Durable viral suppression in the dolutegravir era
A data-enabled, risk-stratified model for integrated HIV care in Uganda
Bibliographic Data
| ID | 22081069 |
|---|---|
| Authors | Maria Magdalene Namaganda (0000-0003-1913-5506, Makerere University), Joyce Nakatumba Nabende (Makerere University), Joyce Nakatumba‐Nabende (0000-0002-0108-3798, Makerere University), David Patrick Kateete (0000-0001-8075-3069, Makerere University), Charles Batte (0000-0003-0351-8705, Makerere University), Gerald Mboowa (0000-0001-8445-9414, Makerere University, corresponding author) |
| Year | 2026 |
| Volume | 14 |
| Pages | 1794681-1794681 |
| Publication date | 2026-05-04 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Frontiers in Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2296-2565 • E-ISSN: 2296-2565 |
| Publisher | Frontiers Media SA (PUBLISHER • CH) |
| DOI | 10.3389/fpubh.2026.1794681 |
| PMID | 42158193 |
| OpenAlex | W7160122329 |
| Language | EN |
| References cited | 14 |
Despite widespread rollout of dolutegravir-based (DTG) antiretroviral therapy (ART) in East Africa, viral non-suppression, advanced HIV disease (AHD), and multimorbidity persist, reflecting gaps in service response rather than regimen potency alone. In Uganda’s The AIDS Support Organization (TASO) routine-care cohort (2014–2024; n = 54,348 people living with HIV), integrase inhibitor uptake is near universal, yet AHD remains common, and tuberculosis (TB) and non-communicable diseases (NCD) increasingly co-occur within HIV care. Among clients with a recorded most recent viral load, 6.4% (2,145/33,384) had viral non-suppression (VL ≥ 1,000 copies/mL). Second, our regional systematic review and meta-analysis (2016–2023; n = 29,829) estimates viral non-suppression at 19.4% and indicates that failure concentrates in predictable social and clinical risk strata. We propose that durable suppression may be strengthened by an accountable, time-bound viral load (VL) cascade, paired with targeted support for clients at elevated clinical and social risk. Building on WHO and national differentiated service delivery and AHD guidance, we outline a pragmatic, data-enabled, risk-stratified model that uses routine electronic health record (EHR) signals to trigger rapid viral non-suppression follow-up, guide delivery of a proposed time-limited adherence and socioeconomic stability bundle, and integrate TB and NCD management within HIV platforms. A minimum actionable dashboard focused on cascade timeliness, high-risk package delivery, and integrated care can translate ART scale-up into durable suppression, fewer preventable AHD complications, and faster progress toward 95–95–95
Cohort · Disease · Dolutegravir · Integrase · Integrase inhibitor · Regimen · Socioeconomic status · Tuberculosis · Viral load · HIV-related health complications and treatments · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions
| Highly cited | No |
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