{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:50:42Z","timestamp":1776106242885,"version":"3.50.1"},"reference-count":142,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The elimination of mother-to-child transmission of human immunodeficiency virus (HIV) is a key global public health priority. In Africa, virologic failure among people living with HIV continues to pose a significant public health challenge, affecting both individual well-being and community health. Maintaining viral load suppression is crucial to prevent vertical transmission of HIV and to minimize maternal morbidity and mortality. To stop the vertical transmission of HIV and lower the risk of maternal morbidity and mortality, it is important to achieve viral load suppression. Although many African countries have adopted the global 95-95-95 targets, comprehensive data on virologic suppression among pregnant and lactating mothers across the continent remains limited. The objective of this systematic review and meta-analysis was to determine the pooled estimate of virologic suppression and to examine the factors associated with it among HIV-positive pregnant and lactating women on antiretroviral therapy in Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251186121). We carried out a thorough systematic review by examining PubMed, ScienceDirect, Hinari, and Google Scholar for relevant studies. Data from the studies were retrieved using an Excel sheet and analyzed with STATA version 17. The Joanna Briggs Institute appraisal tool was used to evaluate the methodological quality of studies. A random-effects model with restricted maximum likelihood (REML) was applied to determine the pooled prevalence of virologic suppression (viral load threshold \u22641000 copies\/ml) among pregnant and lactating mothers in Africa. A funnel plot and the Egger\u2019s test were used to investigate publication bias. Statistical heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0statistic and Cochrane\u2019s Q test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 55 eligible studies, comprising 304,883 participants, were included in the quantitative meta-analysis. Accordingly, the overall prevalence of virologic suppression among HIV-positive pregnant and breastfeeding women in Africa was 80.86% (95% CI: 77.63%, 84.09%, I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999.84%). In contrast, the pooled estimate for achieving an undetectable viral load was substantially lower, at 60.92% (95% CI: 52.46%, 69.39%; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999.91%). Virologic suppression was significantly associated with women\u2019s age (15\u201324 years) (AOR\u2009=\u20090.49; 95% CI: 0.32\u20130.77), disclosure of HIV status to a partner (AOR\u2009=\u20091.66; 95% CI: 1.31\u20132.11), first-line antiretroviral therapy regimen (AOR\u2009=\u20096.53; 95% CI: 1.93\u201322.06), and good antiretroviral drug adherence (AOR\u2009=\u20093.61; 95% CI: 1.18\u201311.02). In addition, other socio-demographic variables, higher educational level, being married\/cohabitant, urban residency, healthcare utilization (time of ANC booking, time of ART initiation, duration of ART), fear of stigma, distance to health facility, shortage of health professionals, ART drug stock-out, and lack of HIV care commodities were significantly associated with virologic suppression among HIV-positive pregnant and lactating women in Africa.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The pooled estimate of virologic suppression among HIV-positive pregnant and breastfeeding women in Africa was approximately 81%, below the global target of 95% virological suppression. This emphasizes the necessity of targeted strategies for younger HIV-positive women, disclosing HIV status, initiating first-line antiretroviral regimens, and promoting antiretroviral treatment adherence. Upgrading health care systems to enable regular viral load monitoring, as well as addressing socio-demographic and antiretroviral therapy-related variables, are vital steps towards attaining and sustaining VS in these groups of population, ultimately assisting in achieving elimination of MTCT of HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346045","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T17:26:07Z","timestamp":1776101167000},"page":"e0346045","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-6164","authenticated-orcid":true,"given":"Berihun Agegn","family":"Mengistie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Getie Mihret","family":"Aragaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gebrye Gizaw","family":"Mulatu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2769-0385","authenticated-orcid":true,"given":"Kindu Yinges","family":"Wondie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alemneh Tadesse","family":"Kassie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7504-4102","authenticated-orcid":true,"given":"Alemken Eyayu","family":"Abuhay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wondimnew Mersha","family":"Biset","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moges Tesfa","family":"Tsega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abay Eyayu","family":"Asrie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tazeb Alemu","family":"Anteneh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habtu Kifle","family":"Negash","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eshet","family":"Gebrie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuhamin Tesfa","family":"Tsega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"pone.0346045.ref001","unstructured":"World Health Organization (WHO). HIV statistics, globally and by WHO region. 2025. https:\/\/cdn.who.int\/media\/docs\/default-source\/hq-hiv-hepatitis-and-stis-library\/who-ias-hiv-statistics_2025-new.pdf"},{"key":"pone.0346045.ref002","unstructured":"United Nations Programme on HIV\/AIDS UNAIDS. Global HIV & AIDS statistics \u2014 Fact sheet. 