A. General Tools

This tool provides holistic and comprehensive advice to patients undergoing TLD transition. This tool was adopted from the Clinton Health Access Initiative counseling job aid for TLD transition published in 2018.

TLD is a pill that contains three medicines: tenofovir (TDF), lamivudine (3TC), and a new medicine – dolutegravir (DTG). It has several benefits. It is very effective for treating HIV, has fewer side effects than other medicines.

Take it upon waking up. Take your TLD pill in the morning because DTG sometimes causes insomnia. This usually gets better after 1–2 months of taking the medicine. If it persists, please discuss this side effect with your clinician.

TLD can also be safely taken with or without food. However, taking DTG with food may increase absorption and this may impact side effects. Calcium (milk, dairy, green leafy vegetables) and iron (red meat, chicken, pork) can reduce absorption of your TLD medicine. This can be avoided by taking calcium or iron supplements 2 hours before or 6 hours after you take your TLD.

TLD has no interaction with hormonal birth control methods. It is safe to take TLD with any hormonal birth control method. Patients using a hormonal birth control method should also use condoms to protect against STIs.

This medication works faster than other ARVs. This is good, because it means your immune system will recover more quickly. However, one possible effect of your immune system recovering quickly is something called Immune Reconstitution Inflammatory Syndrome (IRIS). Common symptoms can vary and include fever, swollen lymph nodes, rashes, pneumonia, and eye inflammation. These symptoms usually start after 2–12 weeks on treatment. If you develop these symptoms, you should come back to the ART clinic as soon as possible. This information is to ensure you are prepared in case they appear, but you shouldn’t be discouraged by it, as they might or not happen. You should not stop taking your medications unless we suggest it to you. There may be additional treatments that are necessary to control these symptoms.

IRIS is different from other ART medication side effects. Rashes, diarrhea, headache, and sleep changes are side effects that usually go away after 1–2 months of taking ART. These may be due to the medication, not due to a hidden infection or IRIS. Again, you should not stop your medications on your own, and should discuss any symptoms with your doctor even if outside of your normal appointment date.

If you experience a cough for 2 weeks, have weight loss, a fever, or night sweats, these may be symptoms of TB. Please come back to the facility to be screened. A key TB medication called rifampicin causes lower levels of DTG in the body. If you need to be treated for TB with rifampicin, your doctor may change your ART regimen. Once you have completed your TB treatment, you may discuss with your doctor if you want to switch back to TLD. Patients whose TB regimen does not contain rifampicin should stay on TLD.

Note: Please see attached in Counselling Tool for Women in Childbearing Age

This is a good opportunity to ask any questions about your treatment.

Adopted from: Clinton Health Access Initiative (2018). Key DTG Counseling Messages. Retrieved November 18, 2020, from https://clintonhealth.app.box.com/s/gkwkxsbass9i6sf82n4k0bhsdw2sjuu3