Clients’ Perspectives on Switching from Old Stable ART Regimens to New Dolutegravir-based Regimen at Joint Clinical Research Centre Uganda

Clients’ Perspectives on Switching from Old Stable ART Regimens to New Dolutegravir-based Regimen at Joint Clinical Research Centre Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clients’ Perspectives on Switching from Old Stable ART Regimens to New Dolutegravir-based Regimen at Joint Clinical Research Centre Uganda Francis Kanyike, Kenneth Katende Kidonge, Sarah Nabukeera, John Bosco Ddamulira, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7453812/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract In 2018, Uganda adopted a Dolutegravir-based regimen (DTG) as its preferred first line antiretroviral therapy(ART). We explored clients’ perspectives on switching stable ART patients to the new regimen at Joint Clinical Research Centre. We purposively sampled 24 clients (16 DTG-experienced, 8 DTG-naïve), conducted face-to-face in-depth interviews, audio-recorded, transcribed verbatim, and analysed data using a thematic framework approach. DTG-experienced were those on previous stable treatment and switched to DTG regimen while the DTG-naïve were yet to be switched. Most DTG-experienced participants expressed concerns about side effects, feeling stable on their previous regimen, and inadequate explanation. Others felt were switched hurriedly and switching seemed compulsory. Some eventually viewed it as beneficial due to smaller pill size, once daily dosing, and rapid viral suppression. Majority of the DTG-naive viewed it as beneficial with similar reasons as the already switched but were hesitant due to anticipated side effects. Switching from stable treatment regimens to a DTG-based regimen initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation waned over time. Switching to new regimens may improve ART adherence if the concerns of new regimens are constantly addressed through continuous health education and promotion. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Antiretroviral Therapy Dolutegravir Human Immunodeficiency Virus Tenofovir/lamivudine/Dolutegravir Clients’ Perspectives Introduction As of 2024, over 39.9 million people were reported to be living with the Human Immunodeficiency Virus (HIV) worldwide, and 70% of these were from sub-Saharan Africa. Moreover, 95% of new infections occur in low and middle-income countries (LMICs).The introduction of antiretroviral therapy (ART), has led to a reduction in HIV morbidity and mortality, improved HIV prognosis and quality of life for people living with HIV (PLHIV) ( 1 ). By the end of December 2023, 30.7 million people were receiving ART up from 7.7 million people in 2010 but still short of the 34 million target of 2025( 2 ). There was a concerted effort to implement Dolutegravir (DTG)-based first and second line ART regimens in LMICs following the World Health Organisation (WHO) guidelines released in 2018 ( 3 ). Uganda, a country in Sub Saharan Africa has an estimated 1.49 million PLHIV, and 20, 000 AIDS-related deaths annually( 4 ). The current national prevalence for adults aged 15 to 49 years is estimated at 5.1% and antiretroviral therapy coverage at 84%( 4 ). Over the years, there have been several ART switch policies and the current one contains a Dolutegravir (DTG) regimen, an integrase strand transfer inhibitor. In compliance with the current WHO guidelines( 3 , 5 ), Uganda launched a country wide implementation of the single-tablet regimen of Tenofovir/lamivudine/Dolutegravir (TLD) as first line and second-line ART for adults and adolescents in President’s Emergency Plan for AIDS Relief (PEPFAR) program, with rollout starting in 2018( 5 ). Large-scale rollout of DTG-based regimen had a prospective to lower treatment costs, simplify drug procurement because the DTG based regimen is a single pill( 3 ) has good tolerability, leads to improved viral suppression and a higher genetic barrier to resistance ( 6 – 8 ). There were growing concerns of increasing levels of transmitted drug resistance, mostly to Non-nucleoside reverse transcriptase inhibitors (NNRTIs), in Uganda( 9 ). However, unlike the NNRTIs, DTG an integrase inhibitor, had a high genetic barrier to resistance meaning patients were less likely to develop resistance and therefore postponing the need for second line treatment( 10 ). DTG was also described in several studies as having a rapid and sustained virologic suppression and this made it superior to other available ART regimens,( 11 , 12 ). DTG also showed substantial reductions in treatment-limiting adverse drug reactions compared to other available regimens ( 6 , 13 ), suppressing viral load twice as fast as Efavirenz (EFV) among pregnant women with HIV infection and their neonates( 14 ), thus potentially reducing the risk of vertical transmission in those who were initiated on treatment late in pregnancy( 15 ). However, DTG use was linked to some side effects that include, weight gain, hyperglycemia in non-diabetics or worsening in diabetics, neural tube defects, the possibility of neurotoxicity and liver injury ( 16 – 22 ). While a few studies have explored provider experiences and perspectives on using DTG in resource-limited settings ( 23 ), there is limited information on the experiences and perspectives of DTG users, particularly regarding the switch from an old, stable ART regimen to a new DTG-based therapy. In this study, we explored the perspectives of clients who were switched from a stable ART regimen to a DTG-based regimen at the Joint Clinical Research Centre (JCRC). Methods Study Setting Joint clinical Research Centre (JCRC) is a medical research institution in Uganda, specializing in HIV/AIDS treatment, medical research, clinical care, training, supporting National HIV programs and offering guidance for policy formulation. The JCRC was suitable for this study since for the last 30 years, JCRC has been specializing in HIV/AIDS treatment and management. From 2018, JCRC adopted the Ministry of health (MOH) guidelines and started switching PLHIV who were virally suppressed on first- and second-line ART to a DTG based regimen. Study Design This was a qualitative study using a narrative inquiry study design to explore the perspectives from clients on switch from a stable ART regimen to a DTG based regimen therapy at JCRC. Narrative inquiry method was used for this study to reveal unique perspectives and to get deeper understanding of the participants’ unique situations. Study Population The study included HIV positive clients aged 18 or older who were on 1st and 2nd line stable treatment and switched to DTG regimen at Joint clinical research centre (DTG-experienced). Participants had been on stable previous ART for not less than one year before they were switched to DTG. The study also included HIV positive clients aged 18 or older who were yet to be switched to a DTG-based regimen (DTG-naïve). Participants’ Selection Participants’ selection was done using purposive sampling based on records and then applied a maximum variation strategy to sample 24 participants. They included 16 DTG-experienced and 8 DTG-naïve participants divided into two groups based on DTG-experience or naivety, DTG duration, sex, and age as shown in Table 1 below. Participant records were obtained from the Integrated Clinical Enterprise Application (ICEA), the patient data system at the Joint Clinical Research Centre (JCRC). From 200 eligible individuals identified by the Data Manager, 50 were purposively selected—36 DTG-experienced and 14 DTG-naïve. Potential participants were contacted by telephone, and 24 consented to participate. Sixteen were classified as DTG-experienced, having received a dolutegravir-based regimen, while eight were DTG-naïve, with no prior dolutegravir exposure. Classifications were based on documented antiretroviral history. Interviews were conducted in private consultation rooms at the JCRC to ensure confidentiality and participant comfort. Table 1 Category and distribution of participants by DTG experience DTG-experienced Participants Duration on DTG Male Female Age Group ≤ 6 months 2 2 18–35 years 2 2 > 35 years > 6 months 2 2 18–35 years 2 2 > 35 years Total 8 8 16 DTG-naive participants N/A Male Female Age Group 2 2 18–35 years 2 2 > 35 years Total 4 4 8 Data Ccollection Procedures Two research assistants, namely one nurse and one data manager, were recruited and trained before the start of data collection. In-depth interviews were used for data collection, and the interview guides were pre-tested in a location outside the study area by research assistants to ensure clarity and completeness of the data. The interview guides were prepared in English and later back translated into commonly used local language (Luganda). Clients were interviewed in either English or Luganda according to their preference and this was done in a private location at the JCRC. Twenty-four face-to-face in-depth interviews were conducted because the information being collected had reached saturation. Participants were asked a range of questions on their perspectives of switching stable ART patients from the old ART regimen to the new DTG based regimen. Their general knowledge, assumptions and what they felt about the new DTG regimen change was explored. The aim of the questions was to determine the participants’ baseline knowledge of the DTG switch, explore any assumptions they held, assess their senses of optimism or pessimism about switching to the new DTG regimen, and explore their general thoughts about the DTG switch. The DTG-experienced participants were asked to comment on their past treatment experiences before they were switched to DTG regimen and compare with the current DTG experiences. This was a strategy to stimulate participants to reflect on probable ideas of uncertainty or discrepancy in their thoughts on the risks and benefits of the DTG treatment switch. Data were collected on the DTG switch preparatory exercise, questions about events at the time of switch, treatment observations and experiences on DTG treatment, DTG adherence, and DTG switch improvement suggestions. For the DTG-naïve clients, data were collected using questions; on knowledge about DTG treatment, the current process of being switched to the new DTG based regimen, perspectives on risks and benefits of DTG regimen switch. Interviewers employed probing methods such as (‘tell me more’) to stimulate participants to continue explaining their answers. Furthermore, when participants introduced subjects or concerns outside the set questions, they were motivated to explore further into the raised subjects and say more. Interviews were audio-recorded with participant consent and transcribed verbatim for data analysis. Transcripts were checked for completeness and accuracy. The study also collected baseline information such as ART regimen for study participants from JCRC patient database Integrated Clinical Enterprise Architecture (ICEA). Data Analysis The study team ensured confidentiality, good data storage and proper record keeping ( 24 ). Transcript recordings and notes were evaluated for data related to the research question and a coding scheme was created. We used an inductive approach to apply descriptive thematic codes, following the steps suggested by Braun and Clarke ( 25 ). Six steps were followed in the inductive thematic approach; In the first step we became familiar with the data, then generated initial codes, after we searched for themes, after this we reviewed themes, we then defined themes, and finally we made the write-up. Inductive thematic analysis helped to organise codes into broader themes, sub-themes and codes that lied outside the known topics of interest. This method helped to identify unexpected themes, explored complexities and contradictions in the data and broke the data into sub-themes. We reported key phrases and verbatim quotes. