Impact of Dolutegravir-Based Antiretroviral Therapy on Viral Load Suppression and Uptake of DTG-Based Regimen Among Pediatric HIV Patients in Africa: A Systematic Review and Meta-Analysis.

Authors

Desalegn Mitiku Kidie, Abraham Dessie Gessesse, Jenberu Mekurianew Kelkay, Tsegaamlak Kumelachew Derse, Addisu Simachew Asgai

Published in

Journal of the International Association of Providers of AIDS Care. Volume 25. Pages 23259582261467826. Epub Jul 14, 2026.

Abstract

BackgroundDespite global advances in HIV care, pediatric populations in Africa continue to experience suboptimal treatment outcomes. Dolutegravir (DTG)-based antiretroviral therapy (ART) offers improved efficacy and tolerability, however, its real-world impact on viral load suppression (VLS) and the uptake of DTG-based regimens from older ART to newly recommended DTG-based ART among children and adolescents in Africa has not been systematically quantified.ObjectiveThis systematic review and meta-analysis aimed to estimate the pooled viral load suppression after initiation of dolutegravir-based ART and the uptake of DTG-based regimens from older regimens to dolutegravir-based ART among children and adolescents living with HIV in Africa.MethodsA systematic review and meta-analysis conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, Google Scholar, ScienceDirect, Hinari, CORE, and DOAJ were performed from January 01-10, 2026. Studies reporting VLS after initiation of DTG-based ART and the uptake of DTG-based regimens among pediatric patients with HIV in Africa were included. Pooled estimates were computed using random-effect models. Heterogeneity was assessed using I² statistics, and subgroup, sensitivity, and publication bias analyses were performed.Resultsout of 7,789 records screened, twenty-four studies comprising 119,292 participants were included. The overall pooled viral load suppression at six months after initiation of DTG-based ART was 82% (95% CI: 79-85%) and 70 (95% CI: 62-77%) among participants who were unsuppressed at baseline. The pooled uptake of DTG-based regimens was 77% (95% CI: 68-86%) based on 23 studies. Substantial heterogeneity was observed across outcomes (I²≥98%). Subgroup analysis indicated regional and study-design variation in the uptake of DTG-based regimens but not in viral suppression. No substantial publication bias was detected among the included studies.ConclusionDTG-based ART effectively suppressed viral load among pediatric patients in Africa, though adoption remains incomplete and below UNAIDS 95-95-95 targets. Significant heterogeneity highlights the influence of contextual and health system factors. Accelerated rollout, strengthened adherence support, and harmonized monitoring are needed to optimize pediatric HIV outcomes.

PMID:
42444527
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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