The literature on dolutegravir (DTG)-based HIV treatment has focused on assessing therapeutic efficacy particularly with regard to viral load suppression.
Sexual dysfunction following transition to DTG-based regimens is common in both sexes of PLHIV, who indicated that they had no prior experience of difficulties in sexual health. Participants reported increased marital strife as a result of their inability to meet the sexual needs of their intimate partners following transition to DTG-based regimens. Participants of both sexes reported diminished interest in sex after transition to DTG-based ART. Recipients of HIV care were unequivocal in relaying the notion that they had been on ART for multiple years without a prior history of difficulties in sexual functioning and that the diminished interest in desire for sex was linked to DTG use. According to the participants, attending clinicians were pre-occupied with viral load suppression and were less concerned with their sexual health or the quality of life of patients under their care. In our sample of patients, feelings of insecurity due to DTG-associated sexual dysfunction were common in both sexes. In our focus groups, female participants reported that their sexual dysfunction was a constant source of marital conflict with their male partners. In analyzing participants’ reported timelines of new onset sexual dysfunction and the resultant separation from long-term partners, we found that the two appeared to correspond. We selected patients who were sexually active and reported ‘new’ sexual dysfunction following transition to DTG-based regimens which were rolled out at participating sites between 2018 and 2019 (Table 1). Participants were selected with the help of the head of the HIV clinic at each of the participating facilities (Table 1) with the aid of manual registers of recorded ADRs which are routinely maintained at health facilities in Uganda for onward transmission to the National Drug Authority. The manual register of recorded suspected ADRs at participating facilities (Table 1) served as a sampling frame for our study. Participants in our focus groups were new and did not participate in the earlier phase of IDIs. We sought to explore gender dynamics in our phenomenon of interest and as such, we conducted gender-disaggregated focus groups (three FGDs with males, three FGDs with females) with one focus group of either gender at all three levels of HIV service delivery in Uganda (Fig. 1). We utilized an approved topic guide in the proceedings that entailed open-ended questions structured around the three themes implicated by the literature on sexual health; (a) lack of desire for sex (b) genital failure and (c) relational constraints [ 32, 33, 34]. We applied probes under the three themes in a flexible way as applicable. The face-to-face interviews were conducted on-site at participating facilities (Table 1). The aim of the IDIs was to enable recipients of HIV care to provide an in-depth narrative of their lived experiences of sexual dysfunction following transition to DTG-based regimens from an individual perspective. The findings reported here are derived from a larger study, aimed at promoting patient-centred pharmacovigilance, in the context of the concurrent roll-out of newer HIV medications such as DTG-based ART and community-based ART delivery models in Uganda [ 3]. The first phase involved interviews with clinicians in HIV clinics to understand provider perspectives on the acceptability and tolerability of DTG-based ART [ 3]. Sexual dysfunction following transition to DTG-based regimens is common in both sexes of PLHIV, who indicated that they had no prior experience of difficulties in sexual health.