{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:12:16Z","timestamp":1785795136637,"version":"3.56.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Despite advances in HIV care, viral load suppression (VLS) among adolescents living with HIV (ALHIV) in Uganda continue to lag behind that of adults, even with the introduction of dolutegravir (DTG)-based regimens, the Youth and Adolescent Peer Supporter (YAPS) model, and community-based approaches. Understanding factors associated with HIV viral load non-suppression in this population is critical to inform HIV treatment policy. This study assessed the prevalence and predictors of viral load non-suppression among ALHIV aged 10\u201319 years on DTG-based ART in Soroti City, Uganda.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a cross-sectional study among 447 ALHIV attending three urban HIV clinics in Soroti City. Data were abstracted using a structured questionnaire and analyzed in STATA 15.0. Modified Poisson regression with robust error variance was used to identify predictors of viral load non-suppression. Adjusted relative risks (aRR) and 95% confidence intervals (CIs) were reported, with statistical significance set at p\u2009\u2264\u20090.05.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 447 participants, 53.5% were female, with a median age of 16 years (IQR: 14.0\u201317.6). The majority (72.9%) were from Soroti district and had been on DTG-based ART for a median of 42.5 months (IQR: 37.0\u201348.0). Most were receiving multi-month dispensing (MMD) (75.2%) and were active in care (98%). The prevalence of viral load non-suppression was 19.2% (86\/447). Independent predictors of non-suppression included older age (15\u201319 vs. 10\u201314 years) (aRR: 1.69; 95% CI: 1.08\u20132.67), male sex (aRR: 1.48; 95% CI: 1.05\u20132.11), prior non-suppression before switching to DTG (aRR: 1.76; 95% CI: 1.19\u20132.59), use of non-fixed dose DTG regimens (aRR: 2.03; 95% CI: 1.23\u20133.33), history of poor adherence (aRR: 4.36; 95% CI: 2.05\u20139.26), and not receiving MMD (aRR: 2.83; 95% CI: 1.93\u20134.15).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Nearly one in five adolescents on DTG-based ART in Soroti City had viral non-suppression, despite optimized treatment regimens. Targeted interventions\u2212particularly enhanced adherence counseling for older and male adolescents, expanding MMD coverage, and provision of fixed-dose regimens\u2212are urgently needed to improve VLS among ALHIV. These findings underscore the need for adolescent-centered HIV care strategies to close the viral suppression gap and advance progress towards epidemic control.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331835","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:34:34Z","timestamp":1757439274000},"page":"e0331835","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and predictors of viral load non-suppression among adolescents on dolutegravir-based antiretroviral therapy: A cross-sectional study from three urban clinics, Soroti City"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6616-9535","authenticated-orcid":true,"given":"Connie","family":"Nait","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simple","family":"Ouma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saadick Mugerwa","family":"Ssentongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boniface","family":"Oryokot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham Ignatius","family":"Oluka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Kusiima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Nankabirwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Bosco","family":"Isunju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"pone.0331835.ref001","unstructured":"Unicef. Global and regional trends. Jul. 2023. Accessed September 08, 2023. [Online]. Available: https:\/\/data.unicef.org\/topic\/hivaids\/global-regional-trends\/"},{"key":"pone.0331835.ref002","author":"UNAIDS","year":"2022"},{"issue":"9","key":"pone.0331835.