2025. https:\/\/www.unaids.org\/en\/resources\/fact-sheet"},{"key":"pone.0346045.ref003","unstructured":"United Nations Programme on HIV\/AIDS UNAIDS. Fact sheet 2024 - Latest global and regional HIV statistics on the status of the AIDS epidemic. 2024."},{"issue":"1","key":"pone.0346045.ref004","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1186\/s12887-024-05061-x","article-title":"Incidence of mother-to-child transmission of HIV and predictors of positivity among HIV exposed infants in South Gondar public hospitals, Northwest Ethiopia: competing risk regression model","volume":"24","author":"BA Tilaye","year":"2024","journal-title":"BMC Pediatr"},{"issue":"8","key":"pone.0346045.ref005","article-title":"Accelerating progress towards the elimination of mother-to-child transmission of HIV: a narrative review","volume":"23","author":"BH Chi","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"pone.0346045.ref006","unstructured":"World Health Organization WHO. Mother-to-child transmission of HIV. 2024. https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/prevention\/mother-to-child-transmission-of-hiv"},{"issue":"1","key":"pone.0346045.ref007","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1186\/s12889-018-5651-y","article-title":"Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review","volume":"18","author":"O Omonaiye","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0346045.ref008","unstructured":"World Health Organization (WHO). Progress report 2016: prevent HIV, test and treat all: WHO support for country impact. 2016."},{"issue":"3","key":"pone.0346045.ref009","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1071\/SH23048","article-title":"Role of viral suppression in HIV treatment and prevention and its potential in addressing harmful laws and discrimination","volume":"20","author":"A Seale","year":"2023","journal-title":"Sex Health"},{"key":"pone.0346045.ref010","volume-title":"The role of HIV viral suppression in improving individual health and reducing transmission: policy brief","author":"World Health Organization (WHO)","year":"2023"},{"key":"pone.0346045.ref011","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.ejogrb.2020.11.034","article-title":"HIV in pregnancy - An update","volume":"256","author":"VN Chilaka","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"pone.0346045.ref012","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12981-022-00480-1","article-title":"Viral load testing among pregnant women living with HIV in Mutare district of Manicaland province, Zimbabwe","volume":"19","author":"CCC Musanhu","year":"2022","journal-title":"AIDS Res Ther"},{"key":"pone.0346045.ref013","volume-title":"Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring","author":"World Health Organization (WHO)","year":"2021"},{"key":"pone.0346045.ref014","volume-title":"Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring","author":"World Health Organization (WHO)","year":"2022"},{"key":"pone.0346045.ref015","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"World Health Organization (WHO)","year":"2016"},{"issue":"4","key":"pone.0346045.ref016","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/QAD.0000000000003459","article-title":"Prevalence and risk factors of unsuppressed viral load among pregnant and breastfeeding women in sub-Saharan Africa: analysis from population-based surveys","volume":"37","author":"LA Schrubbe","year":"2023","journal-title":"AIDS"},{"issue":"1","key":"pone.0346045.ref017","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12985-025-02659-0","article-title":"Human Immunodeficiency Virus (HIV) viral load suppression status and associated factors among pregnant women receiving Highly Active Antiretroviral Therapy (HAART) in Ethiopia","volume":"22","author":"G Hailu","year":"2025","journal-title":"Virol J"},{"key":"pone.0346045.ref018","doi-asserted-by":"crossref","first-page":"1544165","DOI":"10.3389\/fpubh.2025.1544165","article-title":"Factors associated with viral load suppression in pregnant and postpartum women living with HIV in Rwanda: an open-observational cohort study","volume":"13","author":"A Munyaneza","year":"2025","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0346045.ref019","article-title":"Prevention of mother-to-child transmission of HIV (PMTCT) in sub-Saharan Africa: past and present perspectives","volume":"11","author":"O Elijah","year":"2025","journal-title":"International Journal of Forensic Medical Investigation"},{"key":"pone.0346045.ref020","article-title":"Implementation of lifelong ART (Option B) for Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Uganda","author":"AD Mukose","year":"2024","journal-title":"University of Antwerp"},{"key":"pone.0346045.ref021","volume-title":"Introducing a framework for implementing triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus: policy brief","author":"World Health Organization WHO","year":"2024"},{"issue":"2","key":"pone.0346045.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0263921","article-title":"Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria","volume":"17","author":"B Adelekan","year":"2022","journal-title":"PLoS One"},{"key":"pone.0346045.ref023","article-title":"British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018","author":"DY Gilleece","year":"2019","journal-title":"HIV Med"},{"issue":"1","key":"pone.0346045.ref024","doi-asserted-by":"crossref","first-page":"12174","DOI":"10.1038\/s41598-020-68806-5","article-title":"HIV-1 and HIV-2 prevalence, risk factors and birth outcomes among pregnant women in Bissau, Guinea-Bissau: a retrospective cross-sectional hospital study","volume":"10","author":"DN Rasmussen","year":"2020","journal-title":"Sci Rep"},{"key":"pone.0346045.ref025","volume-title":"Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV","author":"World Health Organization WHO","year":"2018"},{"issue":"1","key":"pone.0346045.ref026","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/QAI.0b013e3181cf9979","article-title":"Effects of highly active antiretroviral therapy duration and regimen on risk for mother-to-child transmission of HIV in Johannesburg, South Africa","volume":"54","author":"RM Hoffman","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"7","key":"pone.0346045.ref027","article-title":"Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa","volume":"16","author":"MP Fox","year":"2019","journal-title":"PLoS Med"},{"issue":"4","key":"pone.0346045.