Undiagnosed HIV Infection among Outpatient Attendees and Viral Suppression among Adults Receiving Antiretroviral Therapy in a Conflict-affected District of Southwest Cameroon: A Facility-based Study

Abstract Background Armed conflict can disrupt HIV testing, treatment continuity, and viral load monitoring, increasing the risk of delayed diagnosis and poor treatment outcomes. However, district-level evidence from conflict-affected areas of Cameroon remains limited. This study assessed undiagnosed HIV infection among adults attending outpatient care and viral suppression among clients receiving antiretroviral therapy (ART) in the conflict-affected Limbe Health District, Southwest Cameroon. Methods Two complementary facility-based analyses were conducted between November 2022 and June 2023. First, a cross-sectional survey of adults attending outpatient departments (N = 300) assessed HIV testing history and identified previously undiagnosed HIV infection through provider-initiated testing. Second, a retrospective review of clinical records for ART clients receiving treatment for at least six months (N = 534) evaluated viral suppression (< 1000 copies/mL) and associated factors. Because the two populations were distinct and unlinked, findings are presented as separate analyses. Penalized (Firth) logistic regression was used to examine factors associated with HIV positivity, while bivariate analyses were used to assess factors associated with viral suppression. Results Among 300 outpatient attendees (mean age 38.2 ± 14.0 years; 70.0% female), 24 (8.0%) were HIV-positive. Of these, 10 (41.7%) were previously undiagnosed, despite most reporting a prior HIV test. Unmarried participants had higher odds of HIV positivity than married participants, although the association was borderline (aOR = 2.29, 95% CI: 0.98–5.81; p = 0.057). Among 534 ART clients, 340 (63.7%) achieved viral suppression, while 194 (36.3%) were not suppressed. Viral suppression did not differ significantly by age or sex. Viral suppression differed markedly across adherence categories. All clients classified as having good adherence were virally suppressed, compared with 1.5% of those classified as having fair or poor adherence (Fisher's exact p < 0.001 ). Because adherence ratings incorporated viral-load information, this finding should be interpreted cautiously. Conclusions Substantial gaps in both HIV diagnosis and treatment outcomes persist in this conflict-affected district. Nearly half of HIV-positive outpatient attendees were previously undiagnosed, and more than one-third of ART clients had not achieved viral suppression. Strengthening repeat HIV testing, adherence support, viral load monitoring, and conflict-responsive HIV service delivery may improve outcomes in similar settings.