Published in PLOS One on 2026-06-18, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Trends and spatial distribution of low-level viremia among Ugandan children and adolescents, 2014–2023
Original authors: Janet Kobusinge Lubega, Patrick Twesigye, Richard Migisha, Lilian Bulage, Benon Kwesiga, Proscovia Nambuya, Isaac Sewanyana, Eleanor Namusoke Magongo, Alex Riolexus Ario
Source: PLOS One • DOI 10.1371/journal.pone.0339549
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Low-level viremia (LLV) is as an early warning signal for treatment failure and onward transmission risk. Uganda has achieved major progress in expanding viral load (VL) testing coverage, yet the burden and trends of LLV among children and adolescents living with HIV (CALHIV) remain insufficiently described. This study assessed national LLV prevalence, temporal trends, and regional distribution from 2014–2023 to guide pediatric HIV program planning.
We analyzed routine VL data from Uganda’s Laboratory Information Management System (LIMS) housed at the Central Public Health Laboratories for CALHIV aged 0–19 years with VL results between 2014 and 2023. Viral suppression was defined as <200 copies/mL for plasma and <400 copies/mL for dried blood spot (DBS) samples. LLV was categorized as 201–999 copies/mL for plasma and 401–999 copies/mL for DBS. We analyzed LLV proportions over time and disaggregated them by demographic (age, sex), clinical (ART regimen, duration on ART, adherence, WHO stage), and facility-level (ownership, level of care) characteristics. The Mann-Kendall trend test was used to assess the significance of observed trends.
A total of 974,873 VL tests were analyzed, of which LLV accounted for 14% (138,126). Nationally, LLV increased from 10.5% in 2014 to 16.2% in 2023 (p < 0.001). LLV rose in both males (10.7% to16.9%, p < 0.001) and females (10.3% to15.6%, p = 0.025), with the steepest increase among infants (12.7%to 22.5%, p < 0.001). Increases were observed among CALHIV on first-line regimens (10.2% to15.7%, p < 0.01), those on ART ≥ 5 years (12.5% to17.8%, p < 0.01), and those with good adherence (10.2% to14.9%, p < 0.001). In 2023, five of fifteen regions recorded LLV prevalence above 20%.
The rising LLV burden among CALHIV in Uganda signals emerging virologic challenges that may compromise long-term treatment outcomes. Strengthening VL monitoring, early detection of LLV, and tailored adherence interventions are critical to sustaining viral suppression and preventing progression to high-level viremia.
Background
Despite significant investments in pediatric Antiretroviral Therapy (ART) programs and early infant diagnosis, only 46% of children on ART have achieved viral suppression, far below the adult rates of suppression and the global target of 95% suppression [1,2]. They face higher risks of loss to follow-up, poor adherence, and delayed disclosure of HIV status, all of which hinder treatment outcomes [3]. This persistent gap highlights critical weaknesses in pediatric HIV care and underscores the urgent need for targeted interventions to improve ART adherence, access to optimized regimens, and routine viral load (VL) monitoring among children.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Janet Kobusinge Lubega, Patrick Twesigye, Richard Migisha, Lilian Bulage, Benon Kwesiga, Proscovia Nambuya, Isaac Sewanyana, Eleanor Namusoke Magongo, Alex Riolexus Ario. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis
- Evidence brief: Evaluating the effects of community-based programs on viral rebound and viral suppression among HIV-positive orphaned and vulnerable children receiving antiretroviral treatment: Findings from the ACHIEVE project in Tanzania
- Evidence brief: Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya
