Association between documented mental health disorders and HIV treatment outcomes among adults receiving antiretroviral therapy in rural Zimbabwe

Abstract

BACKGROUND: Mental health conditions undermine HIV treatment outcomes, yet evidence from routine care settings in rural Zimbabwe remains limited. AIM: To examine the association between documented mental health disorders and retention in care and viral suppression among adults receiving antiretroviral therapy (ART) at a rural hospital in central Zimbabwe. METHODS: This retrospective cohort analysis used routinely collected clinical data to examine associations between documented mental health disorders and retention in care and viral suppression among adults living with HIV receiving ART. Sixty-four adults with comorbid HIV and documented mental health disorders were included as cases and matched 1:1 by age (± 1 year), sex, and duration on ART (± 1 year) to 64 adults without documented mental health disorders or other chronic treatment-related conditions, resulting in a total analytic sample of 128 participants. Ficher's exact test and ordered logistic regression models were used to assess associations between mental health disorders and treatment outcomes, adjusting for relevant demographic covariates. RESULTS: The overall prevalence of documented mental health disorders (predominantly psychosis and anxiety) in this study population was low (3.6%), indicating potential underdiagnosis in routine HIV care. Documented mental health disorders were significantly associated with poorer retention in care and lower rates of viral suppression compared with controls (p < 0.05, respectively), with psychosis and suicidality particularly associated with non-retention. CONCLUSION: The findings highlight the need to strengthen mental health integration within HIV care. Targeted interventions for high-risk groups, systematic mental health screening, improved HIV-mental health data integration, and task-shifting to trained non-specialist health workers may improve clinical decision-making and support adherence, retention in care and viral suppression in similar resource-limited settings.