Genotype-guided antiretroviral therapy outcomes in routine clinical practice: a retrospective study of HIV viral load suppression at 6 and 12 months in Uganda.

This study assessed virological outcomes following genotype-guided antiretroviral therapy (GART). We conducted a retrospective cohort of 235 PLHIV (2021-2023) post-GART after virological failure, analyzing baseline characteristics, 6- and 12-month viral load outcomes, and suppression factors using descriptive statistics, chi-square, Z-test, and ordinal logistic regression. The mean age of participants was 28.0 years, with an average ART duration of 11.2 years. Most (80.4%) were failing on second-line ART, while over half had NRTI (50.2%) or NNRTI (52.8%) mutations; INSTI resistance was rare (1.3%). Following GART initiation, viral suppression (≤200 copies/mL) increased significantly (χ 2p < 0.001), reaching 53.3% at 6 months and 62.7% at 12 months. High-level viremia (≥1000 copies/mL) declined from 42.1% to 31.1%, alongside substantial viral load reduction post GART. Multivariable analysis revealed higher odds of high-level viremia among those with two prior regimens (aOR = 13.27, 95% CI: 2.913-80.247, p = 0.005), while failing second-line ART significantly reduced odds (aOR = 0.064, 95% CI: 0.005-0.878, p = 0.040).The observed modest improvement in viral load suppression at 12-month post GART remained below the 95% UNAIDS target. Expanding GART access, resistance monitoring, adherence support, differentiated care, and affordable testing is essential to strengthen long-term virological control and patient outcomes.