Shifting neuropsychiatric diagnoses across the antiretroviral therapy era at an urban Ugandan HIV centre: a descriptive analysis of routinely collected electronic health records, 2017 to April 2026

BACKGROUND: As antiretroviral therapy (ART) coverage has matured in sub-Saharan Africa, the clinical profile of people living with HIV has shifted from acute opportunistic disease toward chronic neuropsychiatric morbidity. Few high-volume African HIV programmes have systematically described the full neuropsychiatric diagnostic architecture captured in their routine electronic records. We characterised the neuropsychiatric diagnoses recorded at Mildmay Uganda, an urban HIV centre serving approximately 14,500 active patients. METHODS: We conducted a descriptive analysis of routinely collected, de-identified electronic health-record data extracted from the ClinicMaster electronic medical record on 25 April 2026. Records with at least one ICD-10-coded neuropsychiatric diagnosis between 31 October 2017 and 23 April 2026 were grouped into nine clinically defined diagnostic categories using a pre-specified code list (Supplementary Table S1). Analyses were conducted at two levels: a record level (all 1,137 records) and a patient-index level (one earliest record per patient, n = 581). The design was cross-sectional and descriptive; no longitudinal follow-up, incidence or time-to-event analyses were undertaken. Proportions are reported with 95% Wilson confidence intervals where patients were the independent unit. Missing data were quantified rather than imputed. RESULTS: The dataset comprised 1,137 records from 581 patients (median 1 record per patient, IQR 1 to 2, maximum 13). Patients were 60.6% female (352/581) with a median age of 44 years (IQR 35 to 52). At the record level, four groups accounted for 90.6% of records: major depressive disorder (302; 26.6%), opportunistic CNS infection (293; 25.8%), HIV-attributed and other organic CNS disorders (256; 22.5%) and bipolar spectrum disorder (179; 15.7%). At the patient-index level, opportunistic CNS infection was the most common index presentation (206; 35.5%, 95% CI 31.7 to 39.4). A clinically coherent ART-duration gradient separated opportunistic CNS infection (median 0.2 years on ART at diagnosis) from chronic neuropsychiatric diagnoses recorded after several years of treatment (Kruskal-Wallis p < 0.001). Among the 406 index patients with viral-load data (69.9%), 82.5% (95% CI 78.5 to 85.9) were suppressed below 1,000 copies/mL. Record-level viral-load completeness ranged from 51.0% (2020) to 87.0% (2019) across the observation period, with an overall availability of 76.5% (870/1,137). CD4 count at ART initiation was unavailable for all records. CONCLUSIONS: These routine data document a measurable treatment-era shift from acute CNS opportunistic disease toward chronic neuropsychiatric diagnoses among people living longer on ART. The findings are descriptive and hypothesis-generating, constrained by reliance on clinician-assigned ICD-10 codes. With standardised neuropsychiatric assessment, this routine-data platform can support prospective brain-health research and mental-health service integration in urban Ugandan HIV care.