On 3 June 2016, a press release from ViiV Healthcare announced an agreement with the Botswana Ministry of Health for dolutegravir to be commissioned as first-line therapy.1
This will be part of a national "Treat All" public health programme to provide universal access to HIV treatment in Botswana.
Botswana is the first country in sub-Saharan Africa to move to using dolutegravir as first-line therapy -- bringing the country in line with guidelines high-income countries that moved to recommend integrase inhibitor combinations rather than starting treatment with efavirenz.
Dolutegravir brings viral load down quicker and more effectively than efavirenz. It is associated with fewer side effects and a lower risk of drug resistance.
The low milligram dose needed for dolutegravir (50 mg vs 600 mg for efavirenz) helped the Clinton Health Access Initiative (CHAI) negotiate for the price of generic dolutegravir to be comparable to generic efavirenz.2
WHO recommended dolutegravir as part of alternative first-line ART in late 2015.
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