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to report study findings ( 26 ). Ethical Considerations Ethical approval was sought from Makerere University School of Public Health Higher Degrees Research and Ethics Committee (MakSPH – HDREC). Permission to carry out this study was obtained from JCRC research department and JCRC administration. All methods were performed in accordance with the relevant guidelines and regulations as per the MakSPH – HDREC. In addition, the researcher explained the importance of the study to all responsible bodies; including health workers and the study subjects. Informed consent was sought from the study subjects prior to enrollement into the study. Any individual not willing to take part in the study had full right not to. All those that accepted to take part in the study had all the information provided treated as highly confidential. Results Participants’ characteristics We interviewed 24 participants and their age ranged from 20 to 59 years. The majority of the participants had been living with HIV for more than a decade and had considerable experience with prior ART switches. Half of the participants were women and all participants had obtained some kind of formal education. Majority (13/24) described themselves as married or cohabiting. DTG-experienced participants had been on previous ART for 20 months to 12 years before they were switched and 3 months to 3 years after being switched. Most participants in both groups had switched ART regimens several times prior to their most recent transition to the DTG regimen. Five participants self-reported experiencing suboptimal adherence after drug switching to DTG. The characteristics of the 24 participants are shown in Table 2 below. No. Age-group (Years) Gender Marital status Education level Duration on ART prior to DTG switch (Years) Duration on DTG after switching (months) DTG adherence history 1 DTG-experienced 1 20-30 Female Single Post-Secondary 5-10 20-30 Optimal 2 50-60 Female Separated Secondary 5-10 30-40 Optimal 3 20-30 Male Married Secondary 1-5 10-20 Suboptimal 4 40-50 Male Married Secondary 1-5 10-20 Optimal 5 40-50 Male Separated Secondary 5-10 Less than 5 months Optimal 6 20-30 Female Single Post-secondary 1-5 Less than 10 months Suboptimal 7 20-30 Male Married Post-secondary 1-5 Less than 5 months Optimal 8 50-60 Female Separated Post-secondary 10-15 Less than 10 months Optimal 9 20-30 Female Married Post- secondary 5-10 20-30 Suboptimal 10 20-30 Female Single Secondary 5-10 Less than 10months Suboptimal 11 50-60 Female Widowed Secondary 1-5 30-40 Optimal 12 20-30 Male Married Secondary 1-5 10-20 Optimal 13 40-50 Male Married Post-secondary 1-5 10-20 Suboptimal 14 50-60 Female Married Secondary 10-15 Less than 10months Optimal 15 40-50 Male Married Post-secondary 5-10 Less than 5 months Optimal 16 20-30 Male Single Secondary 1-5 Less than 5 months Optimal DTG-naïve 17 20-30 Male Married Post-secondary Not applicable (NA) 18 50-60 Female Married Primary 19 20-30 Male Single Secondary 20 30-40 Female Married Post-secondary 21 30-40 Male Married Secondary 22 20-30 Female Married Secondary 23 20-30 Male Single Primary 24 50-60 Female Widowed Post-secondary Table 2. Characteristics of participants . 1 Optimal adherence (took drugs daily on time); suboptimal adherence (Failed to take drugs daily and or on time) Study participants’ perspectives on switching stable HIV clients to a DTG-based regimen The findings from this study reveal that study participants’ perspectives on switching stable HIV clients to a DTG-based regimen depended on whether they were experienced or naïve patients, as shown below. Perspectives among the DTG-experienced participants These were divided into events at the time of switching and events while on DTG regimen. 1. Events at the time of switching We asked participants to take us back to the time when the DTG switch was made and share their experiences at the time, what information they were given regarding the new treatment and how the information helped them understand the treatment they were being switched to. Responses to these questions revealed their sense of fatalism and pessimism about the DTG regimen and were often grounded in their emotional experience rather than factual understanding of the DTG treatment switch. Below are the themes in detail from events at the time of switching. a. DTG-based regimen switch considered a statutory policy Seven of the sixteen DTG-experienced patients felt that they accepted to switch regimens because it was an unavoidable Ministry of health policy. “I was told it was a government policy and every one had to switch to the new drug. So, I had no decision to make. As I said, this was a government policy and when change came, I had to go with the rest. Because I wanted to follow instructions .” (DTG-experienced male patient, aged 47yrs) Another DTG-experienced patient indicated that it was compulsory to change to DTG regimen and felt that he had no choice to object the change, stating: “ Like I have told you before, when it is a policy, you don’t have a choice. When the doctor tells you that we are switching from this line to this line or from this regimen to this regimen you don’t have an option you just accept whether you have been hurt or not “ (DTG-experienced male patient, aged 50yrs) b. Uncertainty about changing to the new regimen Nine of the participants initially hesitated to switch to DTG. They had dismay about possible related side effects “Yeah, I was worried. I was thinking a lot and started asking myself questions that what if I get rash, what if I lose weight. So, I had questions.” (DTG-experienced female patient, aged 40yrs) Some feared the side effects the clinicians explained during the DTG switch preparation process while others feared the side effects they heard other patients already on DTG had experienced. “Thirdly, the rumours about the drug that it caused diabetes, failure to sleep, and loss of man power. I looked at all these and that’s why I was hesitant. Putting that aside, before my switch I saw some people who had been switched, with side effects of leg swelling, failure to sleep and some reported reduced functionality in bed. That is why I was hesitant on the three different occasions .” (DTG-experienced male patient, aged 42yrs) Some actually kept on dodging and postponing the DTG switch because they feared the unknown side effects. “I remember at my time of being switched, I prolonged the counsellor. She could tell me we want to switch you today, I say am not ready first wait, then the second time, am not ready first wait, then the third time, am not ready first wait. Fourth time she had to send me to the Doctor to have a discussion . “(DTG-experienced male patient, aged 30yrs). c. Feeling hurried to change to the new regimen Six participants felt hurried to start the DTG based regimen. They felt as if they had not been given enough time to think about the switch. Some felt as though they had not been given enough information about the new regimen. For some interviewees, the DTG regimen was given during a scheduled visit when they had anticipated collecting their previous ART regimen. They described the DTG switch exercise as “instantaneous”: “I was surprised, when I came, I thought I was going to be given my usual drug (old regimen), only to be told that I was to take the new medication (DTG)….” (DTG-experienced female patient, aged 34yrs) 2. Events while on DTG regimen After exploring their experiences at the time of the DTG switch, we asked them to share their treatment observations and experiences while on DTG based regimen, how the DTG regimen differed and compared to their previous regimen in terms of their clinical benefits. Responses to these questions revealed a mixture of feelings and emotions from participants, while some were optimistic and hopeful about the DTG switch, others expressed regrets. Their positive and negative experiences are organised into sub themes below: a. Feeling more stable on the previous regimen Nine of the sixteen participants felt that they were stable on their older regimen and where not happy that their regimen had been changed, some raised concerns about side effects and regretted changing to the DTG regimen. Here are some of the narratives; “ I did not have the issues am having at the moment. I have taken DTG for 3 years... Yes, I was really doing well with my previous medication and my viral load was much suppressed.” (DTG-experienced male patient, aged 43yrs) b. Dosing schedule change and consequences Five participants felt uneasy for the sudden change in dosing schedule needed for DTG. They were comfortable taking previous ART at night, but with DTG, they were advised to change to morning dosing to avoid lack of sleep a common DTG side effect. Also, the DTG morning dose affected work schedules for some participants who were used to taking at night. “I used to take the old ART at 9pm, yet this new medicine was to be taken in the morning…I was used to taking at night It was very disturbing for me to swallow in the morning.... The truth is sometimes I would miss the morning dose.” ( DTG-experienced female patient, aged 28yrs ) c. DTG dosing ascertained to be simpler than old ART regimen Seven participants said they accepted the persuasion to switch to DTG partly because they preceded that taking a smaller pill just once a day would be more convenient than their past regimen especially for those who had been taking alluvia