{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:11:49Z","timestamp":1787663509151,"version":"build-2736575974"},"reference-count":44,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,8,18]],"date-time":"2024-08-18T00:00:00Z","timestamp":1723939200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH110350"],"award-info":[{"award-number":["R01MH110350"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Millions of people living with HIV (PLWH) take oral antiretroviral therapy (ART), which requires a lifetime of consistent medication adherence. The relationship between adherence and poor HIV outcomes is well documented. Newer ART regimens that include dolutegravir (DTG) could be more forgiving, but empirical evidence on the relationship between adherence and viral suppression under DTG is only emerging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this observational cohort study (secondary analysis of data from a randomized trial), we used data from 313 ART clients from a large HIV clinic in Kampala, Uganda. Over the 4\u2010year study period (January 2018\u2013January 2022), 91% switched from non\u2010DTG regimens to DTG regimens. We measured adherence using Medication Event Monitoring Systems\u2010caps and extracted prescription information and viral load measures from electronic health records. We estimated unadjusted linear regressions and adjusted models that included individual and time fixed\u2010effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Under non\u2010DTG regimens, 96% of participants were virally suppressed (defined as viral load &lt; 200 copies\/ml) when adherence was 90% or higher in the 3 months before viral load measurement. Viral suppression was 32 percentage points lower when adherence was between 0% and 49% (95% CI \u22120.44, \u22120.20, <jats:italic>p<\/jats:italic> &lt; 0.01), 12 percentage points lower when adherence was between 50% and 79% (95% CI \u22120.23, \u22120.02, <jats:italic>p<\/jats:italic> &lt; 0.01), and not significantly different when adherence was between 80% and 89% (effect of 0.00, 95% CI \u22120.06, 0.07, <jats:italic>p<\/jats:italic> = 0.81). In contrast, for participants taking DTG, there was no statistically significant difference in viral suppression among any of the four adherence levels; more than 95% were virally suppressed at each adherence level. On average, switching to DTG increased viral suppression by 6 percentage points in our adjusted models (95% CI 0.00, 0.13, <jats:italic>p<\/jats:italic> = 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was no significant association between adherence levels and viral suppression among PLWH taking DTG regimens, suggesting a high degree of forgiveness for missed doses. The use of DTG should be prioritized over older regimens, particularly for those with low adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Number<\/jats:title><jats:p>NCT03494777.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26350","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T04:19:46Z","timestamp":1724041186000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The association between adherence to antiretroviral therapy and viral suppression under dolutegravir\u2010based regimens: an observational cohort study from Uganda"],"prefix":"10.1002","volume":"27","author":[{"given":"Zachary","family":"Wagner","sequence":"first","affiliation":[{"name":"Center for Economic and Social Research University of Southern California  Los Angeles California USA"},{"name":"Department of Economics Sociology and Statistics RAND Corporation  Santa Monica California 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Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E.","family":"Haberer","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6945-5279","authenticated-orcid":false,"given":"Sebastian","family":"Linnemayr","sequence":"additional","affiliation":[{"name":"Department of Economics Sociology and Statistics RAND Corporation  Santa Monica California USA"},{"name":"Pardee RAND Graduate School  Santa Monica California 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