Antiretroviral Therapy and Laboratory Monitoring in Ghana: The Dolutegravir Transition and Future Treatment Innovation — A Narrative Review
Aziz AdamuBackground
Despite remarkable advances in antiretroviral therapy (ART), sub-Saharan Africa continues to bear the greatest global HIV burden, and Ghana’s mixed epidemic — low general-population prevalence alongside disproportionately high prevalence among key populations — continues to strain diagnostic and treatment-monitoring capacity. This review addresses a focused question: how well is Ghana’s laboratory and treatment-monitoring infrastructure (HIV diagnosis, viral load testing, resistance surveillance) keeping pace with the pharmacological gains of the dolutegravir transition and emerging long-acting agents, and what this implies for the durability of Ghana’s HIV response.
Methods
A narrative review, reported in line with the Scale for the Assessment of Narrative Review Articles (SANRA), was conducted of peer-reviewed literature (PubMed, Google Scholar, Scopus) and authoritative grey literature (WHO, UNAIDS, the Ghana AIDS Commission, the Ghana Health Service, and drug regulatory agencies), searched between November 2025 and February 2026 without restriction on date of publication, supplemented by a targeted update search in August 2026. Evidence is explicitly labelled throughout as Ghana-specific, West African, sub-Saharan African, or global, and quantitative figures are clearly identified as either directly reported estimates or transparently labelled illustrative syntheses.
Results
Ghana’s National HIV Estimates 2024 (released July 2025) show that only 68% of people living with HIV are aware of their status, 69% of those diagnosed are on ART, and 90% of those on ART are virally suppressed — equivalent to roughly 47% of all people living with HIV (PLHIV) on treatment and 42% virally suppressed overall, a materially larger case-finding and linkage gap than earlier estimates suggested. The dolutegravir transition (national first-line policy from July 2019) has improved potency, tolerability, and the genetic barrier to resistance, but is associated with weight gain and, per recent systematic evidence, measurable elevations in liver enzymes and mixed vascular and neuropsychiatric risk signals that warrant monitoring rather than alarm. Persistent challenges include incomplete viral load and resistance-testing capacity, tuberculosis co-infection, stigma-related adherence barriers, and — acutely since January 2025 — disruption to PEPFAR financing, which a seven-country modelling study (not including Ghana) attributes to 20,000–74,000 excess HIV deaths across sub-Saharan Africa depending on scenario. Lenacapavir, approved for prevention (2025) and, as a different formulation, for treatment of multidrug-resistant HIV (2022), is being introduced rapidly elsewhere in the region but had not reached Ghana as of mid-2026.
Conclusions
Pharmacological innovation has outpaced Ghana’s laboratory-monitoring and financing infrastructure. Strengthening viral load and resistance-testing capacity, integrating routine hepatic and metabolic monitoring into dolutegravir-era care, and diversifying domestic HIV financing are likely to matter as much as any further antiretroviral advance for sustaining progress toward epidemic control.