{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:12Z","timestamp":1787027352312,"version":"build-2736575974"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Despite widespread rollout of dolutegravir-based (DTG) antiretroviral therapy (ART) in East Africa, viral non-suppression, advanced HIV disease (AHD), and multimorbidity persist, reflecting gaps in service response rather than regimen potency alone. In Uganda\u2019s The AIDS Support Organization (TASO) routine-care cohort (2014\u20132024;\n                    <jats:italic>n<\/jats:italic>\n                    \u202f=\u202f54,348 people living with HIV), integrase inhibitor uptake is near universal, yet AHD remains common, and tuberculosis (TB) and non-communicable diseases (NCD) increasingly co-occur within HIV care. Among clients with a recorded most recent viral load, 6.4% (2,145\/33,384) had viral non-suppression (VL\u202f\u2265\u202f1,000 copies\/mL). Second, our regional systematic review and meta-analysis (2016\u20132023;\n                    <jats:italic>n<\/jats:italic>\n                    \u202f=\u202f29,829) estimates viral non-suppression at 19.4% and indicates that failure concentrates in predictable social and clinical risk strata. We propose that durable suppression may be strengthened by an accountable, time-bound viral load (VL) cascade, paired with targeted support for clients at elevated clinical and social risk. Building on WHO and national differentiated service delivery and AHD guidance, we outline a pragmatic, data-enabled, risk-stratified model that uses routine electronic health record (EHR) signals to trigger rapid viral non-suppression follow-up, guide delivery of a proposed time-limited adherence and socioeconomic stability bundle, and integrate TB and NCD management within HIV platforms. A minimum actionable dashboard focused on cascade timeliness, high-risk package delivery, and integrated care can translate ART scale-up into durable suppression, fewer preventable AHD complications, and faster progress toward 95\u201395\u201395.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1794681","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:32:57Z","timestamp":1777872777000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Durable viral suppression in the dolutegravir era: a data-enabled, risk-stratified model for integrated HIV care in Uganda"],"prefix":"10.3389","volume":"14","author":[{"given":"Maria Magdalene","family":"Namaganda","sequence":"first","affiliation":[{"name":"Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce Nakatumba","family":"Nabende","sequence":"additional","affiliation":[{"name":"Department of Computer Science, School of Computing and Information Technology, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Patrick","family":"Kateete","sequence":"additional","affiliation":[{"name":"Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Batte","sequence":"additional","affiliation":[{"name":"Lung Institute, School of Medicine, College of Health Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Mboowa","sequence":"additional","affiliation":[{"name":"Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University","place":["Kampala, Uganda"]},{"name":"African Center of Excellence in Bioinformatics and Data-Intensive Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref1","year":"2020"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12688\/f1000research.121980.1","article-title":"Next-generation sequencing (NGS) reveals low-abundance HIV-1 drug resistance mutations among patients experiencing virological failure at the time of therapy switching in Uganda","volume":"11","author":"Namaganda","year":"2022","journal-title":"F1000Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"696","DOI":"10.4102\/sajhivmed.v18i1.696","article-title":"Delays in switching patients onto second-line antiretroviral treatment 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