Transitioning Women With Human Immunodeficiency Virus to First-Line Preferred Regimen of Tenofovir Disoproxil Fumarate, Lamivudine, and Dolutegravir in Sub-Saharan Africa

Background: In 2019, the World Health Organization (WHO) recommended combined tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) as the preferred first-line regimen for adults and adolescents with human immunodeficiency virus (HIV), regardless of childbearing status. Nevertheless, final eligibility is determined by local policies, which may vary from WHO recommendations. We examined TLD transition by sex across 5 HIV care programs in sub-Saharan Africa supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) Methods: The African Cohort Study (AFRICOS) enrolls people with HIV engaged in care in Uganda, Kenya (South Rift Valley and Kisumu West), Tanzania, and Nigeria. People with HIV with ≥1 study visit after the country introduced TLD were included. We generated Kaplan-Meier curves to compare TLD transition by sex from (1) the time countries introduced TLD and (2) the time of TLD eligibility according to local policies. Results: Among 2476 participants enrolled through September 2021 at 4 sites in sub-Saharan Africa and eligible to transition to TLD, fewer women (68%) than men (80%; P <. 001) were taking TLD. Kaplan-Meier analysis showed that time to transition varied by site, with women in Tanzania transitioning at the same rate as men. In Nigeria, women initially had a slower transition but caught up to men. After adjustment for local policies, women in Kisumu West transitioned at the same rate as men. In South Rift Valley and Uganda, women were less likely to be transitioned. Conclusions: Although TLD has been the WHO's preferred regimen since 2019, transition of women to potentially lifesaving TLD has been slower than for men at certain clinical sites, even after accounting for local eligibility criteria.