THAA0102 | HIGH PREVALENCE OF DOLUTEGRAVIR RESISTANCE AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV WITH VIROLOGIC FAILURE IN NORTH EASTERN UGANDA

Saadick Ssentongo, Peter Sekiranda, Christine Ninsiima, Ronald Opito, Abel Munina, Abraham Oluka, Ivan Katende, Baker Bakashaba, Boniface Oryokot | AIDS Information Center, Kampala, Uganda

In 2018 Uganda transitioned people living with HIV (PLHIV) from non-nucleoside reverse transcriptase inhibitors (NNRTIs) to dolutegravir (DTG)-based regimens (DBRs) as per WHO guidance. However, limited data exist on resistance to DTG. This analysis aims to determine the prevalence of DTG resistance and its predictors among PLHIV on DBRs in northeastern Uganda. This retrospective analysis selected PLHIV records from 24 health facilities in North Eastern Uganda between April 2022 and July 2024. Participants included those on DBRs with at least two consecutive viral loads >1000 copies/mL who had HIV drug resistance (HIVDR) testing. Clinical and demographic data were extracted from the National HIVDR database and cross-verified with the facility’s electronic medical records. Data were analyzed using STATA 16 and summarized into frequencies and percentages, while predictors of DTG resistance were determined using the modified Poisson regression model. A p-value <0.05 was considered statistically significant. A total of 225 PLHIV records were analyzed. Overall, 55.11% (124/225) were male, with a median age of 19 (interquartile range [IQR] 15-39), of whom 48% (22/55) were aged 10-19, 32.73% (18/55) were aged >35 years and 20% (11/55) were aged 20-24; 45.3% (102/225) were unemployed; 44.4% (100/225) had primary education; 74.22% (167/225) had not disclosed HIV status; 48.4% (127/225) had WHO Stage I; 36.89% (83/225) were on DTG for 1 to 2 years, while 58.67% (132/225) had a CD4 count of >200 cells/µL; and 31.56% (71/225) experienced stigma and discrimination. Overall, 22.22% (50/225) of individuals had intermediate to high DTG scores (≥30). DTG resistance (intermediate and high) was associated with NRTI resistance [adjusted prevalence ratio (aPR); 4.51, 95% confidence interval [CI]; (1.62-12.48, p=0.004], poor adherence [aPR; 2.69, 95% CI; 1.52-4.55, p=0.001], alcohol and substance abuse [aPR; 1.65, 95% CI; 1.03-2.76, p=0.035], and family dysfunction [aPR; 1.91, 95% CI; 1.01-3.59, p=0.043]. In this study, we determined DTG resistance was high in North Eastern Uganda and was associated with poor adherence, alcohol and substance abuse, and weak family support. Strengthening peer support systems, integrating substance abuse screening, and improving adherence could avert DTG resistance in the region.