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Government"},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15\u201349 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%\u201358.8%) to 90.3% (2022, 95% CI, 89.2%\u201391.4%). By 2020 84.4% (95% CI, 83.7%\u201385.2%) and 64.6% (95% CI, 63.9%\u201365.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate\/high resistance decreased from 51.1% (95% CI, 40.7%\u201364.2%, 2014) to 27.9% (95% CI, 21.3%\u201336.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate\/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23\/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI\/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93\u20131.39; 1.14, 0.86\u20131.42).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Viral suppression increased during the DTG transition with minimal emerging intermediate\/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag161","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T12:48:02Z","timestamp":1772887682000},"page":"e1242-e1251","source":"Crossref","is-referenced-by-count":2,"title":["Patterns of HIV-1 Viral Load Suppression and Drug Resistance During the Dolutegravir Transition: A Population-based Longitudinal Study"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9689-4066","authenticated-orcid":false,"given":"Michael A","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Pathology, Johns Hopkins School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland 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,","place":["Uganda"]},{"name":"Division of Infectious Disease, Department of Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6119-9293","authenticated-orcid":false,"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Kalisizo ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0404-1315","authenticated-orcid":false,"given":"Thomas C","family":"Quinn","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Kalisizo ,","place":["Uganda"]},{"name":"Division of Infectious Disease, Department of Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Kalisizo ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ssekubugu","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Kalisizo ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9751-1808","authenticated-orcid":false,"given":"Ravindra K","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge , Cambridge ,","place":["United Kingdom"]},{"name":"Africa Health Research Institute , KwaZulu-Natal ,","place":["South 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Johns Hopkins School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-4592","authenticated-orcid":false,"given":"Sikhulile","family":"Moyo","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Gaborone ,","place":["Botswana"]},{"name":"Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts ,","place":["USA"]},{"name":"Stellenbosch University Department of Pathology, Division of Medical Virology, Faculty of Medicine and Health Sciences, , Cape Town ,","place":["South Africa"]},{"name":"School of Health Systems and Public Health, University of Pretoria , Pretoria ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-063X","authenticated-orcid":false,"given":"Caitlin E","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-0550","authenticated-orcid":false,"given":"David","family":"Bonsall","sequence":"additional","affiliation":[{"name":"Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3702-5722","authenticated-orcid":false,"given":"Ronald Moses","family":"Galiwango","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program , Kalisizo ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4451-3436","authenticated-orcid":false,"given":"M Kate","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Department of Pathology, Johns Hopkins School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]},{"name":"Rakai Health Sciences Program , Kalisizo 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first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis","volume":"18","author":"Gupta","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2026070722325936600_ciag161-B4","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/hiv.13189","article-title":"Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: a prospective cohort study in Lesotho (DO-REAL study)","volume":"23","author":"Brown","year":"2022","journal-title":"HIV Med"},{"key":"2026070722325936600_ciag161-B5","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.1016\/S2352-3018(22)00136-9","article-title":"Viral suppression and HIV-1 drug resistance 1 year after pragmatic transitioning to dolutegravir first-line therapy in Malawi: a prospective cohort study","volume":"9","author":"Schramm","year":"2022","journal-title":"Lancet 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