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195033","article-title":"Optimizing prevention of HIV mother to child transmission: Duration of antiretroviral therapy and viral suppression at delivery among pregnant Malawian women","volume":"13","author":"MB Chagomerana","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0346045.ref029","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/jrh.12312","article-title":"The Impact of Delivery in a Rural County on a Cohort of Women Living with HIV Infection and Their Infants","volume":"35","author":"GB Lazenby","year":"2019","journal-title":"J Rural Health"},{"issue":"3","key":"pone.0346045.ref030","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s44197-023-00097-1","article-title":"Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review","volume":"13","author":"SA Awaidy","year":"2023","journal-title":"J Epidemiol Glob Health"},{"key":"pone.0346045.ref031","author":"G Mwende Wairimu","journal-title":"The Global Burden of HIV and Progress toward the 2030 UNAIDS Targets: A Comprehensive Review"},{"issue":"8","key":"pone.0346045.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0272405","article-title":"Achieving the 95 95 95 targets for all: a pathway to ending AIDS","volume":"17","author":"L Frescura","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0346045.ref033","doi-asserted-by":"crossref","DOI":"10.1002\/rmv.2540","article-title":"Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis","volume":"34","author":"IH Mosha","year":"2024","journal-title":"Rev Med Virol"},{"issue":"10","key":"pone.0346045.ref034","doi-asserted-by":"crossref","first-page":"3327","DOI":"10.1007\/s10461-022-03610-y","article-title":"Burden and Associated Factors of Virological Failure Among People Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis","volume":"26","author":"CD Agegnehu","year":"2022","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0346045.ref035","doi-asserted-by":"crossref","first-page":"2490774","DOI":"10.1080\/25787489.2025.2490774","article-title":"Prevalence and predictors of virological failure among the people living with HIV on antiretroviral treatment in East Africa: evidence from a systematic review with meta-analysis and meta-regression of published studies from 2016 to 2023","volume":"26","author":"MM Namaganda","year":"2025","journal-title":"HIV Res Clin Pract"},{"issue":"4","key":"pone.0346045.ref036","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae168","article-title":"Virological Suppression and its Predictors Among HIV\/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis","volume":"11","author":"D Melak","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"3","key":"pone.0346045.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4314\/ahs.v24i3.2","article-title":"Burden of virologic failure, and its determinants among HIV positive children in East Africa: a systematic review and meta-analysis","volume":"24","author":"BC Temere","year":"2024","journal-title":"Afr Health Sci"},{"key":"pone.0346045.ref038","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S2055-6640(20)30343-5","article-title":"Achieving UNAIDS 90-90-90 targets for pregnant and postpartum women in sub-Saharan Africa: progress, gaps and research needs","volume":"4","author":"LL Abuogi","year":"2018","journal-title":"J Virus Erad"},{"key":"pone.0346045.ref039","article-title":"HIV viral non-suppression and its associated factors among PMTCT mothers receiving ARV treatment in Ethiopia","volume":"2024","author":"B Woldesemayat","year":"2024","journal-title":"medRxiv"},{"issue":"1","key":"pone.0346045.ref040","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1186\/s12879-021-06608-4","article-title":"Prevalence of undetectable and suppressed viral load in HIV-infected pregnant women initiating Option B+\u2009in Uganda: an observational study nested within a randomized controlled trial","volume":"21","author":"G Gabagaya","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0346045.ref041","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s12879-017-2428-3","article-title":"Factors Associated with Virological Non-suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015","volume":"17","author":"L Bulage","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"10","key":"pone.0346045.ref042","doi-asserted-by":"crossref","first-page":"3327","DOI":"10.1007\/s10461-022-03610-y","article-title":"Burden and Associated Factors of Virological Failure Among People Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis","volume":"26","author":"CD Agegnehu","year":"2022","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0346045.ref043","doi-asserted-by":"crossref","DOI":"10.1186\/s12982-025-00386-z","article-title":"Enhanced adherence counselling completion rates, viral load suppression in people with HIV in Africa: systematic review and meta-analysis","volume":"22","author":"HM Bakari","year":"2025","journal-title":"Discov Public Health"},{"issue":"4","key":"pone.0346045.ref044","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/QAD.0000000000002457","article-title":"Viral suppression and factors associated with failure to achieve viral suppression among pregnant women in South Africa","volume":"34","author":"SA Woldesenbet","year":"2020","journal-title":"AIDS"},{"key":"pone.0346045.ref045","doi-asserted-by":"crossref","first-page":"1609743","DOI":"10.3389\/fpubh.2025.1609743","article-title":"Barriers