{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:05:56Z","timestamp":1784214356624,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["U2RTW012116"],"award-info":[{"award-number":["U2RTW012116"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The scale-up of antiretroviral therapy (ART) has transformed the HIV epidemic in sub-Saharan Africa, yet longitudinal public health insights from national programmatic cohorts remain scarce. As global targets move toward epidemic control and elimination of virological failure, understanding how profiles and outcomes of people living with HIV (PLWH) evolve in real-world settings is essential. The AIDS Support Organisation (TASO), Uganda\u2019s largest HIV care provider, maintains one of the longest-running national registries of PLWH. We aimed to generate insights to inform targeted interventions, optimize programmatic responses and improve long-term care for PLWH in resource-constrained settings. We conducted a secondary analysis of routinely collected data within an open cohort of 54,348 PLWH enrolled at 11 TASO clinics between 2014\u20132024. Descriptive statistics summarized demographic, clinical, immunological, behavioral and socioeconomic characteristics at baseline and follow-up. At most recent recorded follow-up, 60.4% of PLWH were female with median age of 39 years (IQR 31\u201347); 55% aged 25\u201344 years. At ART initiation, non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens dominated (&gt;90% through 2017), by 2024,\u2009&gt;\u200999% of ART initiations were dolutegravir (DTG)- based, aligning with national policy. Immune recovery improved over study period; however, 12% still presented with CD4\u2009&lt;\u2009200 cells\/\u00b5L. Most PLWH initiated care in WHO stage I\u2013II, and prevalence of advanced disease declined further at last record. Self-reported adherence exceeded 95%. Tuberculosis was the most frequent infectious comorbidity (5% prior history), whereas hypertension (3.9%) and diabetes (2.5%) were the leading non-communicable conditions. Socioeconomic vulnerability reported 57% with irregular income and 21% unemployed. Psychosocial stressors, including poverty and stigma, were common. Findings show progress alongside persistent gaps and structural barriers. They mandate earlier diagnosis, integrated tuberculosis and non-communicable disease management, strengthened socioeconomic support, and risk-stratified care using predictive modeling to reduce virological failure and drive Uganda toward 95\u201395\u201395 targets in resource-constrained settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005906","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:33:22Z","timestamp":1773682402000},"page":"e0005906","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decade-long antiretroviral therapy in Uganda: Population-health outcomes from a national HIV treatment cohort, 2014\u20132024"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1913-5506","authenticated-orcid":true,"given":"Maria Magdalene","family":"Namaganda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stathis","family":"Gennatas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Merson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8030-9985","authenticated-orcid":true,"given":"Esteban","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Edinburgh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce Nakatumba","family":"Nabende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Patrick","family":"Kateete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Batte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misaki","family":"Wanyengera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daudi","family":"Jjingo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6305-5242","authenticated-orcid":true,"given":"Florence","family":"Kivunike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunus","family":"Miya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4510-6736","authenticated-orcid":true,"given":"Simple","family":"Ouma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Welty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein Mukasa","family":"Kafeero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8445-9414","authenticated-orcid":true,"given":"Gerald","family":"Mboowa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"4","key":"pgph.0005906.ref001","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1056\/NEJMp1714773","article-title":"PEPFAR - 15 years and counting the lives saved","volume":"378","author":"AS Fauci","year":"2018","journal-title":"N Engl J Med"},{"key":"pgph.0005906.ref002","unstructured":"UNAIDS. Understanding measures of progress towards the 95\u201395\u201395 HIV testing, treatment and viral suppression targets. 2021."},{"issue":"1","key":"pgph.0005906.ref003","first-page":"20","article-title":"Human immunodeficiency virus and AIDS in Uganda","volume":"73","author":"RD Mugerwa","year":"1996","journal-title":"East Afr Med J"},{"key":"pgph.0005906.ref004","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1187274","article-title":"Effect of the \u201cuniversal test and treat\u201d policy on the characteristics of persons registering for HIV care and initiating antiretroviral therapy in Uganda","volume":"11","author":"L Mugenyi","year":"2023","journal-title":"Front Public Health"},{"key":"pgph.0005906.ref005","volume-title":"WHO guidelines approved by the guidelines review committee. consolidated guidelines on the use of antiretroviral drugs for treating and preventing hiv infection: recommendations for a public health approach","author":"WHO","year":"2016"},{"issue":"1","key":"pgph.0005906.ref006","doi-asserted-by":"crossref","first-page":"2490774","DOI":"10.1080\/25787489.2025.2490774","article-title":"Prevalence and predictors of virological failure among the people living with HIV on antiretroviral treatment in East Africa: evidence from a systematic review with meta-analysis and meta-regression of published studies from 2016 to 2023","volume":"26","author":"MM Namaganda","year":"2025","journal-title":"HIV Res Clin