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239087","article-title":"Treatment outcome of the implementation of HIV test and treat policy at The AIDs Support Organization (TASO) Tororo clinic, Eastern Uganda: A retrospective cohort study","volume":"15","author":"R Opito","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331835.ref004","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s13052-018-0469-x","article-title":"Dolutegravir-based anti-retroviral therapy is effective and safe in HIV-infected paediatric patients","volume":"44","author":"E Bruzzese","year":"2018","journal-title":"Ital J Pediatr"},{"key":"pone.0331835.ref005","article-title":"Treatment guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents: an update","volume":"33","author":"CL Gibert","year":"2016","journal-title":"Fed Pract Health Care Prof VA DoD PHS"},{"issue":"3","key":"pone.0331835.ref006","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1177\/1060028013513558","article-title":"Dolutegravir, a second-generation integrase inhibitor for the treatment of HIV-1 infection","volume":"48","author":"RC Rathbun","year":"2014","journal-title":"Ann Pharmacother"},{"key":"pone.0331835.ref007","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"WHO.","year":"2021"},{"issue":"11","key":"pone.0331835.ref008","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1097\/INF.0000000000000848","article-title":"Safety, pharmacokinetics and efficacy of Dolutegravir in treatment-experienced HIV-1 infected adolescents: forty-eight-week results from IMPAACT P1093","volume":"34","author":"RM Viani","year":"2015","journal-title":"Pediatr Infect Dis J"},{"issue":"1","key":"pone.0331835.ref009","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12879-020-05672-6","article-title":"ODYSSEY clinical trial design: a randomised global study to evaluate the efficacy and safety of dolutegravir-based antiretroviral therapy in HIV-positive children, with nested pharmacokinetic sub-studies to evaluate pragmatic WHO-weight-band based dolutegravir dosing","volume":"21","author":"CL Moore","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"11","key":"pone.0331835.ref010","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/FPC.0000000000000308","article-title":"High plasma concentrations of dolutegravir in patients with ABCG2 genetic variants","volume":"27","author":"K Tsuchiya","year":"2017","journal-title":"Pharmacogenet Genomics"},{"issue":"13","key":"pone.0331835.ref011","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1007\/s40265-015-0446-2","article-title":"Use of integrase inhibitors in HIV-infected children and adolescents","volume":"75","author":"W Dehority","year":"2015","journal-title":"Drugs"},{"issue":"1","key":"pone.0331835.ref012","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1186\/s12879-021-06851-9","article-title":"Patient experiences of switching from Efavirenz- to Dolutegravir-based antiretroviral therapy: a qualitative study in Uganda","volume":"21","author":"A Twimukye","year":"2021","journal-title":"BMC Infect Dis"},{"key":"pone.0331835.ref013","unstructured":"PHL Uganda. Uganda Viral Load Dashboard. Accessed: January 26, 2024. [Online]. Available: https:\/\/vldash.cphluganda.org\/"},{"issue":"11","key":"pone.0331835.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25970","article-title":"Effectiveness and safety of dolutegravir and raltegravir for treating children and adolescents living with HIV: a systematic review","volume":"25","author":"CL Townsend","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"8","key":"pone.0331835.ref015","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3390\/tropicalmed8080391","article-title":"Virological non-suppression among newly diagnosed HIV-positive individuals on Dolutegravir-based antiretroviral treatment in Eastern Ethiopia: follow-up study","volume":"8","author":"A Gemechu","year":"2023","journal-title":"Trop Med Infect Dis"},{"issue":"6","key":"pone.0331835.ref016","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/jpids\/piad040","article-title":"Factors associated with viral suppression and drug resistance in children and adolescents living with HIV in care and treatment programs in Southern Tanzania","volume":"12","author":"SA Khamadi","year":"2023","journal-title":"J Pediatric Infect Dis Soc"},{"key":"pone.0331835.ref017","unstructured":"National-Population-and-Housing-Census-2024-Final-Report-Volume-1-Main.pdf.\u201d Accessed Mar. 15, 2025. [Online]. Available: https:\/\/www.ubos.org\/wp-content\/uploads\/2024\/12\/National-Population-and-Housing-Census-2024-Final-Report-Volume-1-Main.pdf"},{"key":"pone.0331835.ref018","unstructured":"Consolidated-HIV-and-AIDS-Guidelines-20230516.pdf.\u201d Accessed Mar. 15, 2025. [Online]. Available: https:\/\/dsduganda.com\/wp-content\/uploads\/2023\/05\/Consolidated-HIV-and-AIDS-Guidelines-20230516.pdf"},{"key":"pone.0331835.ref019","unstructured":"Winnie Byanyima. \u201cUNAIDS welcomes new research on \u2018opt-out\u2019 HIV testing in England,\u201d presented at the HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK, London, Nov. 29, 2023. Accessed Aug. 08, 2021. [Online]. Available: https:\/\/www.unaids.org\/en\/resources\/presscentre\/pressreleaseandstatementarchive\/2023\/november\/20231129_new-research-on-opt-out-hiv-testing-england#:~:text=In%20the%20UNAIDS%20Global%20AIDS,treatment%20to%20be%20virally%20suppressed"},{"key":"pone.0331835.ref020","first-page":"1111","article-title":"Factors associated with viral suppression among adolescents on antiretroviral therapy in Homa Bay County, Kenya: a retrospective cross-sectional study","volume":"13","author":"A Mwangi","year":"2021","journal-title":"HIV AIDS (Auckl)"},{"issue":"8","key":"pone.0331835.ref021","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25773","article-title":"Risk factors for HIV virological non-suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross-sectional study","volume":"24","author":"V Simms","year":"2021","journal-title":"J Int AIDS Soc"},{"issue":"2","key":"pone.0331835.