Auca, AgnesLogose, Barbara ShalahIzudi, Jonathan2026-04-192026-04-192026-03-08Auca, A., Shalah Logose, B., & Izudi, J. (2026). Underweight is associated with detectable viral load among adolescents with HIV in rural eastern Uganda: a retrospective cohort study. Journal of Health, Population and Nutrition.2072-1315https://dir.muni.ac.ug/handle/20.500.12260/957The findings indicate that undernutrition, particularly being underweight, is strongly associated with poor viral load suppression among adolescents with HIV in rural eastern Uganda. This underscores the critical role of adequate nutrition in achieving successful treatment outcomes. The study recommends integrating nutrition support into HIV care. Furthermore, these findings contribute to Sustainable Development Goal (SDG) 3 (Good Health and Well-being) by enhancing HIV treatment, SDG 2 (Zero Hunger) by addressing malnutrition in vulnerable populations, and SDG 10 (Reduced Inequalities) by reducing health disparities among rural adolescents. The results also align with Uganda’s National Development Plan IV, which seeks to strengthen health systems, improve adolescent health services, and promote integrated approaches to disease management and nutrition for sustainable development.Background Detectable viral load (DVL) after ≥ 6 months of antiretroviral therapy (ART) and underweight are common among adolescents with HIV (AWH) but remain understudied. We assessed the association between underweight at ART initiation and DVL among AWH in rural eastern Uganda. Methods We retrospectively reviewed program data for AWH aged 10–19 years from 11 clinics in eight districts. Underweight was defined as body mass index (BMI) for age <5th percentile at ART initiation. DVL was defined as the first viral load ≥ 1,000 copies/mL after ≥ 6 months on ART. Associations were examined using multi-level mixed-effects Poisson regression, adjusting for individual-level factors and accounting for clustering by district and health facility. Results We analyzed 525 AWH, of whom 47.6% were aged 10–14 years and 51.0% were male. At ART initiation, 79.2% were underweight, and 19.0% had DVL after ≥ 6 months on ART. In multivariable analysis, underweight at ART initiation was significantly associated with DVL (adjusted risk ratio [aRR] 1.66, 95% confidence interval [CI] 1.07–2.56). DVL was also associated with baseline CD4 count ≤ 200 cells/µL (aRR 1.36, 95% CI 1.12–1.66), and there was no statistically significant association with interruption in ART (aRR 1.43, 95% CI 0.89–2.29). Conclusion Among AWH in rural eastern Uganda, the prevalence of DVL was nearly four times the UNAIDS target of ≤ 5%. DVL was linked to underweight and severe immunodeficiency. Interventions such as nutritional support, targeted adherence counseling, early HIV diagnosis, and prompt ART initiation are critical to achieving viral suppression in this setting.enAdolescentsAntiretroviral therapyHIVUgandaViral loadArticle