HIV / STI
Mental health disorders and all-cause hospitalizations among people with HIV before and during the COVID-19 pandemic in the US Xianming Zhu* Xianming Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Zhu Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
Background: Over half of people with HIV (PWH) have a mental health disorder (MHD), which may elevate their hospitalization risk. Limited studies of the impact of the COVID-19 pandemic on PWH with MHD have produced mixed results. We examined disparities in hospitalization rate among PWH by MHD before and during the pandemic.
Methods: We included PWH (>18 years) enrolled in 9 US cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) with available MHD and hospitalization data from 01/01/2018-12/31/2021, who had ≥1 CD4 or HIV viral load measurement or hospitalization two years before or during study period. Diagnoses of schizophrenia/schizoaffective disorder (SZ/SZA), bipolar, depression, and anxiety were time-varying and based on ICD-10 codes. Negative binomial models with generalized estimating equation were used to estimate the all-cause hospitalization rate ratio comparing those with vs without each MHD, with an interaction term between MHD and the COVID-19 pandemic (before vs after 03/01/2020), and were adjusted for cohort, age, sex, race/ethnicity, HIV acquisition group, and HIV viral suppression at this study entry.
Results: A total of 62,408 PWH were included (88% male, 44% Black, median age 54 [IQR: 41-62] years, 52% had any MHD). Across all MHD examined, PWH with (vs without) each MHD had a higher hospitalization rate both before and during the pandemic, with the rate declined in all groups. Disparities in hospitalization rate among PWH with (vs without) SZ/SZA and bipolar disorder marginally narrowed during vs before the pandemic, while disparities among PWH with (vs without) other MHD remained similar across the two time periods.
Conclusions: PWH with MHD may be a target group for preventing hospitalizations. Future research is needed to explore factors contributing to the decline in hospitalization rate among PWH with MHD during the pandemic, such as the impact of telehealth, limited elective surgeries, and social demands.
