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Bwire GM, Aiko BG, Mosha IH, Kilapilo MS, Mangara A, Kazonda P, Swai JP, Swalehe O, Jordan MR, Vercauteren J, Sando D, Temba D, Shao A, Mauka W, Decouttere C, Vandaele N, Sangeda RZ, Killewo J, Vandamme AM. High viral suppression and detection of dolutegravir-resistance associated mutations in treatment-experienced Tanzanian adults living with HIV-1 in Dar es Salaam. Sci Rep 2023; 13:20493. [PMID: 37993493 PMCID: PMC10665358 DOI: 10.1038/s41598-023-47795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023] Open
Abstract
To curb HIV infection rate in Tanzania, antiretroviral therapy (ART) has been scaled up since 2006, and in 2019, the country shifted to regimen including dolutegravir as a default first line. We assessed the success of ART and the contribution of HIV drug resistance (HIVDR) to unsuppressed viral loads. Between February and May 2023 a cross-sectional survey with random sampling was conducted in the six clinics in an urban cohort in Dar es Salaam. Patients with unsuppresed viral loads (local criteria viral load (VL) ≥ 1000 copies/mL) were tested for HIVDR mutations using the WHO adapted protocol for plasma samples. Mutations were interpreted using the Stanford HIVDR database. In total 600 individuals participated in this survey, the majority were female (76.83%), mean age ([Formula: see text] standard deviation) was 44.0 ([Formula: see text] 11.6) years. The median duration on ART (interquartile range) was 6.5 (3.9-10.2) years. Approximately 99% were receiving tenofovir + lamivudine + dolutegravir as a fixed dose combination. VL testing was successful in 99.67% (598/600) of survey patients and only 33 had VL ≥ 1000 copies/mL, resulting in a viral suppression level of 94.48% (565/598, 95% CI 92.34-96.17%). For 23 samples, protease and reverse transcriptase (RT) genotyping were successful, with 13 sequences containing RT inhibitor surveillance drug resistance mutations (SDRMs) (56.5%). No SDRM against protease inhibitors were detected. Thirty samples were successfully genotyped for integrase with 3 sequences (10.08%) containing integrase strand transfer inhibitor (INSTI) SDRMs. In samples successfully genotyped in the three genetic regions, 68.18% (16/22) had a genotypic susceptibility score (GSS) ≥ 2.5 for the concurrent regimen, implying factors beyond drug resistance caused the unsuppressed viral load. For five patients, GSS indicated that HIVDR may have caused the unsuppressed viral load. All three patients with INSTI resistance mutations were highly resistant to dolutegravir and accumulated nucleoside and non-nucleoside RT inhibitor HIVDR mutations. Although in this cohort the last 95 UNAIDS target was almost achieved, HIVDR mutations, including INSTIs resistance mutations were detected in HIV-positive individuals taking ART for at least one year. We recommend the design and implementation of high-impact interventions to prevent the increase of HIVDR, failure of dolutegravir and address the non-resistance factors in the study area.
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Affiliation(s)
- George M Bwire
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium.
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania.
| | - Beatrice Godwin Aiko
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Idda H Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania
| | - Mary S Kilapilo
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
| | - Alli Mangara
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Dar es Salaam Urban Cohort Study, Dar es Salaam, 65013, Tanzania
| | - Patrick Kazonda
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Dar es Salaam Urban Cohort Study, Dar es Salaam, 65013, Tanzania
| | - Janeth P Swai
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam, 20266, Tanzania
| | - Omary Swalehe
- Department of Business Studies, School of Business, Mzumbe University, Dar es Salaam, 20266, Tanzania
| | | | - Jurgen Vercauteren
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium
| | - David Sando
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - David Temba
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Amani Shao
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Wilhellmuss Mauka
- Managament and Development for Health, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Catherine Decouttere
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Nico Vandaele
- Faculty of Economics and Business, Access to Medicine Research Center, KU Leuven, 3000, Leuven, Belgium
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania
| | - Anne-Mieke Vandamme
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Rega-Herestraat 49-Bus 1040, 3000, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Sangeda RZ, Saburi HA, Masatu FC, Aiko BG, Mboya EA, Mkumbwa S, Bitegeko A, Mwalwisi YH, Nkiligi EA, Chambuso M, Sillo HB, Fimbo AM, Horumpende PG. National Antibiotics Utilization Trends for Human Use in Tanzania from 2010 to 2016 Inferred from Tanzania Medicines and Medical Devices Authority Importation Data. Antibiotics (Basel) 2021; 10:antibiotics10101249. [PMID: 34680829 PMCID: PMC8532727 DOI: 10.3390/antibiotics10101249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial use (AMU) is one of the major drivers of emerging antimicrobial resistance (AMR). The surveillance of AMU, which is a pillar of AMR stewardship (AMS), helps devise strategies to mitigate AMR. This descriptive, longitudinal retrospective study quantified the trends in human antibiotics utilization between 2010 and 2016 using data on all antibiotics imported for systemic human use into Tanzania’s mainland. Regression and time series analyses were used to establish trends in antibiotics use. A total of 12,073 records for antibiotics were retrieved, totaling 154.51 Defined Daily Doses per 1000 inhabitants per day (DID), with a mean (±standard deviation) of 22.07 (±48.85) DID. The private sector contributed 93.76% of utilized antibiotics. The top-ranking antibiotics were amoxicillin, metronidazole, tetracycline, ciprofloxacin, and cefalexin. The DIDs and percentage contribution of these antibiotics were 53.78 (34.81%), 23.86 (15.44), 20.53 (13.29), 9.27 (6.0) and 6.94 (4.49), respectively. The time series model predicted a significant increase in utilization (p-value = 0.002). The model forecasted that by 2022, the total antibiotics consumed would be 89.6 DIDs, which is a 13-fold increase compared to 2010. Government intervention to curb inappropriate antibiotics utilization and mitigate the rising threat of antibiotic resistance should focus on implementing AMS programs in pharmacies and hospitals in Tanzania.
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Affiliation(s)
- Raphael Zozimus Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania;
- Correspondence:
| | - Habibu Ally Saburi
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania;
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Faustine Cassian Masatu
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Beatrice Godwin Aiko
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania;
| | - Erick Alexander Mboya
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania;
| | - Sonia Mkumbwa
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Adonis Bitegeko
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Yonah Hebron Mwalwisi
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Emmanuel Alphonse Nkiligi
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Mhina Chambuso
- Department of Pharmacy, Kampala International University in Tanzania, P.O. Box 9790, Dar es Salaam, Tanzania;
| | - Hiiti Baran Sillo
- Regulation and Prequalification Department, World Health Organization, 1211 Geneva, Switzerland;
| | - Adam M. Fimbo
- Tanzania Medicines and Medical Devices Authority, P.O. Box 77150, Dar es Salaam, Tanzania; (F.C.M.); (S.M.); (A.B.); (Y.H.M.); (E.A.N.); (A.M.F.)
| | - Pius Gerald Horumpende
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, P.O. Box 2232, Moshi, Tanzania;
- Kilimanjaro Clinical Research Institute (KCRI), P.O. Box 2232, Moshi, Tanzania
- Lugalo Infectious Diseases Hospital and Research Centre, General Military Hospital (GMH) and Military College of Medical Sciences (MCMS), P.O. Box 60126, Dar es Salaam, Tanzania
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