SUAB0303 | TIME TO VIRAL NON-SUPPRESSION AND PREDICTORS AMONG PEOPLE LIVING WITH HIV ON SECOND-LINE ART TRANSITIONED TO DOLUTEGRAVIR IN KAMPALA, UGANDA

Brian Mikka¹, Patrick Kazooba¹, Gertrude Namale¹, Emmanuel Sendaula¹, Douglas Tuhumwire¹, Shanita Ankunda¹, Josephine Kaleebi¹, Grace Namayanja², Peter Sentongo² | ¹Reach Out Mbuya Community Health Initiative, Kampala, Uganda; ²Centers for Disease Control and Prevention, Kampala, Uganda

Despite advancements in antiretroviral therapy (ART), achieving the third UNAIDS 95-95-95 target remains suboptimal in sub-Saharan Africa. In 2020, Uganda transitioned people living with HIV (PLHIV) on second-line regimens, which included protease inhibitors (PI) and with a viral load (VL) <1000 copies/mL, to dolutegravir (DTG)-containing regimens. We assessed the incidence of viral non-suppression (VNS) and predictors of VNS among adult PLHIV on PI-based second-line transitions. We conducted a retrospective analysis of data from November 2020 through November 2024 using routinely collected data at six public HIV clinics in Kampala, Uganda. All adult PLHIV on PIs who were transitioned to DTG were included. VNS was defined as VL ≥1000 copies/mL and low-level viremia (LLV) was defined as VL of 200-999 copies/mL. Time to VNS was estimated and compared using survival methods, i.e., Kaplan-Meier curves and log-rank tests; predictors were identified using Cox proportional hazards models. Adjusted Hazard Ratios (aHR) and their 95% confidence intervals (95% CI) were used to summarize effect measures. From November 2020 to November 2024, 756 individuals living with HIV transitioned from protease inhibitors (PIs) to dolutegravir (DTG). The switch added 16,282 person-months at risk. The median age was 39 (interquartile range: 33-46) years, and the majority (63.8%) were female. At the time of transition, 85 (11.9%) had a VL >200 copies/mL. The incidence rate of VNS was 4.24 per 1,000 person-months (95% CI: 3.35-5.37) per 1,000 person-months, but it did not differ by age (p-value=0.32) and sex (p-value=0.23). The incidence rate was higher among PLHIV with VL ≥ 200 copies/mL (10.52 per 1000 person-months, 95% CI: 6.71-16.50) compared to PLHIV with VL < 200 copies/mL, 3.37 per 1000 person-months (95% CI: 6.71-16.50). The predictors of VNS were LLV (aHR=3.34, 95% CI: 1.33-8.37), a longer time on a PI-based regimen (aHR=0.94, 95% CI: 0.91-0.97), and being male (aHR=0.75, 95% CI: 0.57-0.98). Non-suppression remains a concern, particularly among PLHIV with low-level viremia at transition. Strengthened viral load monitoring and adherence interventions are essential to attain the third 95 and reduce HIV transmission to achieve HIV epidemic control.