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(19)30526-1","article-title":"Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial","volume":"8","author":"W Mavhu","year":"2020","journal-title":"Lancet Glob Health"},{"key":"pone.0331835.ref023","author":"AA Maghembe","year":"2023","journal-title":"HIV viral suppression and associated factors among children and adolescents on a Dolutegravir (DTG) based antiretroviral regimen in Tanzania Mainland. Cold Spring Harbor Laboratory"},{"issue":"3","key":"pone.0331835.ref024","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.3390\/ijerph19031085","article-title":"Predictors of viral non-suppression among patients living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: a prospective cohort study","volume":"19","author":"RT Buju","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0331835.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0200242","article-title":"Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya","volume":"13","author":"J Kadima","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331835.ref026","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/JNC.0000000000000302","article-title":"Kenyan HIV clinics with youth-friendly services and trained providers have a higher prevalence of viral suppression among adolescents and young adults: results from an observational study","volume":"33","author":"K Wilson","year":"2022","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"6","key":"pone.0331835.ref027","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1177\/0956462417748859","article-title":"Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa","volume":"29","author":"D Joseph Davey","year":"2018","journal-title":"Int J STD AIDS"},{"issue":"7","key":"pone.0331835.ref028","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/QAD.0000000000002538","article-title":"Clinic-level and individual-level factors that influence HIV viral suppression in adolescents and young adults: a national survey in Kenya","volume":"34","author":"I Njuguna","year":"2020","journal-title":"AIDS"},{"issue":"1","key":"pone.0331835.ref029","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s12879-017-2428-3","article-title":"Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda, August 2014-July 2015","volume":"17","author":"L Bulage","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0331835.ref030","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/QAI.0000000000000604","article-title":"Gender differences in adherence and response to antiretroviral treatment in the stratall trial in rural district hospitals in Cameroon","volume":"69","author":"C Boull\u00e9","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"3","key":"pone.0331835.ref031","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1080\/09540120903193625","article-title":"Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda","volume":"22","author":"W Kipp","year":"2010","journal-title":"AIDS Care"},{"issue":"2","key":"pone.0331835.ref032","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S1550-8579(07)80025-8","article-title":"Antiretroviral pharmacokinetic profile: a review of sex differences","volume":"4","author":"I Ofotokun","year":"2007","journal-title":"Gend Med"},{"issue":"1","key":"pone.0331835.ref033","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1186\/s12879-021-06459-z","article-title":"HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study","volume":"21","author":"AKA Afrane","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0331835.ref034","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/QAD.0000000000001273","article-title":"Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern","volume":"31","author":"L Muri","year":"2017","journal-title":"AIDS"},{"issue":"2","key":"pone.0331835.