Prevalence of viral load non-suppression and associated factors among adult persons living with HIV on antiretroviral therapy at Kigungu Art Clinic, Entebbe, Wakiso District, Uganda

Abstract

The human immunodeficiency virus (HIV) epidemic remains a global public health problem despite the increased rollout of antiretroviral therapy (ART). In Uganda, only 75.4% of persons living with HIV (PLHIV) on ART achieve viral load suppression. This figure falls short of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 target, which requires 95% of PLHIV on ART to be virally suppressed. To determine the prevalence of viral load non-suppression and associated factors among adult PLHIV receiving ART at Kigungu Health Center III ART clinic in Entebbe, Wakiso District, Uganda. This cross-sectional study utilized patient clinic records and structured questionnaire interviews. A systematic random sampling technique was employed to select 234 participants for inclusion in this study between June and September 2025. The primary outcome was viral load non-suppression. Data were collected using a structured questionnaire to assess socio-demographics and psychological factors. Drug and clinical factors data were extracted from records, entered into Epidata, and subsequently exported to Stata version 18 for analysis. Prevalence was reported as a percentage, and modified Poisson regression analysis was used to determine associated factors. The study enrolled 234 participants with a median age (Interquartile range [IQR]) of 36 (29, 44) years; 59.2% were female, 56.9% were fisher folks, 47.6% had primary-level education, and 47.8% were Catholics. The prevalence of viral load non-suppression was 19.7% (95% CI:15.0- 25.3). Duration on current ART regimen (aPR 1.02, 95% CI:1.01- 1.03), having a recent CD4 Count <200 cells/µL (aPR 2.21, 95% CI:1.26 - 3.87), and being a current smoker (aPR 2.42, 95% CI: 1.07-5.47) were significantly associated with viral load non-suppression. One in every five persons living with HIV on ART may have viral load non-suppression, posing a significant challenge to achieving the third 95% UNAIDS target. Duration of the current ART regimen, recent low CD4 count, and smoking were significantly associated with viral load non-suppression. There is a need to strengthen existing interventions and design new strategies to improve viral load suppression. The Ministry of Health should ensure continuous access to CD4 testing at all ART clinics, enhance structured long-term follow-up programs, and promote smoking cessation among PLHIV on ART.