UPART
Uganda Paediatric and Adolescent HIV Cohort on Antiretroviral Therapy
Accelerating Uganda’s progress towards eliminating paediatric HIV
UPART is a national, multi-partner initiative that combines implementation, clinical care, implementation, and research to close critical gaps in paediatric and adolescent HIV services. Using a representative observational cohort embedded within Ministry of Health clinical networks, UPART generates high-quality data from routine care to inform programme planning, improve clinical practice, and support national and global research on children and adolescents living with HIV (CALHIV).
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End‐to‐End Care for Children and Adolescents Living with HIV
We believe every child and young person living with HIV deserves access to continuous, high-quality care — from diagnosis and treatment to psychosocial support and successful transition to adult services.
Early Diagnosis & Linkage to Care
The UPART cohort study ensures that children and adolescents living with HIV are identified early and linked to care.
Optimised Antiretroviral Treatment (ART) for children and adolescents
Through the UPART study, we encourage the optimisation of ART for children and adolescents living with HIV (CALHIV) in care, offer adherence support and viral load suppression monitoring to support achievement of the 95-95-95 targets.
Comprehensive Clinical & Psychosocial Support
UPART supports holistic care packages that include nutrition and growth monitoring, mental-health screening and support, family-centred counselling, caregiver support, and peer networks — all tailored to the developmental needs of children and adolescents living with HIV.
Prevention of Mother-to-Child Transmission (PMTCT) and Exposed Infant Care
We work alongside maternity and neonatal services to prevent vertical transmission and to ensure HIV-exposed infants receive prompt early infant diagnosis (EID), timely early infant diagnosis, follow-up, and care.
Research, Innovation & Scale-Up for Sustainable Impact
UPART drives implementation science to evaluate new paediatric antiretroviral formulations (for example, dolutegravir), measures their uptake and short- to medium-term outcomes in routine care, and supports scale-up of effective practices across Uganda.
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From Diagnosis to Lifelong Support
The UPART cohort study establishes a nationally representative observational paediatric and adolescent HIV cohort on ART in Uganda, to generate high-quality data on children and adolescents in routine HIV care across the country to address key public-health questions when used adjectivally such as the evolving characteristics of children and adolescents living with HIV (CALHIV), uptake and impact of new treatments and guidance on HIV care.
- Building on the Ministry of Health network of public hospitals and electronic medical records to generate representative, routine-care data
- Integrated clinical, community and research support
- Family-centred and adolescent-friendly services
- Commitment to quality, data-driven improvement, and scale
GET INVOLVED IN CARE
How UPART Works
1
Identify CALHIV
We strengthen facility- and community-based testing for infants, children and adolescents, and ensure immediate linkage into care for those who test positive, following national EID and linkage guidance.
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Provide Comprehensive Care
The study generates real-world data and evidence on the uptake and impact of new HIV-care guidance, such as the STOP AIDS package in children and adolescents (for screening, prevention and treatment of advanced HIV disease) and introduction of differentiated service delivery, to inform the Ugandan Ministry of Health.
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Monitor
We monitor viral suppression and retention, provide ongoing adherence and mental-health support, and prepare adolescents for a supported transition into adult services — using data from the national paediatric cohort to improve outcomes.
FAQs
Find quick, reliable answers to common questions about paediatric and adolescent HIV care in Uganda. UPART provides clear, evidence-based information to help families, caregivers, and health workers to support children and young people living with HIV
UPART (Uganda Paediatric Antiretroviral Therapy) is a national cohort and implementation platform that brings together government, researchers, clinicians, and communities to generate evidence and improve services for children and adolescents living with HIV (CALHIV). Children and adolescents face unique challenges — later diagnosis, adherence difficulties, drug-formulation needs and transition to adult care — which UPART addresses through data, clinical support and systems-strengthening.
Screening is done in health facilities (including paediatric inpatient services), maternal and child health settings, and through outreach. UPART strengthens testing and linkage so children and adolescents who test positive are rapidly connected to care and follow-up, in line with national guidance on EID and linkage.
National guidance recommends optimised paediatric and adolescent ART regimens; UPART evaluates real-world uptake of these regimens (including DTG rollout) and monitors viral load outcomes. Common challenges include limited availability of some paediatric formulations, stock-outs and retention issues, all of which influence long-term viral suppression and health outcomes.
Transition can be a vulnerable time: adolescents must adapt to new clinic environments and manage their own care. UPART promotes adolescent-friendly services, peer support and structured transition processes to maintain continuity of care and viral suppression.
Bridging research to policy and practice.
The clinical cascade for children and adolescents living with HIV (CALHIV) remains behind that of adults. To address this, the Uganda Paediatric Antiretroviral Therapy (UPART) cohort study established a national paediatric and adolescent HIV observational cohort in October 2021 to create a representative cohort of Ugandan children and adolescents living with HIV on ART.