Pract"},{"issue":"1","key":"pgph.0005906.ref007","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12981-021-00338-y","article-title":"Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda","volume":"18","author":"H Musana","year":"2021","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pgph.0005906.ref008","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S1473-3099(09)70321-4","article-title":"Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives","volume":"10","author":"AD Harries","year":"2010","journal-title":"Lancet Infect Dis"},{"key":"pgph.0005906.ref009","unstructured":"UgandaEMR. UgandaEMR. https:\/\/mets-programme.gitbook.io\/ugandaemr-documentation"},{"key":"pgph.0005906.ref010","unstructured":"TASO. The AIDS support organisation. https:\/\/tasouganda.org\/"},{"key":"pgph.0005906.ref011","volume-title":"Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda","author":"Health Mo","year":"2022"},{"key":"pgph.0005906.ref012","volume-title":"Uganda population-based HIV impact assessment (UPHIA) 2020\u20132021: summary sheet","author":"MoH","year":"2022"},{"issue":"10452","key":"pgph.0005906.ref013","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S0140-6736(24)01442-9","article-title":"Reducing HIV in young women in Uganda: the need for autonomy","volume":"404","author":"J Nabayinda","year":"2024","journal-title":"Lancet"},{"key":"pgph.0005906.ref014","doi-asserted-by":"crossref","unstructured":"Nangendo J, Katahoire AR, Armstrong-Hough M, Kabami J, Obeng-Amoako GO, Muwema M, et al. Prevalence, associated factors and perspectives of HIV testing among men in Uganda. 2020.","DOI":"10.1371\/journal.pone.0237402"},{"key":"pgph.0005906.ref015","unstructured":"Uganda AIDS Commission, Ministry of Health. HIV fact sheet 2023: Facts on HIV and AIDS in Uganda. 2023."},{"key":"pgph.0005906.ref016","unstructured":"UAC. HIV AIDS fact sheet 2022: facts on HIV and AIDS in Uganda. 2022."},{"issue":"1","key":"pgph.0005906.ref017","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1186\/s12879-020-05461-1","article-title":"Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda","volume":"20","author":"R Nakalega","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"5","key":"pgph.0005906.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0268226","article-title":"Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: an interrupted time series analysis","volume":"17","author":"L Mugenyi","year":"2022","journal-title":"PLoS One"},{"issue":"8","key":"pgph.0005906.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290445","article-title":"Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: a prospective cohort study","volume":"18","author":"AV Kalinjuma","year":"2023","journal-title":"PLoS One"},{"issue":"2","key":"pgph.0005906.ref020","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(18)30317-5","article-title":"Risks and benefits of dolutegravir-based antiretroviral drug regimens in sub-Saharan Africa: a modelling study","volume":"6","author":"AN Phillips","year":"2019","journal-title":"Lancet HIV"},{"issue":"5","key":"pgph.0005906.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232419","article-title":"High acceptability and viral suppression of patients on Dolutegravir-based first-line regimens in pilot sites in Uganda: a mixed-methods prospective cohort study","volume":"15","author":"VM Nabitaka","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0005906.ref022","unstructured":"WHO. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. 2018."},{"issue":"3","key":"pgph.0005906.ref023","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(19)30400-X","article-title":"Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines","volume":"7","author":"AN Phillips","year":"2020","journal-title":"Lancet HIV"},{"issue":"1","key":"pgph.0005906.ref024","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1186\/s12879-021-06933-8","article-title":"Provider perspectives on the acceptability and tolerability of dolutegravir-based anti-retroviral therapy after national roll-out in Uganda: a qualitative study","volume":"21","author":"H Zakumumpa","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"7","key":"pgph.0005906.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(20)30042-4","article-title":"Dolutegravir-associated hyperglycaemia in patients with HIV","volume":"7","author":"M Lamorde","year":"2020","journal-title":"Lancet HIV"},{"key":"pgph.0005906.ref026","doi-asserted-by":"crossref","first-page":"102255","DOI":"10.1016\/j.eclinm.2023.102255","article-title":"The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis","volume":"65","author":"M Moyo-Chilufya","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pgph.0005906.ref027","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12981-021-00358-8","article-title":"Defining the optimal cut-point of self-reported ART adherence to achieve viral suppression in the era of contemporary HIV therapy: a cross-sectional study","volume":"18","author":"E O\u2019Halloran Leach","year":"2021","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pgph.0005906.ref028","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12981-022-00475-y","article-title":"Predicting viral load suppression by self-reported adherence, pharmacy refill counts and real time medication monitoring among people living with HIV in Tanzania","volume":"19","author":"KM Ngowi","year":"2022","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pgph.0005906.ref029","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12981-023-00549-5","article-title":"Managing household income and antiretroviral therapy adherence among people living with HIV in a low-income setting: a qualitative data from the HPTN 071 (PopART) trial in South Africa","volume":"20","author":"A Mcinziba","year":"2023","journal-title":"AIDS Res Ther"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:33:29Z","timestamp":1773682409000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005906"}},"subtitle":[],"editor":[{"given":"Nei-yuan (Marvin)","family":"Hsiao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005906","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}