PERSPECTIVE article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1667417
This article is part of the Research TopicDefeating HIV in Africa: An Achievable GoalView all articles
The Warning Bell of Dolutegravir Resistance: Rethinking HIV Service Models in Africa Perspective
Provisionally accepted
Fausto Ciccacci1*
Benjamin Welu2Elton Uamusse3
Giovanni Guidotti4Yolanda Vaz3Stefano Capparucci5Gianna Iasilli5Dyna Thembo6
Paola Scarcella7- 1Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- 2DREAM Program, Community of Sant'Egidio, Meru, Kenya
- 3DREAM Program, Community of Sant'Egidio, Maputo, Mozambique
- 4Azienda Sanitaria Locale Roma 1, Rome, Italy
- 5DREAM Program, Community of Sant'Egidio, Rome, Italy
- 6DREAM Program, Community of Sant'Egidio, Blantyre, Malawi
- 7Libera Universita Maria Santissima Assunta, Rome, Italy
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The emergence of resistance to Dolutegravir (DTG) -the cornerstone of first-line antiretroviral therapy -marks a critical turning point in the fight against HIV in Africa. Once considered unlikely due to DTG's high genetic barrier, resistance is now increasingly reported, raising urgent questions about current HIV service models. This Perspective argues that the spread of resistance must be seen not only as a clinical threat but as a warning signal for the broader health system, especially in the wake of post-COVID transformations that have accelerated decentralization, task-shifting, and selfmanaged care. While such innovations offer benefits, they also risk eroding human connection and clinical oversight, which are essential in managing a complex condition like HIV. Drawing on experience from the DREAM program and other field evidence, we identify four strategic priorities for a renewed response: scaling up differentiated service delivery (DSD), expanding access to resistance testing, strengthening community-based support, and ensuring equitable access to advanced treatment options. These pillars aim to safeguard past achievements while adapting to emerging challenges. We call for urgent, equity-driven action to prevent further spread of resistance and to build resilient, person-centered systems capable of delivering sustainable HIV care in Africa and beyond.
Keywords: Public Health, HIV service delivery, resistance testing, Dolutegravir, differentiated service delivery model
Received: 16 Jul 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Ciccacci, Welu, Uamusse, Guidotti, Vaz, Capparucci, Iasilli, Thembo and Scarcella. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fausto Ciccacci, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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