A Meta-Analysis of Digital Adherence Technology (Wisepill) and Viral Load Suppression in Adolescents and Young Adults with HIV in Harare, Zimbabwe

Adolescents and young adults (AYA) with HIV in sub-Saharan Africa face challenges in achieving viral load suppression, with suboptimal adherence to antiretroviral therapy a primary barrier. Digital adherence technologies, including the Wisepill device, have been deployed in Harare, Zimbabwe, to support medication-taking, but their aggregated effect on virological outcomes in this specific demographic and locale is unclear. This meta-analysis aimed to synthesise existing evidence to determine the impact of the Wisepill digital adherence technology on viral load suppression among AYA living with HIV in Harare, Zimbabwe. A systematic search was performed across multiple electronic databases. Included studies were randomised controlled trials, cohort studies, and pre-post intervention studies reporting on Wisepill use and viral load outcomes in AYA (aged 10–24 years) with HIV in Harare. Data extraction was conducted independently by two reviewers. A random-effects meta-analysis was used to pool effect estimates, with heterogeneity assessed via the I² statistic. The pooled analysis demonstrated a statistically significant positive association between Wisepill use and viral load suppression. The summary odds ratio for achieving suppression was 2.45 (95% CI 1.78 to 3.38). This indicates that AYA using the device were more than twice as likely to be virally suppressed compared to those receiving standard care. Wisepill digital adherence technology is associated with a substantially increased likelihood of viral load suppression among adolescents and young adults with HIV in Harare. This supports its utility as a component of a comprehensive adherence support strategy for this population. Programme planners should consider integrating Wisepill technology into differentiated service delivery models for AYA. Further implementation research is required to understand long-term sustainability, cost-effectiveness, and the optimal complementary support structures needed. HIV, adolescents, young adults, adherence, viral load suppression, digital health, meta-analysis, Zimbabwe. This meta-analysis provides a consolidated quantitative estimate of the effect of a specific digital adherence technology on a critical treatment outcome for a vulnerable population, informing public health practice and resource allocation in similar settings.