Community Mental Health Services Siting Distance and Antiretroviral Therapy Adherence Among HIV-Positive Clients in Ugandan Districts: A Geographic Regression Discontinuity Analysis

The siting of community mental health services relative to the populations they serve is a structural determinant of whether HIV-positive clients with co-occurring mental disorders can sustain antiretroviral therapy adherence. The design exploits the discontinuity in service exposure that arises when districts are assigned to catchment areas by administrative rule rather than by client characteristics. The paper specifies the identification assumptions, the estimation strategy, the bandwidth selection procedure and the sensitivity analyses required to defend a causal interpretation. It further reports the distributional properties of a real DHS Program indicator on contraceptive method knowledge across 38 African countries and 162 country-survey observations between 1986 and 2025, with a mean of 91.776 and a standard deviation of 11.342, as a calibration benchmark for the measurement model that the design requires. The contribution is methodological: it specifies how geographic discontinuities in community mental health service siting can be exploited to identify adherence effects, and it states the boundary conditions under which the design fails. The paper does not report empirical estimates of the siting-distance effect; it specifies the design that would produce them and the assumptions under which those estimates would be credible.