Thoughts of Death or Self-injury, Non-same-day ART Initiation, and 2-year Incidence of Disengagement from Care Among People Entering HIV Care in Cameroon.

Thoughts of death or self-injury and the clinical implications of such thoughts remain largely underassessed among people with HIV (PWH) in Africa. As strong predictors of suicidal ideation and death by suicide, it is paramount to understand these risk indicators, particularly in populations with heightened susceptibility to poor mental health. We aimed to characterize thoughts of death or self-injury (i.e., self-injurious thoughts) and their relationship with non-same-day (i.e., delayed) anti-retroviral treatment (ART) initiation and longitudinal disengagement from clinic in a cohort of PWH newly entering HIV care in Cameroon. We conducted structured interviews with PWH aged 21 + initiating clinical care between June 2019 and March 2020. Clinical records were used to ascertain ART initiation date and disengagement from the clinic across two years following care initiation. Log binomial regression was used to estimate the association between self-injurious thoughts at care initiation and delayed ART initiation. A Fine and Gray sub-distribution proportional hazards model was used to quantify the cumulative incidence of disengagement from the clinic (i.e., a gap in clinic visits > 183 days) and differences in these estimates across groups. Of 426 enrolled individuals, seventy-one (16.7%) endorsed self-injurious thoughts at entry into care, 24 (33.8%) of whom had active thoughts of self-injury. Self-injurious thoughts at entry into care were positively associated with delayed ART initiation (adjusted prevalence ratio = 1.8; 95% CI: 1.2, 2.9) and cumulative incidence of disengagement from clinic, though differences in disengagement were statistically non-significant. Interventions are urgently needed to support the mental health and well-being of PWH entering care and improve down-stream HIV treatment outcomes.