Associations of Mental Health Disorders, and Social Support with Retention in HIV Care Following Routine HIV Testing in a Refugee Settlement in Uganda

Uganda hosts a large refugee population, including individuals from neighboring countries with high HIV prevalence. Retention in HIV care for this population is crucial to improve health outcomes and reduce HIV transmission rates. Retention is essential to decreasing viral load and adverse health outcomes, all of which are difficult to manage with the complexities of being a refugee. Further, people living with HIV (PLHIV) tend to experience high rates of poor mental health, affecting their participation in the HIV care continuum. However, limited research has explored the relationship between mental health and retention in care among refugees living with HIV. This study aimed to investigate the association between mental health disorders (anxiety, depression, PTSD [post-traumatic stress disorder]) and lack of social support with retention in HIV care among refugees in Nakivale Refugee Settlement, Uganda. Methods: A prospective cohort study was conducted among refugees and Ugandan nationals accessing routine HIV testing services in Nakivale Refugee Settlement. Participants (n=205) were adults living with HIV who had linked to HIV care. Data were collected through surveys assessing demographic factors, mental health conditions, and social support. HIV attendance data was collected from HIV clinic register. Retention in HIV care was defined as having at least one clinic visit within the last 6 months over a 12-month study period. Negative binomial regression was used to analyze the association between retention in care and mental health disorders, adjusting for sociodemographic characteristics. Results: The study population had a median age of 32 years, and the majority were female (n=88, 66%) and refugees (n=123, 60%). The proportion not retained in care was 60% (n=124). There was no significant association between retention in care and anxiety, depression, PTSD, or lack of social support. Mental health disorders were moderately correlated with each other, while social support showed minimal correlation with mental health measures. Sociodemographic characteristics showed no consistent association with mental health or social support. Conclusion: There was no significant association between mental health disorders and lack of social support with retention in HIV care among refugees in Nakivale Refugee Settlement. However, a substantial proportion of refugees experienced a high mental health burden, and retention in care was alarmingly low. These findings highlight the urgent need for targeted interventions addressing mental health and improving HIV care for refugees in the settlement. Further research is warranted to explore additional factors influencing retention in HIV care and to develop effective strategies to optimize HIV care outcomes among this population.