Association of integrated psychosocial support with retention in care and viral suppression among women living with HIV in the Central African Republic: a retrospective cohort study

Abstract Background Mental health disorders, stigma, and social vulnerability may negatively influence treatment adherence and retention in care among women living with HIV (WLHIV). Evidence on psychosocial support interventions in fragile settings such as the Central African Republic remains limited. This study assessed the association between integrated psychosocial support and HIV treatment outcomes among WLHIV receiving antiretroviral therapy (ART) in Bangui. Methods We conducted a retrospective cohort study using routinely collected medical records from two HIV treatment centres in Bangui. Women aged ≥ 15 years who initiated ART between 1 January and 31 December 2022 were included and followed for 24 months. One centre provided an integrated psychosocial support programme in addition to routine HIV care, whereas the other provided standard care. Data were retrospectively collected between 1 March and 31 May 2025 from paper medical records and the SANTIA electronic database. Outcomes included retention in care, attrition, and viral suppression (< 40 copies/mL) at 24 months. Kaplan-Meier methods and Cox proportional hazards models were used to assess factors associated with attrition. Results A total of 598 women were included, including 314 receiving psychosocial support and 284 receiving standard care. Attrition during follow-up was lower among women receiving psychosocial support than among those receiving standard care (21.0% vs. 39.1%). Retention probability at 24 months was higher in the psychosocial support group (79% vs. 61%; log-rank p < 0.001). Viral suppression at 24 months was also higher among women receiving psychosocial support (78.6% vs. 69.4%; p = 0.031). In multivariable analysis, psychosocial support was associated with a lower risk of attrition (aHR = 0.44, 95% CI: 0.31–0.61 ; p < 0.001), while disclosure of HIV status to a partner was also associated with lower attrition (aHR = 0.69, 95% CI: 0.49–0.96 ; p = 0.031). Conclusions Among WLHIV in Bangui, care in a facility offering integrated psychosocial support was associated with higher retention in care, lower attrition, and higher viral suppression over 24 months. Given the observational design and facility-level definition of exposure, these findings should be interpreted as associations rather than evidence of causality. Further prospective studies are warranted to evaluate the contribution of specific psychosocial support components to HIV treatment outcomes.