Retention in paediatric and adolescent HIV care among ART initiation cohorts in Uganda, 2020-2023

Abstract

BackgroundSustained retention in HIV care is essential for maintaining antiretroviral therapy (ART) and achieving viral suppression. We described national and regional retention in HIV care among paediatric and adolescent ART initiation cohorts in Uganda from 2020-2023.

MethodsWe analyzed aggregated paediatric (aged 0-9 years) and adolescent (aged 10-19 years) ART cohort data reported through the District Health Information Software. We assessed 16 consecutive quarterly ART initiation cohorts per age group, from Quarter 1 2020 to Quarter 4 2023, at 6 (short-term), 12 (intermediate), and 24 (long-term) months after ART initiation. Each cohort comprised clients newly initiated on ART in a specific calendar quarter. Retention was defined as the proportion of clients alive and on ART within the net current cohort (original cohort plus transfer-ins minus transfer-outs). We described retention nationally and by region for each cohort and follow-up time point. We summarized the proportion of cohorts with retention [≥]95% by region as a descriptive measure of high retention.

ResultsAmong paediatric cohorts, median retention was 84% (IQR: 82-85%) at 6 months, 81% (IQR: 78-83%) at 12 months, and 78% (IQR: 75-80%) at 24 months. Only one national paediatric cohort achieved [≥]95% retention at 6 months and one at 12 months; none attained this target at 24 months. The proportion of paediatric cohorts with regional retention [≥]95% was highest in Karamoja at short-term follow-up (31%), in Kigezi at intermediate follow-up (31%), and in Lango at long-term follow-up (13%).

Among adolescent cohorts, median retention was 82% (IQR: 80-85%) at 6 months, 82% (IQR: 81-85%) at 12 months, and 76% (IQR: 74-78%) at 24 months. No national adolescent cohort achieved [≥]95% retention. The proportion of adolescent cohorts with regional retention [≥]95% was highest in West Nile at 6 months (19%) and 12 months (31%), and in Karamoja at 24 months (25%).

ConclusionRetention among paediatric and adolescent ART cohorts declined with longer follow-up and varied across regions. Strengthening age-appropriate support beyond the first year of ART and improving routine cohort-data quality could support more targeted programme responses.

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BibTeX RIS

BibTeX

@misc{aman2026retention,
  title = {{Retention in paediatric and adolescent HIV care among ART initiation cohorts in Uganda, 2020-2023}},
  author = {K. D. Aman and R. Migisha and I. Lukabwe and N. Matovu and A. Nuwamanya and V. J. Kigongo and J. Wobusobozi and W. Nakaweesi and A. L. Alupo and A. Namwabira and F. Nalubega and L. Bulage and B. Kwesiga and A. R. Ario and E. Namusoke Magongo},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.01.26364483},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.01.26364483v1},
  note = {CC BY},
}

RIS

TY  - UNPB
TI  - Retention in paediatric and adolescent HIV care among ART initiation cohorts in Uganda, 2020-2023
AU  - K. D. Aman
AU  - R. Migisha
AU  - I. Lukabwe
AU  - N. Matovu
AU  - A. Nuwamanya
AU  - V. J. Kigongo
AU  - J. Wobusobozi
AU  - W. Nakaweesi
AU  - A. L. Alupo
AU  - A. Namwabira
AU  - F. Nalubega
AU  - L. Bulage
AU  - B. Kwesiga
AU  - A. R. Ario
AU  - E. Namusoke Magongo
PY  - 2026
DA  - 2026/10/01
PB  - medRxiv
DO  - 10.64898/2026.10.01.26364483
UR  - https://www.medrxiv.org/content/10.64898/2026.10.01.26364483v1
AB  - BackgroundSustained retention in HIV care is essential for maintaining antiretroviral therapy (ART) and achieving viral suppression. We described national and regional retention in HIV care among paediatric and adolescent ART initiation cohorts in Uganda from 2020-2023.  MethodsWe analyzed aggregated paediatric (aged 0-9 years) and adolescent (aged 10-19 years) ART cohort data reported through the District Health Information Software. We assessed 16 consecutive quarterly ART initiation cohorts per age group, from Quarter 1 2020 to Quarter 4 2023, at 6 (short-term), 12 (intermediate), and 24 (long-term) months after ART initiation. Each cohort comprised clients newly initiated on ART in a specific calendar quarter. Retention was defined as the proportion of clients alive and on ART within the net current cohort (original cohort plus transfer-ins minus transfer-outs). We described retention nationally and by region for each cohort and follow-up time point. We summarized the proportion of cohorts with retention [≥]95% by region as a descriptive measure of high retention.  ResultsAmong paediatric cohorts, median retention was 84% (IQR: 82-85%) at 6 months, 81% (IQR: 78-83%) at 12 months, and 78% (IQR: 75-80%) at 24 months. Only one national paediatric cohort achieved [≥]95% retention at 6 months and one at 12 months; none attained this target at 24 months. The proportion of paediatric cohorts with regional retention [≥]95% was highest in Karamoja at short-term follow-up (31%), in Kigezi at intermediate follow-up (31%), and in Lango at long-term follow-up (13%).  Among adolescent cohorts, median retention was 82% (IQR: 80-85%) at 6 months, 82% (IQR: 81-85%) at 12 months, and 76% (IQR: 74-78%) at 24 months. No national adolescent cohort achieved [≥]95% retention. The proportion of adolescent cohorts with regional retention [≥]95% was highest in West Nile at 6 months (19%) and 12 months (31%), and in Karamoja at 24 months (25%).  ConclusionRetention among paediatric and adolescent ART cohorts declined with longer follow-up and varied across regions. Strengthening age-appropriate support beyond the first year of ART and improving routine cohort-data quality could support more targeted programme responses.
ER  -

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