A systematic review and meta-analysis on the association between antiretroviral therapy refill type and viral suppression

To reduce barriers to viral suppression, people living with HIV (PLWH) are placed on multi-month dispensing (MMD)
of antiretroviral therapy medication. However, there are concerns about viral rebound following MMD initiation, and
no existing review has compared viral suppression in PLWH on MMD with that in those on monthly refills [standard
of care (SoC)]. This meta-analysis compared viral suppression of PLWH on MMD to those on SoC. In February 2025,
we searched Embase, PubMed, Scopus, and Web of Science for articles (PROSPERO ID: CRD420251006737). Meta
analysis was performed using RStudio. 1078 articles were retrieved from the databases; 25 met our eligibility criteria (21
met meta-analysis criteria). Compared to PLWH on SoC, viral suppression was better among PLWH on 3MMD or more
[risk ratio (RR): 1.17, 1.06–1.30] and 6MMD (RR: 1.24, 1.15–1.34). However, for both 3MMD and 6MMD, the effect
sizes were smaller in RCTs than in observational studies. Furthermore, PLWH on 6MMD were less likely to be virally
suppressed than those on 3MMD (RR: 0.76, 0.67–0.85). Lastly, compared with SoC, 3MMD or more was significantly
associated with viral suppression if defined as < 1000 copies/mL (RR: 1.15, 1.10–1.21), but viral suppression was similar
with a stricter cut-off of 50–500 copies/mL (RR: 1.15, 0.93–1.42). Conclusively, PLWH on MMD had lower viral loads
than those on SoC, but those on 3MMD were more virally suppressed than those on 6MMD. The advantage MMD has
over SoC is insufficient to conclude its superiority. Therefore, MMD implementation should be carefully considered to
meet clinic and PLWH’s needs.

• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Health Systems
  • Governance arrangements
  • Delivery arrangements