regimens that were not only dosed twice daily but also were very big pills. DTG-experienced patients found DTG based regimen easier to swallow than their previous ART because it is smaller and taken once a day. “ The difference, first of all, that entire pill burden! Here you take one pill per day yet before we used to take like four pills in the morning and evening. The other thing, it is easy to swallow. It is easy to swallow (Laughter )” (DTG-experienced female patient, aged 59yrs) d. DTG switch assumed as a sign of good adherence Five of the sixteen participants supposed that their clinicians chose them for the switch because they had excellent adherence and good viral suppression. They felt that they were asked to switch because they had a low viral load, and that their files were ‘ recommended for the new drug’ because of this reason. They actually believed that the DTG treatment switch was a reward for those with good adherence and good viral suppression. “The reason they gave me was that I was taking well so they had to change me. They didn’t explain to me much. They just told me that they are going to change me because am taking well. They recommended my file because I qualified to start the new drug and my viral load was very low.” (DTG-experienced female patient, aged 33yrs). Perspectives among the DTG-naive participants For the DTG-naïve, we asked about their existing familiarity with the DTG switch, if they had ever searched for information about the DTG regimen, their general thoughts about the DTG switch and their perspectives on risks and benefits of the DTG based regimen switch. The following themes emerged from the data. 1. Fearing to be switched to the new regimen When asked why they were not yet switched to the DTG regimen, six reported that they had fear to start; they anticipated that DTG would cause them certain side effects like Diabetes, weight gain, hypertension and raising cholesterol levels. The participants reported that they had witnessed their fellow patients who had been given the DTG regimen faced with side effects. “Now the reason I feared to be switched to DTG, First of all because of my weight. Many people have been switched to DTG and they have gained a lot of weight. So, I have this fear that the moment am switched to DTG, I will gain more weight. My other fear is hypertension. There might be chances that I might develop hypertension along the way. That’s why am reluctant to being switched to DTG. ” (DTG naive female patient, aged 53yrs) Another participant had read about DTG associated side effects which she feared, she explained that old age comes with easy susceptibility to diseases and was worried that the situation would worsen after starting the new regimen (DTG). “I feared mainly because my age is more than 50 years and it’s very easy to get diseases when you are this old. and when I read about DTG being ...., because I read that, it can worsen diabetes. So, that also made me fear to be switched .” (DTG naive female patient, aged 57yrs) Most DTG naive study participants were well acquainted with the side effects associated with DTG through their own fact finding and possibly these contributed to their fears to initiate the DTG regimen. “Yeah, as I was doing some research, sometimes depending on someone’s medical history you can develop hypertension. Someone can develop hypertension, some can develop diabetes. So, I think that’s risk .” (DTG naive female patient) 2. Feeling stable on the current regimen When probed on their general thoughts about the DTG switch and their perspectives on risks and benefits of the DTG based regimen, five participants felt that their current regimen was still working well for them. They admitted the fact that if a patients’ viral load was well suppressed on their old regimen, there was no need to change to another regimen “Yes, because their viral load is suppressed and their ART they are on is working very well. So, there is no reason for being switched .” (DTG naive female patient aged 28 yrs.) 3. Willingness to accept risks in DTG switch due to switch benefits Despite the fears quoted above and the general pessimism from DTG naive participants about the switch, six interviewees thought that switching to DTG was good and were willing to accept the risks that came with the switch. They felt DTG based regimen would lead to improved adherence due to its small pill size and eventually lead to a better viral suppression. Some believed it had rapid viral load suppression. “ My point is, I think it’s not bad because it has made our people take their drugs well. Those who were not adherent, they are adhering well. Since its size also makes it easy for them to take. And mainly the viral load suppression, that issue is very good because many people were not adhering and had high viral loads. Now day’s people have done well after being switched to DTG .” (DTG naive female patient) Discussion Our study of client perspectives on switching HIV clients from a stable treatment to a DTG based regimen shows that to some extent, clients’ perspectives were grounded in their emotional experiences while on the other hand, they were grounded in their treatment experiences. The study shows three highly salient shared perspectives for both the DTG-naïve and experienced clients: fearing to be switched due to anticipated side effects, feeling stable on the previous regimen, and, eventually willingness to accept the DTG regimen due to its benefits. Besides, there were perspectives specific to the DTG-experienced clients alone: switch considered compulsory, and feeling rushed to switch without being given enough time and information to comprehend the new treatment. Overall, these findings show that Switching initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation weaned over time suggesting that switching to a new regimen may be beneficial if the concerns about the new regimen are constantly addressed. Most clients, both the naïve and DTG-experienced, revealed initial consternation due to anticipated side effects from the new treatment, especially those that were aged above 35 years and have been in care longer. Many had trekked long journeys from highly disruptive regimens to their well tolerated current regimens. These findings suggest that clients may have concerns and dismay about new treatment especially if they have been stable on their previous treatment, and this may affect their adherence in the long run if these concerns are not addressed. A study conducted in Masaka-Uganda on barriers to starting ART reported similar findings( 27 ) : fear of ART side effects in this study was the strongest factor for ART delay and poor patient outcomes among ART naïve patients in a trial of cryptococcal disease prevention. Another study conducted in HIV infected women found that fear of side effects such as weight gain was among the causes of poor adherence to their ART( 28 ). However, these findings are not in agreement with those from a study conducted among PLHIV in Spain and the United states in which participants’ experiences with starting a new regimen were positive with no participants, reporting fear of side effects( 29 ) But also uniquely in this study, participants had a longstanding relationship with their provider and this was key to their trust in the new treatment they were provided unlike the case with our study. Collectively, these findings suggest that whilst side effects of ART must not be downplayed, programmes should provide information in a balanced way to prevent unnecessary fear of switching regimens. Further research is warranted to assess tensions around starting new ART and how they can be overcome. Majority of the DTG-experienced participants aged above 40 years felt that the switch was compulsory and had no choice to object the change. Some who were younger (aged less than 35 years) felt hurried to change and described the DTG switch exercise as “instantaneous”. These findings suggest that clients regardless of their age may need informed consent, enough time and information to comprehend the new treatment for better treatment outcomes. The findings are not different from those in a study conducted in Kafue community that explored the conflict perspective in the mandatory and compulsory treatment of HIV in Kafue District-Zambia( 30 ). The study established that: people seeking medication at health centres were being frustrated by the compulsory HIV treatment policy requirements. Some people within the Kafue communities, were shunning the health facilities that had these policies and instead opted for self-medication. This negatively impacted government interventions in the fight against the HIV/AIDS pandemic. In a systematic review study on the effectiveness of compulsory drug treatment, it was observed that compulsory treatment caused negative impacts in two studies( 31 ). Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers. These findings also suggest that public health policy makers should consult widely with PLHIV during the process of policy formulation on ART switches in order to address any possible conflicts. Despite participants’ overall negative experiences about changing to the new drug, majority valued the small pill size, once daily dosing, and rapid viral suppression offered by the new regimen. It was typically because of these benefits that some of the naïve and experienced participants indicated would adopt the DTG regimen switch. This research therefore shows that the DTG regimen was adopted due to its clinical advantages and adds on available data showing that DTG is a superior molecule to other available regimens with a tolerable side-effect profile ( 8 ). The DTG treatment change was propelled by the prospective direct health advantages of DTG regimen including reduced pill burden ( 32 ). Pill burden is usually correlated with poor adherence ( 33 ). The optimal adherence seen among most clients revealed in this study could also be explained by the DTG regimen reduced pill burden. The study has several limitations including the cross-sectional nature of the research which limits our understanding of DTG switch perspectives and experiences over time. Much as we asked the DTG-experienced participants to take us back to the events at the time of the switch, all this data was collected at a single point in time. Patients participating in this research were generally individuals, who were stable on their previous regimen, many of whom had been on ART for a long period of time. A sample with greater diversity in terms of, those on unstable previous treatment, might reveal differences in experiences with and perceptions of the DTG switch. The study did not include