HIV / STI
Mental health disparities in HIV Viral Suppression Before and During the COVID-19 Pandemic Among People With HIV: A Nested Cohort Study in NA-ACCORD, 2018–2021 Yue Zhang* Yue Zhang Zhang Zhang Zhang Zhang Zhang Zhang Zhang Zhang Zhang Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
Background: Mental health disorders (MHD) are common among people with HIV (PWH) and associated with viral non-suppression. During the COVID-19 pandemic, increases in MHD and disruptions in healthcare services may have affected both MHD diagnosis and HIV care. We evaluated the association between four MHD and unsuppressed VL among PWH before and during the pandemic.
Methods: We included PWH (≥18 years) enrolled in 11 U.S. cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) with available MHD data. Eligible participants were engaged in HIV care (≥1 clinical encounter or viral load [VL]) during both intervals: 09/01/2018–02/29/2020 (before pandemic) and 06/01/2020–12/31/2021 (during pandemic) . MHD of interest were clinical diagnoses (both prevalent and new diagnoses) of depression, anxiety, bipolar disorder, and schizophrenia/schizoaffective disorder (SCZ/SZA) based on ICD-10 codes. Logistic regression models with general estimating equations estimated adjusted ORs of unsuppressed VL (>200 copies/mL) for each MHD. Models included a term for pandemic period (before vs during), an interaction term between MHD and the pandemic period, and were adjusted for age, sex, race/ethnicity, HIV acquisition group, and baseline CD4 count.
Results: A total of 47,690 PWH (median age of 54 years, 88% male, 43% non-Hispanic Black) were included, with median follow-up time of 32 months. Diagnosis of any of the MHDs of interest (vs. no MHD) was associated with higher odds of unsuppressed VL before the pandemic and the magnitude of this association increased during the pandemic (Figure). Diagnosis of depression (vs. no depression, bipolar or SCZ/SZA), bipolar (vs. no bipolar or SCZ/SZA), or SCZ/SZA (vs. no SCZ/SZA or bipolar) were each independently associated with higher odds of unsuppressed VL before the pandemic, and the magnitude of all these associations increased during the pandemic. There was no association of anxiety and unsuppressed VL before or during the pandemic.
Conclusions: Disparities in unsuppressed VL widened among those with depression, bipolar disorder, or SCZ/SZA during the pandemic highlighting a need for targeted support of PWH with these MHD during future public health emergencies.
