Summary
An analysis of 16 quarterly HIV treatment cohorts in Uganda found that median retention among children and adolescents was lower at 24 months than at six months after starting ART. Retention also varied by region.
A medRxiv preprint analysing national routine health data from Uganda reports that retention in HIV care among children and adolescents declined between six and 24 months after starting antiretroviral therapy (ART). Across 16 quarterly treatment-initiation cohorts from 2020 to 2023, median retention at 24 months was 78% for children aged 0–9 and 76% for adolescents aged 10–19.
The study describes patterns in reported cohort data; it does not identify why people disengaged from care. The authors say age-appropriate support beyond the first year of ART and better routine cohort-data quality could help guide programme responses.
How the cohorts were assessed
The researchers analysed aggregated data reported through Uganda’s District Health Information Software. Each quarterly cohort consisted of children or adolescents newly starting ART in that quarter. The analysis covered 16 cohorts per age group, from the first quarter of 2020 through the fourth quarter of 2023, and assessed retention at 6, 12 and 24 months after treatment initiation.
Retention was defined as the proportion of clients alive and on ART in the “net current cohort”: the original group, adjusted for people transferred into or out of it. The results are medians across the quarterly cohorts, rather than a single estimate of the share retained across all children or adolescents in Uganda. The reported interquartile ranges describe the spread of cohort estimates around each median.
Retention was lower at longer follow-up
For children, median retention was 84% at six months (interquartile range, or IQR: 82–85%), 81% at 12 months (IQR: 78–83%) and 78% at 24 months (IQR: 75–80%). For adolescents, it was 82% at six months (IQR: 80–85%), 82% at 12 months (IQR: 81–85%) and 76% at 24 months (IQR: 74–78%).
The paper also counted how often regional cohort results met a 95% retention threshold. Among paediatric cohorts, only one national cohort reached that level at six months and one at 12 months; none did so at 24 months. The regions with the highest proportions of paediatric cohorts meeting the threshold were Karamoja at six months (31%), Kigezi at 12 months (31%) and Lango at 24 months (13%). These percentages refer to the share of cohorts meeting the threshold, not the regions’ median retention rates.
No national adolescent cohort reached 95% retention. By region, West Nile had the highest proportion of adolescent cohorts meeting the threshold at six months (19%) and 12 months (31%); at 24 months, Karamoja was highest (25%).
What the findings can inform
Maintaining ART supports ongoing HIV treatment, so retention over time is an important programme measure. The reported decline at longer follow-up, alongside regional variation, points to where health services may examine continuity of care and the quality of their cohort reporting. Because the analysis used aggregated surveillance data and was descriptive, it maps these patterns but does not explain their causes. The manuscript is a preprint.