to ART adherence in sub-Saharan Africa: a scoping review toward achieving UNAIDS 95-95-95 targets","volume":"13","author":"J Magura","year":"2025","journal-title":"Front Public Health"},{"key":"pone.0346045.ref046","doi-asserted-by":"crossref","first-page":"1658229","DOI":"10.3389\/fpubh.2025.1658229","article-title":"HIV response financing challenges in Sub-Saharan Africa: barriers to achieving the 95-95-95 UNAIDS targets","volume":"13","author":"BW Kulohoma","year":"2025","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0346045.ref047","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12981-025-00792-y","article-title":"At a crossroads: confronting setbacks and advancing the 95-95-95 HIV targets in sub-Saharan Africa","volume":"22","author":"O Mukuku","year":"2025","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pone.0346045.ref048","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12981-021-00395-3","article-title":"Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis","volume":"18","author":"BM Kadia","year":"2021","journal-title":"AIDS Res Ther"},{"key":"pone.0346045.ref049","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"key":"pone.0346045.ref050","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"World Health Organization (WHO)","year":"2021"},{"issue":"2","key":"pone.0346045.ref051","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/QAD.0000000000002733","article-title":"Achieving maternal viral load suppression for elimination of mother-to-child transmission of HIV in South Africa","volume":"35","author":"F Moyo","year":"2021","journal-title":"AIDS"},{"issue":"3","key":"pone.0346045.ref052","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/XEB.0000000000000054","article-title":"Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data","volume":"13","author":"Z Munn","year":"2015","journal-title":"Int J Evid Based Healthc"},{"issue":"3","key":"pone.0346045.ref053","doi-asserted-by":"crossref","first-page":"441","DOI":"10.11124\/JBIES-24-00103","article-title":"The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies","volume":"23","author":"TH Barker","year":"2025","journal-title":"JBI Evid Synth"},{"issue":"2","key":"pone.0346045.ref054","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/1082-989X.11.2.193","article-title":"Assessing heterogeneity in meta-analysis: Q statistic or I\u00b2 index?","volume":"11","author":"TB Huedo-Medina","year":"2006","journal-title":"Psychological Methods"},{"issue":"1","key":"pone.0346045.ref055","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1002\/jrsm.1316","article-title":"A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses","volume":"10","author":"D Langan","year":"2019","journal-title":"Res Synth Methods"},{"issue":"3","key":"pone.0346045.ref056","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1037\/met0000241","article-title":"Evaluation of heterogeneity and heterogeneity interval estimators in random-effects meta-analysis of the standardized mean difference in education and psychology","volume":"25","author":"P Boedeker","year":"2020","journal-title":"Psychol Methods"},{"issue":"4","key":"pone.0346045.ref057","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"CB Begg","year":"1994","journal-title":"Biometrics"},{"issue":"1","key":"pone.0346045.ref058","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s12978-022-01419-5","article-title":"Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: a cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control","volume":"19","author":"NP Ntombela","year":"2022","journal-title":"Reprod Health"},{"issue":"3","key":"pone.0346045.ref059","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-058347","article-title":"HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey","volume":"12","author":"NK Ngandu","year":"2022","journal-title":"BMJ Open"},{"issue":"10","key":"pone.0346045.ref060","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/cid\/ciab206","article-title":"Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis","volume":"73","author":"OV Adeniyi","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0346045.ref061","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/tmi.13001","article-title":"Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010-2015","volume":"23","author":"T Chetty","year":"2018","journal-title":"Tropical Medicine & International Health"},{"key":"pone.0346045.ref062","article-title":"Linkage to care, mobility and retention of HIV-positive postpartum women in antiretroviral therapy services in South Africa","author":"TK Phillips","year":"2018","journal-title":"J Int AIDS Soc"},{"issue":"7","key":"pone.0346045.ref063","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271564","article-title":"Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa: Results from the 2017 and 2019 national Antenatal HIV Sentinel Surveys","volume":"17","author":"S Woldesenbet","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0346045.ref064","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0265124","article-title":"Association between viral suppression during the third trimester of pregnancy and unintended pregnancy among women on antiretroviral therapy: Results from the 2019 antenatal HIV Sentinel Survey, South Africa","volume":"17","author":"S Woldesenbet","year":"2022","journal-title":"PLoS One"},{"issue":"4","key":"pone.0346045.ref065","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/cid\/ciw792","article-title":"Frequency of Viremic Episodes in HIV-Infected Women Initiating Antiretroviral Therapy During Pregnancy: A Cohort Study","volume":"64","author":"L Myer","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0346045.ref066","doi-asserted-by":"crossref","first-page":"20045","DOI":"10.7448\/IAS.18.1.20045","article-title":"Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa","volume":"18","author":"L