private patient participants (those that pay for HIV care) who may have given additional insights and unique experiences. Despite these limitations, this study has important strengths. Participants in this research reflect a depth of experience with ART that offers unique and valuable insights into the decision to transition to the DTG regimen and experiences with that transition from a patient perspective. Conclusions Switching from a stable treatment regimen to a DTG-based regimen initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation weaned over time. This study fills a gap in the literature about the thought process through which individuals move when deciding to transition from a stable regimen to a new regimen as a policy requirement. These findings suggest that switching to anew regimen may help to improve ART adherence if the concerns about the new regimen are constantly addressed. It is important to strengthen effective communication and training at all levels in order to suitably support ART switching. There is also need to conduct more research to figure out how to communicate ART treatment switch and devise more acceptable ways to prepare clients to accept ART switches. Declarations Author contributions F.K and J.K.B.M conceptualized and designed the study, supervised the research process, and provided critical revisions to the manuscript. J.K.B.M provided technical input regarding aspects of qualitative research writing F.K, took the lead in writing the manuscript but received support from J.K.B.M and K.K.K who constantly provided critical feedback and helped shape the research, analysis and manuscript. JKBM, KKK, S.N and J.B.M.D did the critical reading and revisions of the manuscript. Supervision of questionnaire completion was by FK and KKK. All authors have read and approved the final version of the article. Data availability statement The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable [email protected] . Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Competing interests The authors declare no competing interests. Ethical approval Ethical approval was sought from Makerere University School of Public Health Higher Degrees Research and Ethics Committee (MakSPH – HDREC). Permission to carry out this study was obtained from JCRC research department and JCRC administration. References Saag, M. S. et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the International Antiviral Society–USA Panel. ; 320 (4):379–396. (2018). UNAIDS. UNAIDS fact sheet 2024 Global HIV statistics. (2024). WHO. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection (World Health Organization, 2018). MOH. 2024 Uganda HIV and AIDS fact sheet. (2024). MOH. 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Pre-treatment integrase inhibitor resistance is uncommon in antiretroviral therapy-naive individuals with HIV-1 subtype A1 and D infections in Uganda. ; 35 (7):1083–1089. (2021). Chrdle, A., Jerhotová, Z., Vacík, M., Linka, M. & Chmelík VJIjoS, A. I. D. S. Crushed dolutegravir/abacavir/lamivudine given via nasogastric tube in gastric outlet obstruction caused by cancer resulted in rapid viral load suppression. ; 30 (1):94–98. (2019). Cento, V. & Perno, C. F. J. J. G. A. R. Two-drug regimens with dolutegravir plus rilpivirine or lamivudine in HIV-1 treatment-naïve, virologically-suppressed patients: Latest evidence from the literature on their efficacy and safety. ; 20 :228–237. (2020). Zakumumpa, H. et al. Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study. ; 21 (1):1–13. (2021). Khoo, S. J. A. dolPHIN-1: Randomised controlled trial of dolutegravir (DTG)-versus efavirenz (EFV)-based therapy in mothers initiating antiretroviral treatment in late pregnancy [homepage on the Internet]. (2018). Waitt, C. et al. Safety and pharmacokinetics of dolutegravir in pregnant mothers with HIV infection and their neonates: a randomised trial (DolPHIN-1 study). PLoS Med. 16 (9), e1002895 (2019). Phillips, A. N. et al. Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study. ; 6 (2):e116–e27. (2019). Dugdale, C. M. et al. Risks and benefits of dolutegravir-and efavirenz-based strategies for South African women with HIV of child-bearing potential: a modeling study. ; 170 (9):614–625. (2019). Zash, R., Makhema, J. & Shapiro, R. L. Neural-tube defects with dolutegravir treatment from the time of conception. N. Engl. J. Med. 379 (10), 979 (2018). Caniglia, E. C. et al. Weight gain during pregnancy among women initiating dolutegravir in Botswana. EClinicalMedicine 29 , 100615 (2020). Kamal, P. & Sharma, S. J. J. E. S. SUN-187 Dolutegravir Causing Diabetes. ;3(Supplement_1):SUN-187. (2019). Calza, L. et al. Improvement in insulin sensitivity and serum leptin concentration after the switch from a ritonavir-boosted PI to raltegravir or dolutegravir in non-diabetic HIV-infected patients. ; 74 (3):731–738. (2019). Hoffmann, C. et al. Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients. ; 18 (1):56–63. (2017). Campbell, J. et al. (eds) Patient and Provider Experience of Using Dolutegravir in Resource Limited Settings: Acceptability Findings from Uganda and Nigeria Methods Results: Patient Acceptability, Side Effects, and Viral Load Results: Prescriber Acceptability. Glasgow: HIV Glasgow Conference; (2018). Lin, L-C-J-D-C-C-N. Data Manage. Secur. qualitative Res. ; 28 (3):132–137. (2009). Braun, V. & Clarke, V. Using thematic analysis in psychology. Qualitative Res. Psychol. 3 (2), 77–101 (2006). Tong, A., Sainsbury, P. & Craig, J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care . 19 (6), 349–357 (2007). Parkes-Ratanshi, R. et al. Barriers to starting ART and how they can be overcome: individual and operational factors associated with early and late start of treatment. Tropical Med. Int. Health . 15 (11), 1347–1356 (2010). Roberts, K. J. & Mann, T. Barriers to antiretroviral medication adherence in HIV-infected women. AIDS care . 12 (4), 377–386 (2000). Davis, W. et al. It made me more confident that I have it under control: Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain. PLoS One . 15 (5), e0232473 (2020). Chinyanta, A. Exploring the conflict perspective in the mandatory and compulsory testing and treatment of HIV-AIDS in the community: a case study of selected communities in Kafue district (The University of Zambia, 2022). Werb, D. et al. The effectiveness of compulsory drug treatment: a systematic review. Int. J. Drug Policy . 28 , 1–9 (2016). Organization, W. H. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach (World Health Organization, 2016). Kini, V. & Ho, P. M. J. J. Interventions to improve medication adherence: a review. ; 320 (23):2461–2473. (2018). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7453812","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":514293277,"identity":"b49d1008-c718-465f-91ed-30097c99eddd","order_by":0,"name":"Francis Kanyike","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBAC9h4QaZDAwM9wgEgtPGegWiQbSNPCkMBgQKwOBh6ew88e8xSkyRkfPPzsww8Gm3x5Bx7jF3i18LaZG/MY5BibHThmPLOHIc1y4wEeMwt8Wuz5GcykeQwqErcdOMPMzMBw2MCwgcfMAK8t/OzfQFrqNzcQrYW3B2RLToIBA1SLPAOP8QO8WnjOlEnOMUgznAH0C2OPQZqBATNbGT4dQC3p2yTe/EmW559x+DHDjwobA/n25s0f8OoBAiYeEClxAEgAPWFwmIFNgpAWxh8gkr8BwpNvYGAmaMsoGAWjYBSMKAAA0m1BkiumPFEAAAAASUVORK5CYII=","orcid":"","institution":"Joint Clinical Research Centre","correspondingAuthor":true,"prefix":"","firstName":"Francis","middleName":"","lastName":"Kanyike","suffix":""},{"id":514293278,"identity":"ee791b54-9a90-4627-a4c8-a57615c91625","order_by":1,"name":"Kenneth Katende Kidonge","email":"","orcid":"","institution":"Joint Clinical Research Centre","correspondingAuthor":false,"prefix":"","firstName":"Kenneth","middleName":"Katende","lastName":"Kidonge","suffix":""},{"id":514293279,"identity":"336ec01c-b3a6-426e-bae4-b6f8d7120dbb","order_by":2,"name":"Sarah Nabukeera","email":"","orcid":"","institution":"Makerere University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Nabukeera","suffix":""},{"id":514293280,"identity":"3f28f02a-334d-4942-bac2-3d2396a80c27","order_by":3,"name":"John Bosco Ddamulira","email":"","orcid":"","institution":"Makerere University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"Bosco","lastName":"Ddamulira","suffix":""},{"id":514293281,"identity":"d649da29-b28a-4996-8d8a-a2b86f2cbd89","order_by":4,"name":"Joseph KB Matovu","email":"","orcid":"","institution":"Makerere University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"KB","lastName":"Matovu","suffix":""}],"badges":[],"createdAt":"2025-08-25 12:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7453812/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7453812/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91527705,"identity":"12fd73fa-8e3d-44d9-8337-b6d4ebf56c69","added_by":"auto","created_at":"2025-09-17 11:21:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1154304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7453812/v1/856d7648-8832-4333-bedc-f288b0bdbcef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clients’ Perspectives on Switching from Old Stable ART Regimens to New Dolutegravir-based Regimen at Joint Clinical Research Centre Uganda","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs of 2024, over 39.9\u0026nbsp;million people were reported to be living with the Human Immunodeficiency Virus (HIV) worldwide, and 70% of these were from sub-Saharan Africa. Moreover, 95% of new infections occur in low and middle-income countries (LMICs).The introduction of antiretroviral therapy (ART), has led to a reduction in HIV morbidity and mortality, improved HIV prognosis and quality of life for people living with HIV (PLHIV) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). By the end of December 2023, 30.7\u0026nbsp;million people were receiving ART up from 7.7\u0026nbsp;million people in 2010 but still short of the 34\u0026nbsp;million target of 2025(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). There was a concerted effort to implement Dolutegravir (DTG)-based first and second line ART regimens in LMICs following the World Health Organisation (WHO) guidelines released in 2018 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUganda, a country in Sub Saharan Africa has an estimated 1.49\u0026nbsp;million PLHIV, and 20, 000 AIDS-related deaths annually(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The current national prevalence for adults aged 15 to 49 years is estimated at 5.1% and antiretroviral therapy coverage at 84%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Over the years, there have been several ART switch policies and the current one contains a Dolutegravir (DTG) regimen, an integrase strand transfer inhibitor. In compliance