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0116144","article-title":"Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland","volume":"10","author":"K Jobanputra","year":"2015","journal-title":"PLoS One"},{"issue":"11","key":"pone.0331835.ref036","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/INF.0000000000001672","article-title":"Predictors of virologic failure on first-line antiretroviral therapy among children in a referral pediatric center in Cameroon","volume":"36","author":"AE Njom Nlend","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0331835.ref037","doi-asserted-by":"crossref","first-page":"1309740","DOI":"10.3389\/frph.2024.1309740","article-title":"Trend and factors associated with non-suppression of viral load among adolescents on ART in Tanzania: 2018-2021","volume":"6","author":"AS Quaker","year":"2024","journal-title":"Front Reprod Health"},{"issue":"6","key":"pone.0331835.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0305129","article-title":"High viral suppression rates among PLHIV on dolutegravir who had an initial episode of viral non-suppression in Uganda September 2020-July 2021","volume":"19","author":"GA Namayanja","year":"2024","journal-title":"PLoS One"},{"issue":"2","key":"pone.0331835.ref039","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofu079","article-title":"Association of first-line and second-line antiretroviral therapy adherence","volume":"1","author":"HO Ramadhani","year":"2014","journal-title":"Open Forum Infect Dis"},{"issue":"23","key":"pone.0331835.ref040","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1001\/jama.2018.19271","article-title":"Interventions to improve medication adherence: a review","volume":"320","author":"V Kini","year":"2018","journal-title":"JAMA"},{"issue":"5","key":"pone.0331835.ref041","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/1120009X.2023.2297095","article-title":"Fixed-dose antiretroviral combinations in children living with human immunodeficiency virus type 1 (HIV-1): a systematic review","volume":"36","author":"F Attaianese","year":"2024","journal-title":"J Chemother"},{"issue":"2","key":"pone.0331835.ref042","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/QAD.0000000000000123","article-title":"Incomplete adherence to antiretroviral therapy is associated with higher levels of residual HIV-1 viremia","volume":"28","author":"JZ Li","year":"2014","journal-title":"AIDS"},{"issue":"1","key":"pone.0331835.ref043","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1186\/s12889-018-5964-x","article-title":"Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda","volume":"18","author":"E Nasuuna","year":"2018","journal-title":"BMC Public Health"},{"issue":"12","key":"pone.0331835.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0113813","article-title":"Expanding access to HIV viral load testing: a systematic review of RNA stability in EDTA tubes and PPT beyond current time and temperature thresholds","volume":"9","author":"K Bonner","year":"2014","journal-title":"PLoS One"},{"issue":"6","key":"pone.0331835.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0286303","article-title":"Increasing multimonth dispensing of antiretrovirals and assessing the effect on viral load suppression among children and adolescents receiving HIV services in Nigeria","volume":"18","author":"C Casalini","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331835.ref046","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1186\/s12887-024-05295-9","article-title":"Viral load suppression and retention in care among children and adolescents receiving multi-month anti-retroviral therapy refills: a program data review in Uganda","volume":"24","author":"B Ainembabazi","year":"2024","journal-title":"BMC Pediatr"},{"issue":"11","key":"pone.0331835.ref047","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25640","article-title":"Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review","volume":"23","author":"L Long","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"12","key":"pone.0331835.ref048","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25649","article-title":"Twenty-four-month outcomes from a cluster-randomized controlled trial of extending antiretroviral therapy refills in ART adherence clubs","volume":"23","author":"T Cassidy","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"8","key":"pone.0331835.ref049","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0073190","article-title":"Among patients with sustained viral suppression in a resource-limited setting, CD4 gains are continuous although gender-based differences occur","volume":"8","author":"JB Sempa","year":"2013","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331835","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:34:42Z","timestamp":1757439282000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331835"}},"subtitle":[],"editor":[{"given":"YAGAI","family":"BOUBA","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331835","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}