Myer","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"12","key":"pone.0346045.ref067","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1080\/09540121.2018.1503637","article-title":"Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa","volume":"30","author":"K Brittain","year":"2018","journal-title":"AIDS Care"},{"issue":"4","key":"pone.0346045.ref068","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/QAI.0000000000002267","article-title":"Characterizing Viral Load Burden Among HIV-Infected Women Around the Time of Delivery: Findings From Four Tertiary Obstetric Units in Gauteng, South Africa","volume":"83","author":"F Moyo","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"2","key":"pone.0346045.ref069","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/hiv.12397","article-title":"HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa","volume":"18","author":"L Myer","year":"2017","journal-title":"HIV Med"},{"issue":"6","key":"pone.0346045.ref070","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25133","article-title":"Same-day antiretroviral therapy (ART) initiation in pregnancy is not associated with viral suppression or engagement in care: A cohort study","volume":"21","author":"N Langwenya","year":"2018","journal-title":"J Int AIDS Soc"},{"issue":"3","key":"pone.0346045.ref071","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26235","article-title":"Factors associated with vertical transmission of HIV in the Western Cape, South Africa: a retrospective cohort analysis","volume":"27","author":"K Anderson","year":"2024","journal-title":"J Int AIDS Soc"},{"key":"pone.0346045.ref072","article-title":"HIV viral load monitoring in HIV-infected pregnant women established on antiretroviral therapy in Cape Town, South Africa","author":"PR Tsondai","year":"2016","journal-title":"University of Cape Town"},{"issue":"3","key":"pone.0346045.ref073","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248559","article-title":"Early post-partum viremia predicts long-term non-suppression of viral load in HIV-positive women on ART in Malawi: Implications for the elimination of infant transmission","volume":"16","author":"M Landes","year":"2021","journal-title":"PLoS One"},{"issue":"12","key":"pone.0346045.ref074","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0209052","article-title":"Prevalence of antiretroviral therapy treatment failure among HIV-infected pregnant women at first antenatal care: PMTCT Option B+ in Malawi","volume":"13","author":"MB Chagomerana","year":"2018","journal-title":"PLoS One"},{"issue":"6","key":"pone.0346045.ref075","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25290","article-title":"Low detectable postpartum viral load is associated with HIV transmission in Malawi\u2019s prevention of mother-to-child transmission programme","volume":"22","author":"M Landes","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"2","key":"pone.0346045.ref076","doi-asserted-by":"crossref","first-page":"232","DOI":"10.21106\/ijma.374","article-title":"Detectable HIV-RNA Viral Load Among HIV-Infected Pregnant Women on Treatment in Northern Uganda","volume":"9","author":"A Napyo","year":"2020","journal-title":"Int J MCH AIDS"},{"key":"pone.0346045.ref077","doi-asserted-by":"crossref","first-page":"1544165","DOI":"10.3389\/fpubh.2025.1544165","article-title":"Factors associated with viral load suppression in pregnant and postpartum women living with HIV in Rwanda: an open-observational cohort study","volume":"13","author":"A Munyaneza","year":"2025","journal-title":"Front Public Health"},{"issue":"12","key":"pone.0346045.ref078","article-title":"Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study","volume":"11","author":"MM Gill","year":"2016","journal-title":"PLoS One"},{"issue":"3","key":"pone.0346045.ref079","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/QAI.0000000000001228","article-title":"Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda","volume":"74","author":"CA Koss","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"11","key":"pone.0346045.ref080","doi-asserted-by":"crossref","first-page":"3494","DOI":"10.1007\/s10461-022-03666-w","article-title":"Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya","volume":"26","author":"JM Humphrey","year":"2022","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0346045.ref081","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232358","article-title":"Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals","volume":"15","author":"M Sandbulte","year":"2020","journal-title":"PLoS One"},{"key":"pone.0346045.ref082","doi-asserted-by":"crossref","first-page":"1308019","DOI":"10.3389\/fgwh.2024.1308019","article-title":"Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study","volume":"5","author":"A Boisson-Walsh","year":"2024","journal-title":"Front Glob Womens Health"},{"issue":"9","key":"pone.0346045.ref083","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25376","article-title":"HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI-PMTCT study","volume":"22","author":"M Yotebieng","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0346045.ref084","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12985-025-02659-0","article-title":"Human Immunodeficiency Virus (HIV) viral load suppression status and associated factors among pregnant women receiving Highly Active Antiretroviral Therapy (HAART) in Ethiopia","volume":"22","author":"G Hailu","year":"2025","journal-title":"Virol J"},{"key":"pone.0346045.ref085","first-page":"127","article-title":"Evaluation of Antiretroviral Therapy Initiated Among Pregnant Women Under Option B+ by Viral Load and CD4 Count Outcomes in Selected Hospitals of West Shewa Zone, Oromia Region, Ethiopia","volume":"12","author":"DB Demissie","year":"2020","journal-title":"HIV AIDS (Auckl)"},{"key":"pone.0346045.ref086","first-page":"209","article-title":"Virological Outcomes Among Pregnant Women Receiving Antiretroviral Treatment in the Amhara Region, North West Ethiopia","volume":"15","author":"D