with the current WHO guidelines(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), Uganda launched a country wide implementation of the single-tablet regimen of Tenofovir/lamivudine/Dolutegravir (TLD) as first line and second-line ART for adults and adolescents in President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) program, with rollout starting in 2018(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLarge-scale rollout of DTG-based regimen had a prospective to lower treatment costs, simplify drug procurement because the DTG based regimen is a single pill(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) has good tolerability, leads to improved viral suppression and a higher genetic barrier to resistance (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). There were growing concerns of increasing levels of transmitted drug resistance, mostly to Non-nucleoside reverse transcriptase inhibitors (NNRTIs), in Uganda(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, unlike the NNRTIs, DTG an integrase inhibitor, had a high genetic barrier to resistance meaning patients were less likely to develop resistance and therefore postponing the need for second line treatment(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). DTG was also described in several studies as having a rapid and sustained virologic suppression and this made it superior to other available ART regimens,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). DTG also showed substantial reductions in treatment-limiting adverse drug reactions compared to other available regimens (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), suppressing viral load twice as fast as Efavirenz (EFV) among pregnant women with HIV infection and their neonates(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), thus potentially reducing the risk of vertical transmission in those who were initiated on treatment late in pregnancy(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, DTG use was linked to some side effects that include, weight gain, hyperglycemia in non-diabetics or worsening in diabetics, neural tube defects, the possibility of neurotoxicity and liver injury (\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). While a few studies have explored provider experiences and perspectives on using DTG in resource-limited settings (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), there is limited information on the experiences and perspectives of DTG users, particularly regarding the switch from an old, stable ART regimen to a new DTG-based therapy. In this study, we explored the perspectives of clients who were switched from a stable ART regimen to a DTG-based regimen at the Joint Clinical Research Centre (JCRC).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Setting\u003c/h2\u003e\u003cp\u003eJoint clinical Research Centre (JCRC) is a medical research institution in Uganda, specializing in HIV/AIDS treatment, medical research, clinical care, training, supporting National HIV programs and offering guidance for policy formulation. The JCRC was suitable for this study since for the last 30 years, JCRC has been specializing in HIV/AIDS treatment and management. From 2018, JCRC adopted the Ministry of health (MOH) guidelines and started switching PLHIV who were virally suppressed on first- and second-line ART to a DTG based regimen.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis was a qualitative study using a narrative inquiry study design to explore the perspectives from clients on switch from a stable ART regimen to a DTG based regimen therapy at JCRC. Narrative inquiry method was used for this study to reveal unique perspectives and to get deeper understanding of the participants\u0026rsquo; unique situations.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study included HIV positive clients aged 18 or older who were on 1st and 2nd line stable treatment and switched to DTG regimen at Joint clinical research centre (DTG-experienced). Participants had been on stable previous ART for not less than one year before they were switched to DTG. The study also included HIV positive clients aged 18 or older who were yet to be switched to a DTG-based regimen (DTG-na\u0026iuml;ve).\u003c/p\u003e\n\u003ch3\u003eParticipants’ Selection\u003c/h3\u003e\n\u003cp\u003eParticipants\u0026rsquo; selection was done using purposive sampling based on records and then applied a maximum variation strategy to sample 24 participants. They included 16 DTG-experienced and 8 DTG-na\u0026iuml;ve participants divided into two groups based on DTG-experience or naivety, DTG duration, sex, and age as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003eParticipant records were obtained from the Integrated Clinical Enterprise Application (ICEA), the patient data system at the Joint Clinical Research Centre (JCRC). From 200 eligible individuals identified by the Data Manager, 50 were purposively selected\u0026mdash;36 DTG-experienced and 14 DTG-na\u0026iuml;ve. Potential participants were contacted by telephone, and 24 consented to participate. Sixteen were classified as DTG-experienced, having received a dolutegravir-based regimen, while eight were DTG-na\u0026iuml;ve, with no prior dolutegravir exposure. Classifications were based on documented antiretroviral history. Interviews were conducted in private consultation rooms at the JCRC to ensure confidentiality and participant comfort.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCategory and distribution of participants by DTG experience\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eDTG-experienced Participants\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration on DTG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDTG-naive participants\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData Ccollection Procedures\u003c/h3\u003e\n\u003cp\u003eTwo research assistants, namely one nurse and one data manager, were recruited and trained before the start of data collection. In-depth interviews were used for data collection, and the interview guides were pre-tested in a location outside the study area by research assistants to ensure clarity and completeness of the data. The interview guides were prepared in English and later back translated into commonly used local language (Luganda). Clients were interviewed in either English or Luganda according to their preference and this was done in a private location at the JCRC. Twenty-four face-to-face in-depth interviews were conducted because the information being collected had reached saturation.\u003c/p\u003e\u003cp\u003eParticipants were asked a range of questions on their perspectives of switching stable ART patients from the old ART regimen to the new DTG based regimen. Their general knowledge, assumptions and what they felt about the new DTG regimen change was explored. The aim of the questions was to determine the participants\u0026rsquo; baseline knowledge of the DTG switch, explore any assumptions they held, assess their senses of optimism or pessimism about switching to the new DTG regimen, and explore their general thoughts about the DTG switch. The DTG-experienced participants were asked to comment on their past treatment experiences before they were switched to DTG regimen and compare with the current DTG experiences. This was a strategy to stimulate participants to reflect on probable ideas of uncertainty or discrepancy in their thoughts on the risks and benefits of the DTG treatment switch. Data were collected on the DTG switch preparatory exercise, questions about events at the time of switch, treatment observations and experiences on DTG treatment, DTG adherence, and DTG switch improvement suggestions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor the DTG-na\u0026iuml;ve clients, data were collected using questions; on knowledge about DTG treatment, the current process of being switched to the new DTG based regimen, perspectives on risks and benefits of DTG regimen switch. Interviewers employed probing methods such as (\u0026lsquo;tell me more\u0026rsquo;) to stimulate participants to continue explaining their answers. Furthermore, when participants introduced subjects or concerns outside the set questions, they were motivated to explore further into the raised subjects and say more. Interviews were audio-recorded with participant consent and transcribed verbatim for data analysis. Transcripts were checked for completeness and accuracy. The study also collected baseline information such as ART regimen for study participants from JCRC patient database Integrated Clinical Enterprise Architecture (ICEA).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe study team ensured confidentiality, good data storage and proper record keeping (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Transcript recordings and notes were evaluated for data related to the research question and a coding scheme was created. We used an inductive approach to apply descriptive thematic codes, following the steps suggested by Braun and Clarke (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Six steps were followed in the inductive thematic approach; In the first step we became familiar with the data, then generated initial codes, after we searched for themes, after this we reviewed themes, we then defined themes, and finally we made the write-up. Inductive thematic analysis helped to organise codes into broader themes, sub-themes and codes that lied outside the known topics of interest. This method helped to identify unexpected themes, explored complexities and contradictions in the data and broke the data into sub-themes. We reported key phrases and verbatim quotes. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to report study findings (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eEthical approval was sought from Makerere University School of Public Health Higher Degrees Research and Ethics Committee (MakSPH \u0026ndash; HDREC). Permission to carry out this study was obtained from JCRC research department and JCRC administration. All methods were performed in accordance with the relevant guidelines and regulations as per the MakSPH \u0026ndash; HDREC. In addition, the researcher explained the importance of the study to all responsible bodies; including health workers and the study subjects. Informed consent was sought from the study subjects prior to enrollement into the study. Any individual not willing to take part in the study had full right not to. All those that accepted to take part in the study had all the information provided treated as highly confidential.