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South Africa introduced dolutegravir (DTG)\u2010based antiretroviral therapy (ART) in 2019. We sought to generate updated estimates of viral suppression in South African adults on ART and investigate predictors of viral non\u2010suppression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study used data from seven South African cohorts participating in the International epidemiology Databases to Evaluate AIDS collaboration. Three main analyses were performed using a viral suppression threshold of 1000 HIV RNA copies\/ml. In the first analysis, we fitted a logistic regression model using the full data from the study period (2005\u22122023). Then, in two causal analyses, we used logistic regression with inverse probability weighting to assess the effects of starting ART on DTG\u2010based regimens (as opposed to starting on non\u2010DTG\u2010based ART) and switching to DTG while virally suppressed (compared to remaining on non\u2010DTG\u2010based ART). In sensitivity analyses, we reduced the suppression threshold to 400 copies\/ml and excluded those with missing baseline CD4+ cell count measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 380,720 participants contributing 2,090,912 person\u2010years of observation. Most participants were female (64.7%), and the median age at ART initiation was 35.0 years (interquartile range 28.9\u221242.3). Viral suppression increased over time, reaching 95.9% in 2023. Twenty\u2010one percent of participants either started ART on DTG\u2010based regimens (7.1%) or switched to DTG\u2010based regimens from a virally suppressed state (14.0%). DTG\u2010based ART was protective against viral non\u2010suppression in both causal models, with adjusted odds ratios of 0.54 (95% confidence interval [CI] 0.48\u22120.61) and 0.36 (95% CI 0.32\u22120.39) for those initiating ART on DTG and those switching to DTG, respectively. A history of ART interruption was strongly associated with viral non\u2010suppression, with adjusted odds ratios ranging from 2.49 to 4.55. The odds of non\u2010suppression decreased with increasing age, increasing duration on ART and increasing baseline CD4+ cell count. Results were consistent across sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DTG\u2010based regimens improve viral suppression among both ART\u2010na\u00efve individuals and those transitioning while suppressed. ART interruptions pose a risk to the sustained success of ART programmes and may further impede efforts to recover from the impacts of recent funding cuts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70076","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T07:51:36Z","timestamp":1768895496000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimates and predictors of HIV viral non\u2010suppression in South African adults on antiretroviral treatment"],"prefix":"10.1002","volume":"29","author":[{"given":"Haroon","family":"Moolla","sequence":"first","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research School of Public Health University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reshma","family":"Kassanjee","sequence":"additional","affiliation":[{"name":"Centre for Integrated 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