The Dolutegravir Debate

Advocacy Featured Research

Welcome to the Dolutegravir Debate

October 2019 Our updated version of the dolutegravir advocacy brief is out now and available here. This version includes a preface which references WHO’s updated guidelines on DTG from July 2019.

The Spanish version of this updated version is now available here.

The French version will be ready very soon.

October 2019 A webinar on dolutegravir updates took place on 8 October, co-hosted with ITPC. It is now available as a recording online on our vimeo site.

To access the introductory and final slides from Salamander Trust and ITPC, and the individual presentations from the WHO, leaders of the Tsepamo Study and Jacque Wambui of AFROCAB, click on the relevant links.

September 2019 Our latest podcast in our WHAVE series is out now. In Episode no. 9 Lucy Wanjiku returns to give us an update on the dolutegravir debate, now that WHO has released its new guidelines on use of dolutegravir by all women living with HIV.

February 2019  Our collaborative booklet on this is now out. You can read it on issuu or as a pdf. You can also listen to the podcast by Lucy Wanjiku of Kenya here.

What is it? Salamander Trust was requested by UNAIDS to bolster civil society’s advocacy, communications and consultations with women living with HIV and partners on two key issues: Dolutegravir (DTG) and cervical cancer.

On November 15th 2018 Salamander Trust organised a webinar on Access to Treatment Options for Women Living with HIV. To review the note for the record click here.  Click here to listen to the webinar and click here to access the webinar slides.

Some Background: The WHO 2017 Consolidated Guideline on the Sexual and Reproductive Health and Rights (SRHR) of women living with HIV is a ground-breaking document, which upholds the rights of women in several key areas. Since 2013, Salamander played a major role facilitating the global values and preferences survey on the SRHR of women living with HIV. This fed into the development of the new consolidated guideline. As part of this process, WHO Department of Reproductive Health and Research asked Salamander to develop a checklist tool, to support women in countries to ensure the full implementation of the Guideline. This checklist has now been endorsed by the heads of 5 UN agencies.

Why this work now? No matter how great the Guideline is, as our research with partners for UN Women has shown, women continue to face challenges in accessing treatment options. Barriers to access and ‘options’ for women have become even more visible over recent months, following mixed reactions to the WHO HIV Department warning on May 8, 2018 citing a potential risk of neural tube defects (NTDs) for babies born to women taking Dolutegravir (DTG) during conception and pregnancy in Botswana. This was from preliminary unscheduled analysis of an ongoing birth surveillance study in Botswana. The study is called Tsepamo, and it reported an increased risk of NTDs among infants of women who became pregnant while taking DTG. Defects were reported in four out of 426 infants born to women who were put on DTG in pregnancy. The next formal analysis will occur after 31 March 2019 and will include women already exposed to DTG from conception before the recent change in guidance. Tsepamo has expand the study from 8 to 18 sites, increasing from 45% to 72% of births in Botswana. The next analysis will include: NTDs; all major malformations; and other adverse birth outcomes (stillbirth, preterm, small for gestational age and neonatal death).

Some key resources so far in chronological order – if you know of others you think we should add, please do send them to us:

  • Jan 2012: Collaborative statement by women living with HIV and colleagues on hormonal contraceptives and HIV
  • Jan 2015: “Building a safe house on firm ground: Global Values and Preferences Survey on the SRHR of women living with HIV
  • March 2017: WHO Consolidated Guideline on the SRHR of women living with HIV
  • May 8 2018: WHO Statement on DTG
  • June 28 2018: National Empowerment Network of people living with HIV in Kenya (NEPHAK)
    – Letter to MoH Demanding DTG
  • July 2018 Updated recommendations on first-line and second-line antiretroviral
    regimens and post-exposure prophylaxis and recommendations on early infant
    diagnosis of HIV: interim guidance
  • July 1 2018: Comparative safety of dolutegravir-based or efavirenz-based antiretroviral
    treatment started during pregnancy in Botswana: an observational study: The Lancet
  • July 11 2018: iBase – Dolutegravir preconception signal: time is up for shoddy surveillance
  • July 13 – 14 2018: IAS2018: Communique of the Kigali Dolutegravir Stakeholder Meeting of
    African Women Living with HIV, hosted by African Community Advisory Board (AfroCAB)
  • July 16 2018: NOTHING FOR US WITHOUT US: Statement by the AfroCAB on Dolutegravir
    and neural tube defects in women living with HIV of child bearing age
  • July 18 2018: Time to realise our sexual and reproductive health and rights – the Lancet
  • July 23 2018: Give Women Living with HIV full information on the benefits and risks of DTG,
    Contraceptives for them to exercise choice – ICW East Africa 
  • July 2018: The updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV  – WHO
  • Aug 2018: IPPF Technical Brief: Dolutegravir for women living with HIV of reproductive age
  • Aug 3 2018: iBase – No additional neural tube defects among a further 170 preconception
    dolutegravir exposures in Botswana: Tsepamo study (July 2018)
  • August 2018: ICW East Africa – WHO Reviews DTG Guidelines to Allow Women and Adolescents on Consistent FP Methods Access
  • August 20 2018: Dolutegravir drug is safe for women living with HIV: Martha Akello – New Vision
  • August 31 2018: Introducing the DolPHIN-2 Story – Liverpool Drug Interactions
  • 1-4 October 2018: European Medicines Agency (EMA) Pharmacovigilance Risk
    Assessment Committee (PRAC) confirmed its precautionary advice issued earlier this
    year on the use of DTG in pregnant women and for use of effective contraception
    while taking DTG in women who can become pregnant
  • Sept – Nov 2018: Forum on the risks of preconception dolutegravir exposure: IAS – CDC.
  • 13 Nov 2018: iBase – Insufficient data on risk of neural tube defects with exposure to
    elvitegravir or bictegravir exposure during preconception or first trimester
  • 13 Nov 2018: iBase – No additional neural tube defects with preconception dolutegravir:
    data from three birth outcome cohorts.
  • 30 Nov 2018: Health GAP and Spotlight Policy Brief: Dolutegravir in Southern & Eastern Africa and the right to choose
  • 13 Feb 2019: Webinar with Dr Rebecca Zash: more background info about the Tsepamo study
  • 25 Feb 2019: FBLive session hosted by UNAIDS on DTG: sexual & reproductive health autonomy in motion – DTG and the meaningful engagement of women living with HIV.

If you are a woman living with HIV who would like to join the debate please contact us through the CONTACT page on this website.

Disclaimer: This is an information website and, while we have tried to make its content as accurate as possible, any information on it can only be advisory. Please also always refer to your own country’s national guidelines and the advice of your own medical practitioner before deciding if and what ARTs you should take yourself.