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eParticipants\u0026rsquo; characteristics\u003c/h2\u003e\n\u003cp\u003eWe interviewed 24 participants and their age ranged from 20 to 59 years.\u0026nbsp;\u0026nbsp;The majority of the participants had been living with HIV for more than a decade and had considerable experience with prior ART switches. Half of the participants were women and all participants had obtained some kind of formal education. Majority (13/24) described themselves as married or cohabiting. DTG-experienced participants had been on previous ART for 20 months to 12 years before they were switched and 3 months to 3 years after being switched. Most participants in both groups had switched ART regimens several times prior to their most recent transition to the DTG regimen. Five participants self-reported experiencing suboptimal adherence after drug switching to DTG. The characteristics of the 24 participants are shown in Table 2 below. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1060\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge-group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003elevel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART prior to DTG switch (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on DTG after switching (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDTG adherence history\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 1060px;\"\u003e\n \u003cp\u003eDTG-experienced\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSuboptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e40-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e40-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 10 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSuboptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 10 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost- secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSuboptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 10months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSuboptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e40-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eSuboptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 10months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e40-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess than 5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eOptimal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 1060px;\"\u003e\n \u003cp\u003eDTG-na\u0026iuml;ve\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"8\" valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNot applicable (NA)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Characteristics of participants\u003cem\u003e\u003csup\u003e.\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eOptimal adherence (took drugs daily on time); suboptimal adherence (Failed to take drugs daily and or on time)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy participants\u0026rsquo; perspectives on switching stable HIV clients to a DTG-based regimen\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from this study reveal that study participants\u0026rsquo; perspectives on switching stable HIV clients to a DTG-based regimen depended on whether they were experienced or na\u0026iuml;ve patients, as shown below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003ePerspectives among the DTG-experienced participants\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThese were divided into events at the time of switching and events while on DTG regimen.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e1. Events at the time of switching\u003c/h2\u003e\n\u003cp\u003eWe asked participants to take us back to the time when the DTG switch was made and share their experiences at the time, what information they were given regarding the new treatment and how the information helped them understand the treatment they were being switched to. Responses to these questions revealed their sense of fatalism and pessimism about the DTG regimen and were often grounded in their emotional experience rather than factual understanding of the DTG treatment switch. Below are the themes in detail from events at the time of switching.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc123846050\"\u003e\u003cem\u003ea.\u0026nbsp; \u0026nbsp;DTG-based regimen switch considered a\u0026nbsp;\u003c/em\u003e\u003cem\u003estatutory policy\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eSeven of the sixteen DTG-experienced patients felt that they accepted to switch regimens because it was an unavoidable Ministry of health policy.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was told it was a government policy and every one had to switch to the new drug. So, I had no decision to make. As I said, this was a government policy and when change came, I had to go with the rest.\u003c/em\u003e \u003cem\u003eBecause I wanted to follow instructions\u003c/em\u003e\u003cstrong\u003e.\u0026rdquo;\u003c/strong\u003e (DTG-experienced male patient, aged 47yrs)\u003c/p\u003e\n\u003cp\u003eAnother DTG-experienced patient indicated that it was compulsory to change to DTG regimen and felt that he had no choice to object the change, stating:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ldquo;\u003c/strong\u003e\u003cem\u003eLike I have told you before, when it is a policy, you don\u0026rsquo;t have a choice. When the doctor tells you that we are switching from this line to this line or from this regimen to this regimen you don\u0026rsquo;t have an option you just accept whether you have been hurt or not \u0026ldquo;\u003c/em\u003e(DTG-experienced male patient, aged 50yrs)\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eb. \u0026nbsp; Uncertainty about changing to the new regimen\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eNine of the participants initially hesitated to switch to DTG. They had dismay about possible related side effects\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yeah, I was worried. I was thinking a lot and started asking myself questions that what if I get rash, what if I lose weight. So, I had questions.\u0026rdquo;\u003c/em\u003e (DTG-experienced female patient, aged 40yrs)\u003c/p\u003e\n\u003cp\u003eSome feared the side effects the clinicians explained during the DTG switch preparation process while others feared the side effects they heard other patients already on DTG had experienced.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Thirdly, the rumours about the drug that it caused diabetes, failure to sleep, and loss of man power. I looked at all these and that\u0026rsquo;s why I was hesitant. Putting that aside, before my switch I saw some people who had been switched, with side effects of leg swelling, failure to sleep and some reported reduced functionality in bed. That is why I was hesitant on the three different occasions\u003c/em\u003e.\u0026rdquo; (DTG-experienced male patient, aged 42yrs)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome actually kept on dodging and postponing the DTG switch because they feared the unknown side effects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I remember at my time of being switched, I prolonged the counsellor. She could tell me we want to switch you today, I say am not ready first wait, then the second time, am not ready first wait, then the third time, am not ready first wait. Fourth time she had to send me to the Doctor to have a discussion\u003c/em\u003e. \u0026ldquo;(DTG-experienced male patient, aged 30yrs).\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003ec. \u0026nbsp; Feeling hurried to change to the new regimen\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eSix participants felt hurried to start the DTG based regimen. They felt as if they had not been given enough time to think about the switch. Some felt as though they had not been given enough information about the new regimen. For some interviewees, the DTG regimen was given during a scheduled visit when they had anticipated collecting their previous ART regimen. They described the DTG switch exercise as \u0026ldquo;instantaneous\u0026rdquo;:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was surprised, when I came, I thought I was going to be given my usual drug (old regimen), only to be told that I was to take the new medication (DTG)\u0026hellip;.\u0026rdquo;\u003c/em\u003e (DTG-experienced female patient, aged 34yrs)\u003c/p\u003e\n\u003ch3 id=\"_Toc123846053\"\u003e\u003cbr\u003e\u003c/h3\u003e\n\u003ch2\u003e2. Events while on DTG regimen\u003c/h2\u003e\n\u003cp\u003eAfter exploring their experiences at the time of the DTG switch, we asked them to share their treatment observations and experiences while on DTG based regimen, how the DTG regimen differed and compared to their previous regimen in terms of their clinical benefits.\u003c/p\u003e\n\u003cp\u003eResponses to these questions revealed a mixture of feelings and emotions from participants, while some were optimistic and hopeful about the DTG switch, others expressed regrets. Their positive and negative experiences are organised into\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esub themes below:\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003ea. Feeling more stable on the previous regimen\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eNine of the sixteen participants felt that they were stable on their older regimen and where not happy that their regimen had been changed, some raised concerns about side effects and regretted changing to the DTG regimen. Here are some of the narratives;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eI did not have the issues am having at the moment. I have taken DTG for 3 years... Yes, I was really doing well with my previous medication and my viral load was much suppressed.\u0026rdquo;\u003c/em\u003e (DTG-experienced male patient, aged 43yrs)\u003c/p\u003e\n\u003ch3 id=\"_Toc123846054\"\u003e\u003cem\u003eb. Dosing schedule change and consequences\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eFive participants felt uneasy for the sudden change in dosing schedule needed for DTG. They were comfortable taking previous ART at night, but with DTG, they were advised to change to morning dosing to avoid lack of sleep a common DTG side effect. Also, the DTG morning dose affected work schedules for some participants who were used to taking at night.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I used to take the old ART at 9pm, yet this new medicine was to be taken in the morning\u0026hellip;I was used to taking at night It was very disturbing for me to swallow in the morning.... The truth is sometimes I would miss the morning dose.