The World Health Organisation in July revised the guidelines on Dolutegravir also known DTG to allow Adolescent girls and women of childbearing potential who do not currently want to become pregnant to receive DTG together with consistent and reliable contraception. The review comes as a result of engagement between WHO and different stakeholders especially women living with HIV who protested that the previous guideline did not take into account the treatment needs and priorities of women and girls living with HIV and lacks the women centered approach to treatment.
The guidelines however continue to recommend an Effavirenz based regimen as an alternative safe and effective first-line regimen that adolescent girls and women of childbearing potential can use during the period of potential risk for developing neural tube defects (at conception and up to eight weeks after conception).
Birth defects
On May 18th 2017, WHO issued an alert of a possible safety concern with DTG. The concerns arise as a result of an observational study that was carried out in Botswana that identified a potential safety risk for developing neural tube defects among infants born to women taking DTG at conception. Further studies are being carried out to ascertain these concerns. Results of these studies will be out in early 2019.
Following these concerns, different countries including Uganda and Kenya had to halt the earlier planned roll out of DTG with many countries in Africa blocking all women of reproductive age from accessing DTG. This however raised concerns due to its blanket nature and has attracted international dialogue on the need to allow for information and choice in the guidelines on DTG.
It has also given mileage on the on going discussion on integration of SRHR in ART clinics. This is because the success of DTG for women of child bearing age depends on their ability to access Family Planning.
ICWEA’s stand on DTG
Following the concerns on DTG, ICWEA mobilized women of reproductive age in Uganda to take part on consultations to inform ICWEAs stand on DTG. During the consultations, participants said, it was important to provide women living with HIV information on both DTG and Family planning. They also said that the blanket statement on DTG was unfortunate as it did not take into account the diverse nature of women living with HIV when it comes to treatment. These consultations informed ICWEAs statement (http://www.icwea.org/publications/download-info/give-women-living-with-hiv-full-information-on-the-benefits-and-risks-of-dtg-contraceptives-for-them-to-exercise-choice/) that was released at International Aids Conference on DTG.
Based on this, ICWEA was able to engage with different stakeholders such as WHO and the Ministry of Health in Uganda to allow for information and choice for women living with HIV on matters of DTG.
Also Read
Dolutegravir: update on infant neural tube defects from Botswana
http://www.aidsmap.com/Dolutegravir-update-on-infant-neural-tube-defects-from-Botswana/page/3312898/
https://www.newvision.co.ug/new_vision/news/1483955/dolutegravir-drug-safe-women-living-hiv
