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We compared DTG uptake of people with HIV (PWH) by sex in Latin America and the Caribbean (LAC) and its potential impact on virologic outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated DTG initiation among antiretroviral therapy (ART)\u2010na\u00efve and \u2010experienced cisgender PWH \u226516 years of age after DTG availability in Brazil (February\/2017), Chile (August\/2019), Haiti (November\/2018) and Honduras (December\/2018). Time was divided into pre\u2010 (before May\/2018), during\u2010 (May\/2018\u2212July\/2019) and post\u2010 (after July\/2019) warning periods. We examined interactions of sex, age and calendar era with multivariable modified Poisson regression models and Cox proportional hazard models for the outcomes of DTG initiation among ART\u2010na\u00efve and ART\u2010experienced PWH, respectively, and HIV RNA &lt;50 copies\/ml in the first year of therapy among ART\u2010na\u00efve PWH, adjusting for site and tuberculosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 4622 ART\u2010na\u00efve PWH, 3853 (83%) initiated DTG. ART\u2010na\u00efve females aged 16\u201349 years were less likely to initiate DTG compared to males of the same age both in the pre\/during\u2010warning (adjusted prevalence ratio [aPR]: 0.75 [95% confidence interval (95% CI): 0.71\u22120.80]) and in the post\u2010warning periods (aPR: 0.97 [95% CI: 0.95\u22121.00]). Among 16,154 ART\u2010experienced PWH, 9236 (57%) initiated DTG. ART\u2010experienced females 16\u201349 years were less likely to initiate DTG compared to males of the same age in the pre\/during\u2010warning (adjusted hazard ratio [aHR]: 0.69 [95% CI: 0.66\u22120.73]) and post\u2010warning periods (aHR: 0.79 [95% CI: 0.70\u22120.90]). This sex difference was not observed among older ART\u2010experienced females and males pre\/during\u2010warning (aHR: 1.06 [95% CI: 0.99\u22121.14]). Compared to starting ART without DTG, DTG\u2010based ART use was associated with a higher likelihood of HIV RNA suppression in the first year (aPR = 1.10 [95% CI: 1.04\u22121.16]). In the post\u2010warning period, females aged 16\u201349 years had a likelihood of viral suppression similar to males of the same age (aPR: 1.03 [95% CI: 0.96\u22121.10]), which did not change after adjusting for DTG use (aPR: 1.03 [95% CI: 0.97\u22121.11]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the updated guidelines recommending DTG for all PWH, there are persistent sex disparities in the access to DTG in LAC, especially among females within the reproductive age.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26470","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T06:58:02Z","timestamp":1752130682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Persistent sex disparities in access to dolutegravir\u2010based antiretroviral therapy in Latin America and the Caribbean: results from a retrospective observational study using data from 2017 to 2022"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5403-181X","authenticated-orcid":false,"given":"Fernanda F.","family":"Fonseca","sequence":"first","affiliation":[{"name":"AIDS Health Care Foundation, Global Program Sao Paulo Brazil"},{"name":"Fiocruz, Instituto Nacional de Infectologia Evandro Chagas Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paridhi","family":"Ranadive","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan E.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia G. 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