\u0026rdquo; (\u003c/em\u003eDTG-experienced female patient, aged 28yrs\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ec. \u0026nbsp; DTG dosing ascertained to be simpler than old ART regimen\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeven participants said they accepted the persuasion to switch to DTG partly because they preceded that taking a smaller pill just once a day would be more convenient than their past regimen especially for those who had been taking alluvia regimens that were not only dosed twice daily but also were very big pills. DTG-experienced patients found DTG based regimen easier to swallow than their previous ART because it is smaller and taken once a day.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe difference, first of all, that entire pill burden! Here you take one pill per day yet before we used to take like four pills in the morning and evening. The other thing, it is easy to swallow. It is easy to swallow (Laughter\u003c/em\u003e)\u0026rdquo; (DTG-experienced female patient, aged 59yrs)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ed. \u0026nbsp; DTG switch assumed as a sign of good adherence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive of the sixteen participants supposed that their clinicians chose them for the switch because they had excellent adherence and good viral suppression. They felt that they were asked to switch because they had a low viral load, and that their files were \u0026lsquo;\u003cem\u003erecommended for the new drug\u0026rsquo;\u003c/em\u003e because of this reason. They actually believed that the DTG treatment switch was a reward for those with good adherence and good viral suppression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The reason they gave me was that I was taking well so they had to change me.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThey didn\u0026rsquo;t explain to me much. They just told me that they are going to change me because am taking well. They recommended my file because I qualified to start the new drug and my viral load was very low.\u0026rdquo;\u003c/em\u003e (DTG-experienced female patient, aged 33yrs).\u003c/p\u003e\n\u003ch2 id=\"_Toc123846058\"\u003ePerspectives among the DTG-naive participants\u003c/h2\u003e\n\u003cp id=\"_Toc123846059\"\u003eFor the DTG-na\u0026iuml;ve, we asked about their existing familiarity with the DTG switch, if they had ever searched for information about the DTG regimen, their general thoughts about the DTG switch and their perspectives on risks and benefits of the DTG based regimen switch. The following themes emerged from the data.\u003c/p\u003e\n\u003ch3\u003e1. \u0026nbsp;Fearing to be switched to the new regimen\u003c/h3\u003e\n\u003cp\u003eWhen asked why they were not yet switched to the DTG regimen, six reported that they had fear to start; they anticipated that DTG would cause them certain side effects like Diabetes, weight gain, hypertension and raising cholesterol levels. The participants reported that they had witnessed their fellow patients who had been given the DTG regimen faced with side effects.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Now the reason I feared to be switched to DTG, First of all because of my weight. Many people have been switched to DTG and they have gained a lot of weight. So, I have this fear that the moment am switched to DTG, I will gain more weight. My other fear is hypertension. There might be chances that I might develop hypertension along the way. That\u0026rsquo;s why am reluctant to being switched to DTG.\u003c/em\u003e\u0026rdquo; (DTG naive female patient, aged 53yrs)\u003c/p\u003e\n\u003cp\u003eAnother participant had read about DTG associated side effects which she feared, she explained that old age comes with easy susceptibility to diseases and was worried that the situation would worsen after starting the new regimen (DTG).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;I feared mainly because my age is more than 50 years and it\u0026rsquo;s very easy to get diseases when you are this old. and when I read about DTG being ...., because I read that, it can worsen diabetes. So, that also made me fear to be switched\u003c/em\u003e.\u0026rdquo; (DTG naive female patient, aged 57yrs)\u003c/p\u003e\n\u003cp\u003eMost DTG naive study participants were well acquainted with the side effects associated with DTG through their own fact finding and possibly these contributed to their fears to initiate the DTG regimen.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yeah, as I was doing some research, sometimes depending on someone\u0026rsquo;s medical history you can develop hypertension. Someone can develop hypertension, some can develop diabetes. So, I think that\u0026rsquo;s risk\u003c/em\u003e.\u0026rdquo; (DTG naive female patient)\u003c/p\u003e\n\u003ch3\u003e2. Feeling stable on the current regimen\u003c/h3\u003e\n\u003cp\u003eWhen probed on their general thoughts about the DTG switch and their perspectives on risks and benefits of the DTG based regimen, five participants felt that their current regimen was still working well for them. They admitted the fact that if a patients\u0026rsquo; viral load was well suppressed on their old regimen, there was no need to change to another regimen\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, because their viral load is suppressed and their ART they are on is working very well. So, there is no reason for being switched\u003c/em\u003e\u003cspan id=\"_Toc123846061\"\u003e.\u0026rdquo; (DTG naive female patient aged 28 yrs.)\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003e3. \u0026nbsp;Willingness to accept risks in DTG switch due to switch benefits\u003c/h3\u003e\n\u003cp\u003eDespite the fears quoted above and the general pessimism from DTG naive participants about the switch, six interviewees thought that switching to DTG was good and were willing to accept the risks that came with the switch. They felt DTG based regimen would lead to improved adherence due to its small pill size and eventually lead to a better viral suppression. Some believed it had rapid viral load suppression.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eMy point is, I think it\u0026rsquo;s not bad because it has made our people take their drugs well. Those who were not adherent, they are adhering well. Since its size also makes it easy for them to take. And mainly the viral load suppression, that issue is very good because many people were not adhering and had high viral loads. Now day\u0026rsquo;s people have done well after being switched to DTG\u003c/em\u003e.\u0026rdquo; (DTG naive female patient)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study of client perspectives on switching HIV clients from a stable treatment to a DTG based regimen shows that to some extent, clients\u0026rsquo; perspectives were grounded in their emotional experiences while on the other hand, they were grounded in their treatment experiences. The study shows three highly salient shared perspectives for both the DTG-na\u0026iuml;ve and experienced clients: fearing to be switched due to anticipated side effects, feeling stable on the previous regimen, and, eventually willingness to accept the DTG regimen due to its benefits. Besides, there were perspectives specific to the DTG-experienced clients alone: switch considered compulsory, and feeling rushed to switch without being given enough time and information to comprehend the new treatment. Overall, these findings show that Switching initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation weaned over time suggesting that switching to a new regimen may be beneficial if the concerns about the new regimen are constantly addressed.\u003c/p\u003e\u003cp\u003eMost clients, both the na\u0026iuml;ve and DTG-experienced, revealed initial consternation due to anticipated side effects from the new treatment, especially those that were aged above 35 years and have been in care longer. Many had trekked long journeys from highly disruptive regimens to their well tolerated current regimens. These findings suggest that clients may have concerns and dismay about new treatment especially if they have been stable on their previous treatment, and this may affect their adherence in the long run if these concerns are not addressed. A study conducted in Masaka-Uganda on barriers to starting ART reported similar findings(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) : fear of ART side effects in this study was the strongest factor for ART delay and poor patient outcomes among ART na\u0026iuml;ve patients in a trial of cryptococcal disease prevention. Another study conducted in HIV infected women found that fear of side effects such as weight gain was among the causes of poor adherence to their ART(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, these findings are not in agreement with those from a study conducted among PLHIV in Spain and the United states in which participants\u0026rsquo; experiences with starting a new regimen were positive with no participants, reporting fear of side effects(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) But also uniquely in this study, participants had a longstanding relationship with their provider and this was key to their trust in the new treatment they were provided unlike the case with our study. Collectively, these findings suggest that whilst side effects of ART must not be downplayed, programmes should provide information in a balanced way to prevent unnecessary fear of switching regimens. Further research is warranted to assess tensions around starting new ART and how they can be overcome.\u003c/p\u003e\u003cp\u003eMajority of the DTG-experienced participants aged above 40 years felt that the switch was compulsory and had no choice to object the change. Some who were younger (aged less than 35 years) felt hurried to change and described the DTG switch exercise as \u0026ldquo;instantaneous\u0026rdquo;. These findings suggest that clients regardless of their age may need informed consent, enough time and information to comprehend the new treatment for better treatment outcomes. The findings are not different from those in a study conducted in Kafue community that explored the conflict perspective in the mandatory and compulsory treatment of HIV in Kafue District-Zambia(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The study established that: people seeking medication at health centres were being frustrated by the compulsory HIV treatment policy requirements. Some people within the Kafue communities, were shunning the health facilities that had these policies and instead opted for self-medication. This negatively impacted government interventions in the fight against the HIV/AIDS pandemic. In a systematic review study on the effectiveness of compulsory drug treatment, it was observed that compulsory treatment caused negative impacts in two studies(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers. These findings also suggest that public health policy makers should consult widely with PLHIV during the process of policy formulation on ART switches in order to address any possible conflicts.