Endalamaw Alamneh","year":"2023","journal-title":"HIV AIDS (Auckl)"},{"issue":"2","key":"pone.0346045.ref087","doi-asserted-by":"crossref","first-page":"65","DOI":"10.7196\/sajog.1611","article-title":"Medication adherence in HIV-positive pregnant women on antiretroviral therapy attending antenatal clinics in Ado metropolis, south-west Nigeria: A multicentre study","volume":"26","author":"OP Aduloju","year":"2020","journal-title":"S Afr J OG"},{"issue":"1","key":"pone.0346045.ref088","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12981-022-00480-1","article-title":"Viral load testing among pregnant women living with HIV in Mutare district of Manicaland province, Zimbabwe","volume":"19","author":"CCC Musanhu","year":"2022","journal-title":"AIDS Res Ther"},{"key":"pone.0346045.ref089","article-title":"Predictors and Timing to Viral Suppression in HIV-Infected Pregnant Women in the University of Zimbabwe Birth Cohort Study During the Era of Lifelong Antiretroviral Therapy (Option B+ Treatment Strategy)","volume":"2","author":"K Duri","year":"2022","journal-title":"FrontVirol"},{"issue":"1","key":"pone.0346045.ref090","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s12884-018-2058-9","article-title":"Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B","volume":"18","author":"PN Atanga","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"issue":"11","key":"pone.0346045.ref091","article-title":"Evaluation of plasma viral-load monitoring and the prevention of mother-to-child transmission of HIV-1 in three health facilities of the Littoral region of Cameroon","volume":"17","author":"EVF Kafack","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pone.0346045.ref092","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s12884-024-06435-w","article-title":"Epidemiological and virological surveillance of the prevention of mother-to-child transmission of HIV among pregnant women in Togo","volume":"24","author":"K Tegueni","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"pone.0346045.ref093","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/QAI.0000000000002744","article-title":"Association of Maternal Viral Load and CD4 Count With Perinatal HIV-1 Transmission Risk During Breastfeeding in the PROMISE Postpartum Component","volume":"88","author":"PM Flynn","year":"2021","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0346045.ref094","doi-asserted-by":"crossref","first-page":"44","DOI":"10.24248\/EASci-D-20-00009","article-title":"Detectable viral load among HIV -1 positive pregnant women on ART (Option B +) in northern Tanzania: Baseline results from the HIVDR study","volume":"3","author":"NS Mazuguni","year":"2021","journal-title":"EASci"},{"issue":"9","key":"pone.0346045.ref095","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25376","article-title":"HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI-PMTCT study","volume":"22","author":"M Yotebieng","year":"2019","journal-title":"J Int AIDS Soc"},{"issue":"10","key":"pone.0346045.ref096","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/cid\/ciab206","article-title":"Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis","volume":"73","author":"OV Adeniyi","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pone.0346045.ref097","doi-asserted-by":"crossref","first-page":"1308019","DOI":"10.3389\/fgwh.2024.1308019","article-title":"Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study","volume":"5","author":"A Boisson-Walsh","year":"2024","journal-title":"Front Glob Womens Health"},{"key":"pone.0346045.ref098","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2147\/HIV.S389506","article-title":"Virological outcomes among pregnant women receiving antiretroviral treatment in the Amhara Region, North West Ethiopia","author":"ED Alamneh","year":"2023","journal-title":"HIV\/AIDS-Research and Palliative Care"},{"issue":"3","key":"pone.0346045.ref099","article-title":"A multicomponent, peer-led intervention for pregnant and postpartum women with HIV improves viral suppression over time in rural Uganda","volume":"1","author":"J Kabami","year":"2025","journal-title":"AJE Advances: Research in Epidemiology"},{"issue":"1","key":"pone.0346045.ref100","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s44155-024-00120-1","article-title":"\u201cI desire to have an HIV-free baby\u201d: pregnant and breastfeeding mothers\u2019 perceptions of Viral load testing and suppression in HIV care in southwestern Uganda","volume":"4","author":"J Kabami","year":"2024","journal-title":"Discov Soc Sci Health"},{"issue":"3","key":"pone.0346045.ref101","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/QAI.0000000000001228","article-title":"Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda","volume":"74","author":"CA Koss","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"8","key":"pone.0346045.ref102","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256249","article-title":"Food insecurity, drug resistance and non-disclosure are associated with virologic non-suppression among HIV pregnant women on antiretroviral treatment","volume":"16","author":"BH Chohan","year":"2021","journal-title":"PLoS One"},{"issue":"11","key":"pone.0346045.ref103","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-087569","article-title":"Virological failure and associated factors among patients receiving anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis","volume":"14","author":"TM Aytenew","year":"2024","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0346045.ref104","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0174767","article-title":"Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis","volume":"12","author":"F Taieb","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"pone.0346045.ref105","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae168","article-title":"Virological Suppression and its Predictors Among HIV\/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis","volume":"11","author":"D