The nationwide cohort assesses evolving characteristics of CALHIV in Uganda and generates high-quality data from routine HIV care to address public-health questions such as the uptake and impact of newly rolled-out paediatric drugs and formulations. UPART supplements national surveillance by providing robust, programmatically relevant evidence to guide planning, improve clinical care, and contribute to international research.
Phase 1, from October 2021 to December 2024, recruited participants from three high-burden facilities (Mildmay Hospital, Hoima Regional Referral Hospital, and Lira Regional Referral Hospital). Recruitment for Phase 1 began October 2021, targeting 2,700 CALHIV; between November 2021 and December 2023 a total of 1,494 participants were enroled and Phase 1 concluded in December 2024. Phase 1 findings were disseminated at international meetings including the International Workshop on HIV Paediatrics (July 2023, Brisbane) and IPHASA 2023, as well as at a stakeholder dissemination workshop (August 2024).
Phase 2 received ethical approval and began in June 2025, expanding to two additional sites (Jinja RRH and Masaka RRH). Phase 2 will enrol approximately 3,000 CALHIV from five facilities. As of 30 September 2025, 930 participants had been enroled into the cohort. The study team presented additional findings at the International Workshop on HIV Paediatrics (July 2025, Kigali, Rwanda).
Funding and partnerships: Phase 1 was funded by the MRC Clinical Trials Unit at UCL and international stakeholders including USAID, WHO, CIPHER/IAS and UNICEF. The second phase has two sub-studies, the UPART DTG sub-study, funded by ViiV Healthcare, and the UPART THRIVE sub-study, funded by Unitaid.
UPART DTG study — Evaluates uptake and outcomes of dolutegravir DTG-based regimens (DBRs) among children (0–9 years) and adolescents (10–19 years).
Primary objectives:
Describe uptake of DTG in the UPART cohort and characteristics at start of DBRs.
Describe mortality and loss to follow-up after DBR initiation.
Assess effectiveness of DBRs by describing viral load response (suppression and failure) over time.
Secondary objectives include:
- Identifying factors associated with viral failure.
- Reasons for discontinuation of DTG
- Monitoring growth (weight, height, BMI) over time on DBR. This sub-study is funded by ViiV Healthcare and aims to enrol ~3,000 participants across the five sites. Study activities: 1 Jan 2024 – 31 Dec 2027.
The UPART THRIVE (AHD) sub-study focuses on diagnosis, prevention and treatment of Advanced HIV Disease (AHD) among CALHIV.
The sub-study aims to enrol approximately 3,000 study participants from all five sites in addition to those enrolled in phase 1. Study activities started on 1 January 2024 and will end on 31 December 2027.
The second sub-study is: Uganda Paediatric Antiretroviral Therapy UPART THRIVE Sub-study on diagnosis, prevention, and treatment of advanced HIV disease in Children and Adolescents living with HIV in Uganda
The research objectives are:
- To assess the cascade (receipt of all components of care within one month of being eligible for screening), of care among CALHIV with AHD, dissecting all steps included in the Ugandan national guidelines (including screening for AHD and OI, treatment, optimisation of care and prophylaxis).
Secondary Objectives
- Describe the number and proportion of CALHIV who were eligible for AHD screening per calendar year starting in 2023 among all those in follow-up in UP ART that year
- Describe the prevalence and incidence of AHD and its characteristics at the time of AHD diagnosis.
(i) Prevalence is based on the proportion screened for AHD who met the definition of AHD at initial screening
(ii) Incidence will be estimated in two groups:
a. among those screened and not diagnosed with AHD at initial screening who meet the definition of AHD within 12 months of initial screening.
b. among those eligible for screening who were not screened for AHD, who met the definition of AHD within 12 months of becoming eligible for screening - Assess the clinical progression and outcomes of children and adolescents with AHD diagnosis, including mortality, morbidity (new and recurrent WHO 3 and 4 events), retention in HIV care, treatment interruption, and growth changes by 12 months after AHD diagnosis.
Strengthen data quality and completeness of AHD-related data captured in electronic medical records through dedicated training, data-monitoring plans, and regular feedback to clinic staff.
This sub-study aims to enrol approximately 2,000 study participants from three HIV high-burden facilities (Mildmay Uganda, Hoima RRH and Lira RRH). Study activities started on 1 January 2024 and will end on 31 December 2026. The sub-study is funded by Unitaid.
Each participating facility is supported by a dedicated nurse and a data quality assurance clinician to strengthen enrolment and data processes. As of 30 September 2025, a total of 930 participants have been enrolled into the cohort. The study team also disseminated additional findings at the International Workshop on HIV Paediatrics (July 2025, Kigali, Rwanda)
