DOLPHIN-3 · Drug Optimisation in LMICs of Pregnant HIV women and their Infants: temporary switch to CAB/RPV long acting injections

Sustained ART use is essential for achieving SDG3 by reducing HIV burden and promoting maternal and infant health. Ensuring consistent adherence and engagement in care is crucial to achieving UNAIDS 95-95-95 viral suppression targets (in treated individuals) by 2030. Despite ART's success, low adherence presents a significant barrier to maintaining long-term viral suppression. Challenges are notably heightened in postpartum WLHIV, as transition into motherhood introduces a range of changes and stressors that can significantly impact adherence. Therefore there's an urgent need to prioritise interventions enhancing engagement and promoting adherence, inorder to achieve viral load suppression and prevent mother to child transmission. DOLPHIN3 aims to operationalise an implementation project using a mixed methods approach to generate evidence on optimal use of long-acting injectable ART as a strategy to improve adherence rates and overall health outcomes among postpartum women in South Africa and Uganda. The project's objectives are to: i. establish effectiveness of a temporary switch to cabotegravir (CAB)/rilpivirine (RPV) LA as a bridging strategy during breastfeeding, ii. explore strategies to safely re-establish oral ART after discontinuation of CAB/RPV LA, iii. explore maternal, infant and breastmilk pharmacokinetics, and iv. engage with stakeholders to generate insights for sustainable future deployment of LAI. The DOLPHIN consortium possesses a proven track record in conducting clinical trials specifically in the population of women initiating ART late in pregnancy. Our proposed project aligns with the EDCTP3 broader objectives of evaluating the real-life impact of existing interventions in women and children's health and improving maternal, neonatal, and child health in sub-Saharan Africa. Our proficiency in implementation research empowers us to transform our research findings into practical recommendations for healthcare systems and policymakers.