Melak","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"6","key":"pone.0346045.ref106","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: a unique complexity","volume":"63","author":"G Mor","year":"2010","journal-title":"Am J Reprod Immunol"},{"issue":"5","key":"pone.0346045.ref107","doi-asserted-by":"crossref","first-page":"556","DOI":"10.2174\/1381612825666190320162507","article-title":"Pharmacokinetics, Placental and Breast Milk Transfer of Antiretroviral Drugs in Pregnant and Lactating Women Living with HIV","volume":"25","author":"EM Hodel","year":"2019","journal-title":"Curr Pharm Des"},{"issue":"3","key":"pone.0346045.ref108","doi-asserted-by":"crossref","DOI":"10.1002\/rmv.2540","article-title":"Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis","volume":"34","author":"IH Mosha","year":"2024","journal-title":"Rev Med Virol"},{"key":"pone.0346045.ref109","article-title":"Adverse pregnancy outcomes, non-retention, eligibility of differentiated care and virologic failure among women living with HIV in prevention of vertical transmission programs","author":"W Jiang","year":"2023","journal-title":"University of Washington"},{"key":"pone.0346045.ref110","doi-asserted-by":"crossref","unstructured":"Ankunda C. Longitudinal analysis of viral suppression before, during, and after pregnancy among women on antiretroviral therapy in Uganda: six-year real-world evidence. 2025.","DOI":"10.21203\/rs.3.rs-6550065\/v1"},{"issue":"2","key":"pone.0346045.ref111","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0317850","article-title":"Gaps, challenges and opportunities towards achieving the 95-95-95 targets in Cameroon: A systematic review and meta-analysis protocol","volume":"20","author":"E Ngoufack Jagni Semengue","year":"2025","journal-title":"PLoS One"},{"key":"pone.0346045.ref112","doi-asserted-by":"crossref","first-page":"1701425","DOI":"10.3389\/fpubh.2025.1701425","article-title":"Challenges in reaching the UNAIDS 95-95-95 targets in sub-Saharan Africa: status, innovations and pathways forward","author":"O Mukuku","year":"2025","journal-title":"Frontiers in Public Health"},{"issue":"1","key":"pone.0346045.ref113","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1186\/s12879-022-07428-w","article-title":"HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast","volume":"22","author":"MK Nyongesa","year":"2022","journal-title":"BMC Infect Dis"},{"key":"pone.0346045.ref114","unstructured":"United Nations Programme on HIV\/AIDS UNAIDS. Young people and HIV. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/young-people-and-hiv_en.pdf"},{"issue":"5","key":"pone.0346045.ref115","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276411","article-title":"Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis","volume":"18","author":"LD Hlophe","year":"2023","journal-title":"PLoS One"},{"issue":"12","key":"pone.0346045.ref116","article-title":"Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries","volume":"8","author":"WM Han","year":"2021","journal-title":"Lancet HIV"},{"issue":"8","key":"pone.0346045.ref117","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(23)00118-2","article-title":"A multilevel health system intervention for virological suppression in adolescents and young adults living with HIV in rural Kenya and Uganda (SEARCH-Youth): a cluster randomised trial","volume":"10","author":"T Ruel","year":"2023","journal-title":"Lancet HIV"},{"key":"pone.0346045.ref118","article-title":"\u201cI was still very young\u201d: agency, stigma and HIV care strategies at school, baseline results of a qualitative study among youth in rural Kenya and Uganda","author":"J Johnson-Peretz","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"9903","key":"pone.0346045.ref119","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/S0140-6736(13)61809-7","article-title":"The end of AIDS: HIV infection as a chronic disease","volume":"382","author":"SG Deeks","year":"2013","journal-title":"Lancet"},{"issue":"5","key":"pone.0346045.ref120","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0285571","article-title":"The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis","volume":"18","author":"MM Mengesha","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"pone.0346045.ref121","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/QAD.0000000000000054","article-title":"High attrition before and after ART initiation among youth (15-24 years of age) enrolled in HIV care","volume":"28","author":"MR Lamb","year":"2014","journal-title":"AIDS"},{"issue":"1","key":"pone.0346045.ref122","doi-asserted-by":"crossref","first-page":"20683","DOI":"10.7448\/IAS.19.1.20683","article-title":"High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo","volume":"19","author":"M Salou","year":"2016","journal-title":"J Int AIDS Soc"},{"key":"pone.0346045.ref123","article-title":"Predictors and Timing to Viral Suppression in HIV-Infected Pregnant Women in the University of Zimbabwe Birth Cohort Study During the Era of Lifelong Antiretroviral Therapy (Option B+ Treatment Strategy)","volume":"2","author":"K Duri","year":"2022","journal-title":"FrontVirol"},{"issue":"1","key":"pone.0346045.ref124","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1186\/s12879-019-4148-3","article-title":"The effect of disclosure on adherence to antiretroviral therapy among adults living with HIV in Ethiopia: a systematic review and meta-analysis","volume":"19","author":"G Dessie","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pone.0346045.ref125","doi-asserted-by":"crossref","first-page":"17455065211063021","DOI":"10.1177\/17455065211063021","article-title":"Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review","volume":"17","author":"A Endalamaw","year":"2021","journal-title":"Womens Health (Lond)"},{"issue":"1","key":"pone.0346045.ref126","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1186\/s12889-019-8097-y","article-title":"Sero-positive HIV