Gender, mental health symptoms, loss to clinic, and viral non-suppression 6 months after HIV care initiation among a cohort of people with HIV in Cameroon

Background: People with HIV (PWH) experience high levels of mental health or substance use disorders (MSDs) which may compromise HIV treatment outcomes. Differences in the relationship between MSDs and HIV treatment outcomes by gender remain understudied. Methods: We conducted interviews with 426 PWH aged ≥ 21 years initiating HIV care in Cameroon between June 2019 and March 2020. Clinic data and laboratory results were used to ascertain loss to clinic and viral non-suppression six months after HIV care initiation. We used log binomial regression models to assess the relationship between symptoms of depression (PHQ-9 scores > 9), anxiety (GAD-7 scores > 9), post-traumatic stress disorder (PTSD; PCL-5 scores > 30), and harmful alcohol use (AUDIT scores > 15) at HIV care initiation and 6-month loss to clinic and viral non-suppression in the study population overall, and among men and women, separately. Results: Nearly 25% of individuals (N = 100) were lost to clinic at 6 months. Among the 326 individuals retained in care at their original clinic at 6 months, 234 had a measured viral load, of whom 28% were virally non-suppressed (N = 65). Among men, the risk of disengagement was greater among those who reported PTSD symptoms at care initiation compared to those who did not. Viral non-suppression was significantly higher among those reporting symptoms of anxiety at care initiation in the population retained overall and among men. Conclusions: Men initiating HIV care with poor mental health may be particularly vulnerable to unstable care engagement and viral non-suppression. Interventions are needed for men specifically to foster improved mental health.