Experience of a Nationwide implementation of single-tablet second-generation integrase inhibitors-based treatment in Mexico.

Objectives: In Mexico, until 2018, antiretroviral therapy (ART) primarily relied on efavirenz-containing regimens or other options suitable for optimization, with ART costs among the highest in the region. This study evaluated the impact of a national strategy using single-tablet, second-generation integrase inhibitors (STSGII)-either bictegravir, emtricitabine, and tenofovir alafenamide or abacavir/lamivudine/dolutegravir-for ART initiation or switch. Methods: Adults initiating or switching to STSGII between June 1, 2019, and June 30, 2021, at clinics for individuals without social security, were categorized into three groups: G1 (initiated with STSGII), G2 (initiated with non-STSGII), and G3 (switched to STSGII). The switch was defined as individuals changing ART in the presence of virological suppression. Viral suppression (VS) at 6 months post-initiation or switch was reported. A Cox model evaluated VS and regimen durability, defined as maintaining VS without ART change, loss to follow-up, or death. Results: A total of 70,732 individuals were included; 24,133 (34.1%) on G1, 4605 (6.5%) on G2, and 41,994 (59.4%) on G3. VS was achieved in 85.7%, 52.7%, and 82.7% of individuals in G1, G2, and G3, respectively. Durability was met in 85.1%, 41.3%, and 90.8% of individuals in G1, G2, and G3. Conclusions: Second-generation INSTIs are effective and durable in this 2-year follow-up analysis, both for ART initiation and optimization in Mexico's population, offering a valuable strategy for improving ART outcomes.