result disclosure to sexual partner in Ethiopia: a systematic review and meta-analysis","volume":"19","author":"FA Mekonnen","year":"2019","journal-title":"BMC Public Health"},{"issue":"10","key":"pone.0346045.ref127","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1111\/tmi.13473","article-title":"Association between HIV stigma and antiretroviral therapy adherence among adults living with HIV: baseline findings from the HPTN 071 (PopART) trial in Zambia and South Africa","volume":"25","author":"HS Jones","year":"2020","journal-title":"Trop Med Int Health"},{"issue":"2","key":"pone.0346045.ref128","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s10461-024-04534-5","article-title":"Impact of HIV-Related Stigma on Antiretroviral Therapy Adherence, Engagement and Retention in HIV Care, and Transition to Adult HIV Care in Pediatric and Young Adult Populations Living With HIV: A Literature Review","volume":"29","author":"T Perger","year":"2025","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0346045.ref129","doi-asserted-by":"crossref","first-page":"2447613","DOI":"10.1080\/22221751.2024.2447613","article-title":"The prevalence of low-level viraemia and its association with virological failure in people living with HIV: a systematic review and meta-analysis","volume":"14","author":"S Zhao","year":"2025","journal-title":"Emerg Microbes Infect"},{"key":"pone.0346045.ref130","article-title":"Factors associated with virological non-suppression in treatment-experienced HIV patients in Kenya: a populationwide study","author":"NK Kibui","year":"2024","journal-title":"University of Nairobi"},{"key":"pone.0346045.ref131","unstructured":"Ministry of Health E. National guideline for prevention of mother-to-child transmission of HIV, syphilis and hepatitis B virus. 2021. https:\/\/www.prepwatch.org\/wp-content\/uploads\/2022\/07\/National-Guideline-for-Prevention-of-Mother-to-child-Transmission-of-HIV-Syphilis-and-Hepatitis-B-Virus-2021.pdf"},{"issue":"1","key":"pone.0346045.ref132","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1186\/s12879-025-10858-x","article-title":"INSTIs-centered antiviral regimens for first-line treatment of HIV\/AIDS: a network meta-analysis and cost-effectiveness analysis","volume":"25","author":"J Yang","year":"2025","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0346045.ref133","doi-asserted-by":"crossref","first-page":"818","DOI":"10.3390\/pathogens14080818","article-title":"Maternal HIV Infection and Antiretroviral Therapy in Pregnancy: Implications for Vertical Transmission, Fetal Safety, and Long-Term Infant Outcomes","volume":"14","author":"T Fle\u0219eriu","year":"2025","journal-title":"Pathogens"},{"issue":"1","key":"pone.0346045.ref134","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s12889-023-17004-9","article-title":"Adherence to option B\u2009+\u2009antiretroviral therapy and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa: a systematic review and meta-analysis","volume":"24","author":"LC Fassinou","year":"2024","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0346045.ref135","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciac703","article-title":"Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery","volume":"76","author":"J Sibiude","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0346045.ref136","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2174\/187152611795589663","article-title":"HIV treatment adherence, drug resistance, virologic failure: evolving concepts","volume":"11","author":"JB Nachega","year":"2011","journal-title":"Infect Disord Drug Targets"},{"issue":"3","key":"pone.0346045.ref137","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/tmi.13854","article-title":"Virological failure and adherence to antiretroviral therapy in adolescents and young adults living with human immunodeficiency virus","volume":"28","author":"ACB Daltro","year":"2023","journal-title":"Trop Med Int Health"},{"issue":"1","key":"pone.0346045.ref138","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0191294","article-title":"Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV","volume":"13","author":"T Gils","year":"2018","journal-title":"PLoS One"},{"issue":"17","key":"pone.0346045.ref139","doi-asserted-by":"crossref","first-page":"6163","DOI":"10.3390\/ijerph17176163","article-title":"Promoting undetectable equals untransmittable in sub-saharan africa: Implication for clinical practice and art adherence","volume":"17","author":"NE Thomford","year":"2020","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"1","key":"pone.0346045.ref140","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12981-020-00283-2","article-title":"Habit formation in support of antiretroviral medication adherence in clinic-enrolled HIV-infected adults: a qualitative assessment using free-listing and unstructured interviewing in Kampala, Uganda","volume":"17","author":"L Jennings Mayo-Wilson","year":"2020","journal-title":"AIDS Res Ther"},{"issue":"10","key":"pone.0346045.ref141","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0108150","article-title":"A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women","volume":"9","author":"CJ Colvin","year":"2014","journal-title":"PLoS One"},{"issue":"2","key":"pone.0346045.ref142","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jana.2017.09.014","article-title":"The Effect of Antiretroviral Stock-Outs on Medication Adherence Among Patients Living With HIV in Ghana: A Qualitative Study","volume":"29","author":"K Moriarty","year":"2018","journal-title":"J Assoc Nurses AIDS Care"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T17:26:39Z","timestamp":1776101199000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346045"}},"subtitle":[],"editor":[{"given":"Richard","family":"Makurumidze","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":142,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0346045","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}