Walter Akol2026-09-162026-09-162026-09-16https://bdears.busitema.ac.ug/handle/123456789/9559out of pocket expenditure.Background: Virologic non-suppression, defined in this study as a viral load of at least 1,000 copies/mL at six months after ART initiation, increases the risk of HIV disease progression, opportunistic infections, drug resistance and mortality. Children living with HIV continue to experience lower viral suppression than adults. This study determined virologic non-suppression at six months, described six-month clinical status and assessed associated factors among children aged 2 to 14 years receiving first-line ART at the Chronic Care Clinic of Mbale Regional Referral Hospital. Methods: A retrospective cross-sectional study was conducted using medical records of children aged 2 to 14 years on first-line antiretroviral therapy at Mbale Regional Referral Hospital Chronic Care Clinic. All eligible records were included. Data were abstracted on socio-demographic characteristics, antiretroviral therapy history, adherence, clinical status, opportunistic infections, nutritional status, and viral load outcomes. Virologic non-suppression was defined as viral load of at least 1,000 copies per millilitre after at least six months of antiretroviral therapy. Data were analysed using descriptive statistics and modified Poisson regression. Adjusted prevalence ratios, 95% confidence intervals, and p values were reported. Results: A total of 274 children’s records were analysed. Overall, 23.7% of the children had not achieved virological suppression after six months of antiretroviral therapy. Of the children, 49.3% were in World Health Organisation clinical stage II, while 28.8% were in stage III or IV. Opportunistic infections were documented 32.7% of children. The factors independently associated with virologic non-suppression were caregivers being relatives other than parents [adjusted prevalence ratio (aPR): 1.91; 95% confidence interval (CI): 1.11 to 3.93], poor treatment adherence [aPR: 2.92; 95% CI: 1.53 to 5.51], World Health Organization clinical stage III or IV [aPR: 1.57; 95% CI: 1.01 to 3.02], and having opportunistic infections at six months [aPR: 1.81; 95% CI: 1.05 to 3.12] at six months in Conclusion: Virologic non-suppression was common among children on first-line antiretroviral therapy at Mbale Regional Referral Hospital. Strengthening adherence support, caregiver-centred follow-up, clinical monitoring, and timely management of opportunistic infections is critical for improving paediatric human immunodeficiency virus treatment outcomes.enBook