectious Diseasesen_US
dc.subjectDolutegravir‑baseden_US
dc.subjectAnti‑retroviral therapyen_US
dc.subjectNational roll‑outen_US
dc.titleProvider perspectives on the acceptability and tolerability of dolutegravir‑based anti‑retroviral therapy after national roll‑out in Uganda: a qualitative studyen_US
dc.typeArticleen_US
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