HIV drug resistance among adults initiating antiretroviral therapy in Uganda

Christine Watera, Deogratius Ssemwanga, Grace Namayanja, Juliet Asio, Tom Lutalo, Alice Namale, Grace Sanyu, Isaac Ssewanyana, Jesus Fidel Gonzalez-Salazar, Jamirah Nazziwa, Maria Nanyonjo, Elliot Raizes, Usher Kabuga, Christina Mwangi, Wilford Kirungi, Joshua Musinguzi, Kaggwa Mugagga, Edward Katongole Mbidde, Pontiano Kaleebu

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review


BACKGROUND: WHO revised their HIV drug resistance (HIVDR) monitoring strategy in 2014, enabling countries to generate nationally representative HIVDR prevalence estimates from surveys conducted using this methodology. In 2016, we adopted this strategy in Uganda and conducted an HIVDR survey among adults initiating or reinitiating ART.

METHODS: A cross-sectional survey of adults aged ≥18 years initiating or reinitiating ART was conducted at 23 sites using a two-stage cluster design sampling method. Participants provided written informed consent prior to enrolment. Whole blood collected in EDTA vacutainer tubes was used for preparation of dried blood spot (DBS) specimens or plasma. Samples were shipped from the sites to the Central Public Health Laboratory (CPHL) for temporary storage before transfer to the Uganda Virus Research Institute (UVRI) for genotyping. Prevalence of HIVDR among adults initiating or reinitiating ART was determined.

RESULTS: Specimens from 491 participants (median age 32 years and 61.5% female) were collected between August and December 2016. Specimens from 351 participants were successfully genotyped. Forty-nine had drug resistance mutations, yielding an overall weighted HIVDR prevalence of 18.2% with the highest noted for NNRTIs at 14.1%.

CONCLUSIONS: We observed a high HIVDR prevalence for NNRTIs among adults prior to initiating or reinitiating ART in Uganda. This is above WHO's recommended threshold of 10% when countries should consider changing from NNRTI- to dolutegravir-based first-line regimens. This recommendation was adopted in the revised Ugandan ART guidelines. Dolutegravir-containing ART regimens are preferred for first- and second-line ART regimens.

Sidor (från-till)2407-2414
TidskriftThe Journal of antimicrobial chemotherapy
StatusPublished - 2021 aug. 12
Externt publiceradJa

Bibliografisk information

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Ämnesklassifikation (UKÄ)

  • Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
  • Infektionsmedicin


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