Geospatial and temporal mapping of detectable HIV-1 viral loads amid dolutegravir rollout in KwaZulu-Natal, South Africa

• Published in: PLOS global public health 2024, Vol.4 (5), p.e0003224
• Main Authors: Gounder, Lilishia, Tomita, Andrew, Lessells, Richard, Moodley, Sandrini, Francois, Kerri-Lee, Khan, Aabida, Pillay, Melendhran, Manyana, Sontaga C, Govender, Subitha, Govender, Kerusha, Moodley, Pravi, Parboosing, Raveen, Msomi, Nokukhanya, Tanser, Frank, Naidoo, Kogieleum, Chimukangara, Benjamin
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Medicine and Health Sciences; People and places
• ISSN: 2767-3375; 2767-3375
• DOI: 10.1371/journal.pgph.0003224

South Africa rolled out dolutegravir (DTG) as first-line antiretroviral therapy (ART) in December 2019 to overcome high rates of pretreatment non-nucleoside reverse transcriptase inhibitor drug resistance. In the context of transition to DTG-based ART, this study spatiotemporally analysed detectable HIV viral loads (VLs) prior to- and following DTG rollout in public-sector healthcare facilities in KwaZulu-Natal (KZN) province, the epicentre of the HIV epidemic in South Africa. We retrospectively curated a HIV VL database using de-identified routine VL data obtained from the National Health Laboratory Service for the period January 2018 to June 2022. We analysed trends in HIV viraemia and mapped median log10 HIV VLs per facility on inverse distance weighted interpolation maps. We used Getis-Ord Gi* hotspot analysis to identify geospatial HIV hotspots. We obtained 7,639,978 HIV VL records from 736 healthcare facilities across KZN, of which 1,031,171 (13.5%) had detectable VLs (i.e., VLs ≥400 copies/millilitre (mL)). Of those with detectable VLs, we observed an overall decrease in HIV VLs between 2018 and 2022 (median 4.093 log10 copies/mL; 95% confidence interval (CI) 4.087-4.100 to median 3.563 log10 copies/mL; CI 3.553-3.572), p