\u003c/p\u003e\u003cp\u003eDespite participants\u0026rsquo; overall negative experiences about changing to the new drug, majority valued the small pill size, once daily dosing, and rapid viral suppression offered by the new regimen. It was typically because of these benefits that some of the na\u0026iuml;ve and experienced participants indicated would adopt the DTG regimen switch. This research therefore shows that the DTG regimen was adopted due to its clinical advantages and adds on available data showing that DTG is a superior molecule to other available regimens with a tolerable side-effect profile (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The DTG treatment change was propelled by the prospective direct health advantages of DTG regimen including reduced pill burden (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Pill burden is usually correlated with poor adherence (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The optimal adherence seen among most clients revealed in this study could also be explained by the DTG regimen reduced pill burden.\u003c/p\u003e\u003cp\u003eThe study has several limitations including the cross-sectional nature of the research which limits our understanding of DTG switch perspectives and experiences over time. Much as we asked the DTG-experienced participants to take us back to the events at the time of the switch, all this data was collected at a single point in time. Patients participating in this research were generally individuals, who were stable on their previous regimen, many of whom had been on ART for a long period of time. A sample with greater diversity in terms of, those on unstable previous treatment, might reveal differences in experiences with and perceptions of the DTG switch. The study did not include private patient participants (those that pay for HIV care) who may have given additional insights and unique experiences. Despite these limitations, this study has important strengths. Participants in this research reflect a depth of experience with ART that offers unique and valuable insights into the decision to transition to the DTG regimen and experiences with that transition from a patient perspective.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSwitching from a stable treatment regimen to a DTG-based regimen initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation weaned over time. This study fills a gap in the literature about the thought process through which individuals move when deciding to transition from a stable regimen to a new regimen as a policy requirement. These findings suggest that switching to anew regimen may help to improve ART adherence if the concerns about the new regimen are constantly addressed. It is important to strengthen effective communication and training at all levels in order to suitably support ART switching. There is also need to conduct more research to figure out how to communicate ART treatment switch and devise more acceptable ways to prepare clients to accept ART switches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eAuthor contributions\u003c/h3\u003e\n\u003cp\u003eF.K and J.K.B.M conceptualized and designed the study, supervised the research process, and provided critical revisions to the manuscript. J.K.B.M provided technical input regarding aspects of qualitative research writing F.K, took the lead in writing the manuscript but received support from J.K.B.M and K.K.K who constantly provided critical feedback and helped shape the research, analysis and manuscript. JKBM, KKK, S.N and J.B.M.D did the critical reading and revisions of the manuscript. Supervision of questionnaire completion was by FK and KKK. All authors have read and approved the final version of the article.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData availability statement\u003c/h3\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable [email protected].\u003c/p\u003e\n\u003ch3\u003eFunding\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought from Makerere University School of Public Health Higher Degrees Research and Ethics Committee (MakSPH \u0026ndash; HDREC). Permission to carry out this study was obtained from JCRC research department and JCRC administration.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaag, M. S. et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the International Antiviral Society\u0026ndash;USA Panel. ;\u003cb\u003e320\u003c/b\u003e(4):379\u0026ndash;396. (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUNAIDS. UNAIDS fact sheet 2024 Global HIV statistics. 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(2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCento, V. \u0026amp; Perno, C. F. J. J. G. A. R. Two-drug regimens with dolutegravir plus rilpivirine or lamivudine in HIV-1 treatment-na\u0026iuml;ve, virologically-suppressed patients: Latest evidence from the literature on their efficacy and safety. ;\u003cb\u003e20\u003c/b\u003e:228\u0026ndash;237. (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZakumumpa, H. et al. Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study. ;\u003cb\u003e21\u003c/b\u003e(1):1\u0026ndash;13. (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhoo, S. J. A. dolPHIN-1: Randomised controlled trial of dolutegravir (DTG)-versus efavirenz (EFV)-based therapy in mothers initiating antiretroviral treatment in late pregnancy [homepage on the Internet]. (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaitt, C. et al. Safety and pharmacokinetics of dolutegravir in pregnant mothers with HIV infection and their neonates: a randomised trial (DolPHIN-1 study). \u003cem\u003ePLoS Med.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e (9), e1002895 (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhillips, A. N. et al. Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study. ;\u003cb\u003e6\u003c/b\u003e(2):e116\u0026ndash;e27. (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDugdale, C. M. et al. Risks and benefits of dolutegravir-and efavirenz-based strategies for South African women with HIV of child-bearing potential: a modeling study. ;\u003cb\u003e170\u003c/b\u003e(9):614\u0026ndash;625. (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZash, R., Makhema, J. \u0026amp; Shapiro, R. L. 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(2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antiretroviral Therapy, Dolutegravir, Human Immunodeficiency Virus, Tenofovir/lamivudine/Dolutegravir, Clients’ Perspectives","lastPublishedDoi":"10.21203/rs.3.rs-7453812/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7453812/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn 2018, Uganda adopted a Dolutegravir-based regimen (DTG) as its preferred first line antiretroviral therapy(ART). We explored clients\u0026rsquo; perspectives on switching stable ART patients to the new regimen at Joint Clinical Research Centre. We purposively sampled 24 clients (16 DTG-experienced, 8 DTG-na\u0026iuml;ve), conducted face-to-face in-depth interviews, audio-recorded, transcribed verbatim, and analysed data using a thematic framework approach. DTG-experienced were those on previous stable treatment and switched to DTG regimen while the DTG-na\u0026iuml;ve were yet to be switched. Most DTG-experienced participants expressed concerns about side effects, feeling stable on their previous regimen, and inadequate explanation. Others felt were switched hurriedly and switching seemed compulsory. Some eventually viewed it as beneficial due to smaller pill size, once daily dosing, and rapid viral suppression. Majority of the DTG-naive viewed it as beneficial with similar reasons as the already switched but were hesitant due to anticipated side effects. Switching from stable treatment regimens to a DTG-based regimen initially created tension among stable clients who felt comfortable staying on their old regimens but this hesitation waned over time. Switching to new regimens may improve ART adherence if the concerns of new regimens are constantly addressed through continuous health education and promotion.\u003c/p\u003e","manuscriptTitle":"Clients’ Perspectives on Switching from Old Stable ART Regimens to New Dolutegravir-based Regimen at Joint Clinical Research Centre Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 11:05:29","doi":"10.21203/rs.3.rs-7453812/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T12:12:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T06:09:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T16:19:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315501808905727412767026839425737153801","date":"2025-12-04T10:45:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64828019023220995085699099564205947816","date":"2025-12-02T10:23:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T21:53:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62492498831490801765298291907156686692","date":"2025-09-12T12:21:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339951649897521316993785081430741601037","date":"2025-09-10T13:54:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247845333179453062885010459490427478134","date":"2025-09-10T12:55:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169267510579750002798539026869232706975","date":"2025-09-10T12:30:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T12:15:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T12:11:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T21:18:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T10:52:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-08-28T10:46:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"354d8d0e-84c4-4f20-94b7-25f6d77ea474","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":54641680,"name":"Health sciences/Diseases"},{"id":54641681,"name":"Health sciences/Health care"},{"id":54641682,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-15T17:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 11:05:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7453812","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7453812","identity":"rs-7453812","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}