{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T14:17:57Z","timestamp":1780669077166,"version":"3.54.1"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,11,8]],"date-time":"2012-11-08T00:00:00Z","timestamp":1352332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The impact of severe mental illness (<jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content>) on retention in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> care remains uncertain. We aimed to measure the association between <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> at antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) initiation and subsequent retention in care in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected Ugandan adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We conducted cohort study of 773 patients who initiated <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> between <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>anuary 2005 and <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>uly 2009 at the <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>utabika <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> clinic in <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ampala, <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ganda. <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> was defined as any clinically diagnosed organic brain syndrome, affective disorder or psychotic disorder. We used <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>aplan\u2013<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>eier and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ox proportional hazards analysis to evaluate the association between <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> and retention in care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation was 23%. Patients with <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> at baseline were similar to those without <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> in terms of age (median [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>]: 35 [28\u201340] vs. 35 [30\u201340], <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03), sex (36% vs. 35% female, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.86) and baseline <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4+ T\u2010cell count (112 [54\u2013175] vs. 120 [48\u2013187] cells\/mm3, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.86). At 12\u00a0months after <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation, Kaplan\u2013Meier estimates of continuous retention in care were 65% (95% confidence interval, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 31\u201339%) among patients without <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content>,<jats:italic> vs<\/jats:italic>. 47% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 39\u201355%) among those with <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). All\u2010cause mortality in the two groups was similar: 1.2% vs. 2.0% (<jats:italic>P<\/jats:italic>\u00a0&gt;\u00a00.05). In multivariable analysis, the only baseline variable independently associated with breakage of continuous care was <jats:styled-content style=\"fixed-case\">SMI<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a01.58, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.06\u25002.33).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Severe mental illness at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation is associated with worse retention\u00a0in <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> care in this urban Ugandan referral hospital. As <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> is scaled up across sub\u2010Saharan Africa, greater attention must be paid to the burden of mental illness and its impact on retention in care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12019","type":"journal-article","created":{"date-parts":[[2012,11,9]],"date-time":"2012-11-09T05:00:52Z","timestamp":1352437252000},"page":"53-57","source":"Crossref","is-referenced-by-count":32,"title":["Severe mental illness at <scp>ART<\/scp> initiation is associated with worse retention in care among <scp>HIV<\/scp>\u2010infected <scp>U<\/scp>gandan adults"],"prefix":"10.1111","volume":"18","author":[{"given":"Jean B.","family":"Nachega","sequence":"first","affiliation":[{"name":"Department of Medicine and Centre for Infectious Diseases Stellenbosch University Cape Town South Africa"},{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Mutamba","sequence":"additional","affiliation":[{"name":"Butabika National Referral Mental Hospital Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Basangwa","sequence":"additional","affiliation":[{"name":"Butabika National Referral Mental Hospital Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoang","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Dowdy","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Mills","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Ottawa Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elly","family":"Katabira","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences University of Ottawa Ottawa ON Canada"},{"name":"Faculty of Health Sciences Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethel","family":"Nakimuli\u2010Mpungu","sequence":"additional","affiliation":[{"name":"Butabika National Referral Mental Hospital Kampala Uganda"},{"name":"Faculty of Health Sciences Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,11,8]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.4314\/ajpsy.v13i1.53429"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-010-9778-9"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2006.20.175"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200666060-00004"},{"key":"e_1_2_3_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-7358(97)00018-4"},{"issue":"6","key":"e_1_2_3_7_1","first-page":"27","article-title":"Schizophrenia and comorbid human immunodeficiency virus or hepatitis C virus","volume":"66","author":"Cournos F","year":"2005","journal-title":"The Journal of Clinical Psychiatry"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0B013E31822D490A"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.70.3.626"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2010.498939"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.163.8.1349"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.49.6.530"},{"key":"e_1_2_3_13_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.50.4.325"},{"key":"e_1_2_3_14_1","first-page":"5","article-title":"Effect of HIV infection on time to recovery from an acute manic episode","volume":"2","author":"Nakimuli\u2010Mpungu E","year":"2010","journal-title":"HIV\/AIDS \u2010 Research and Palliative Care"},{"key":"e_1_2_3_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-011-0087-8"},{"key":"e_1_2_3_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-008-0025-1"},{"key":"e_1_2_3_17_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0012715"},{"key":"e_1_2_3_18_1","first-page":"1602","article-title":"An empirical literature review of definitions of severe and persistent mental illness","volume":"147","author":"Schinnar AP","year":"1990","journal-title":"African Journal of Psychiatry"}],"container-title":["Tropical Medicine &amp; 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