Treatment outcomes five years after transition from efavirenz (TLE)- to dolutegravir (TLD) -based antiretroviral therapy at Newlands Clinic, in Zimbabwe.
1
Newlands Clinic, Harare, Zimbabwe
2
Graduate School for Health Sciences, University of Bern Institute of Social and Preventive Medicine, Bern, Switzerland
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Following the 2019 WHO guidelines, many programs , including Zimbabwe transitioned people living with HIV (PLWH) from efavirenz-based ART (TLE) to dolutegravir-based regimens (TLD). Mid- to long-term outcomes of this shift are still emerging. We evaluated treatment outcomes at Newlands Clinic in Harare.
METHODS:
We conducted a retrospective cohort analysis of PLWH transitioned from TLE to TLD between 2019–2020 and followed until 2025. Demographic characteristics, ART history, viral loads (VL), and care outcomes were abstracted from clinic records. Viral suppression was defined as VL <1,000 copies/mL. Outcomes assessed included retention in care, regimen durability, and time to regimen switch. Descriptive statistics were used.
RESULTS:
A total of 4,092 PLWH (2,812 [68.7%] female; median age 43.4 years [IQR: 34.3–50.5]) transitioned from TLE to TLD. At transition, 3,609 (88.2%) were virally suppressed and 24 (0.6%) were not. Another 459 (11.2%) transitioned before NC enrolment, so VL data were unavailable. At analysis, 3,570 (87.2%) remained in care, 177 (4.3%) had died, 99 (2.4%) were lost to follow-up, and 246 (6.0%) transferred out. Among those in care, 3,541 (99.2%) were virally suppressed. Of these, 2,934 (82.2%) remained on TLD, among whom 2,909 (99.2%) were virally suppressed. A total of 634 switched ART regimens; suppression was maintained in 631 (99.5%). Reasons for regimen change included renal dysfunction (557, 87.9%) and virologic failure (12, 1.9%). Ten (1.58%) reverted to TLE, 6/10 due to DTG-associated weight gain and 4/10 due to other adverse effects. Median time on TLD before switching was 190 weeks (IQR: 119–279).
CONCLUSIONS:
Five years after transition to TLD, this cohort maintained high viral suppression, retention, and regimen durability. Most regimen changes were unrelated to virologic failure, with renal dysfunction the leading reason. These results strengthen real-world evidence for the long-term effectiveness and durability of DTG-based ART in African programs.
Following the 2019 WHO guidelines, many programs , including Zimbabwe transitioned people living with HIV (PLWH) from efavirenz-based ART (TLE) to dolutegravir-based regimens (TLD). Mid- to long-term outcomes of this shift are still emerging. We evaluated treatment outcomes at Newlands Clinic in Harare.
METHODS:
We conducted a retrospective cohort analysis of PLWH transitioned from TLE to TLD between 2019–2020 and followed until 2025. Demographic characteristics, ART history, viral loads (VL), and care outcomes were abstracted from clinic records. Viral suppression was defined as VL <1,000 copies/mL. Outcomes assessed included retention in care, regimen durability, and time to regimen switch. Descriptive statistics were used.
RESULTS:
A total of 4,092 PLWH (2,812 [68.7%] female; median age 43.4 years [IQR: 34.3–50.5]) transitioned from TLE to TLD. At transition, 3,609 (88.2%) were virally suppressed and 24 (0.6%) were not. Another 459 (11.2%) transitioned before NC enrolment, so VL data were unavailable. At analysis, 3,570 (87.2%) remained in care, 177 (4.3%) had died, 99 (2.4%) were lost to follow-up, and 246 (6.0%) transferred out. Among those in care, 3,541 (99.2%) were virally suppressed. Of these, 2,934 (82.2%) remained on TLD, among whom 2,909 (99.2%) were virally suppressed. A total of 634 switched ART regimens; suppression was maintained in 631 (99.5%). Reasons for regimen change included renal dysfunction (557, 87.9%) and virologic failure (12, 1.9%). Ten (1.58%) reverted to TLE, 6/10 due to DTG-associated weight gain and 4/10 due to other adverse effects. Median time on TLD before switching was 190 weeks (IQR: 119–279).
CONCLUSIONS:
Five years after transition to TLD, this cohort maintained high viral suppression, retention, and regimen durability. Most regimen changes were unrelated to virologic failure, with renal dysfunction the leading reason. These results strengthen real-world evidence for the long-term effectiveness and durability of DTG-based ART in African programs.
| eISSN: | 2654-1459 |
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