The impact of the COVID-19 pandemic on mental health care utilization among people living with HIV: A real-world data study

Abstract Objective The COVID-19 pandemic has profoundly impacted mental health worldwide, particularly among vulnerable populations such as people living with HIV (PLWH). However, large-scale, real-world data on mental health care utilization and associated factors among PLWH remain limited. This study leveraged electronic health records (EHR) and Basics survey data from the All of Us program to explore mental health care utilization and associated factors among PLWH during the COVID-19 pandemic. Methods Using a retrospective cohort design, we identified and included 4, 575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) concept sets from the All of Us program between March 2018 and March 2022. Mental health care utilization was measured using the yearly count of mental health care visits over this period. The pattern of mental health care utilization was compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRR) from the Poisson generalized linear mixed models (GLMM) were used to examine associations between mental health care utilization, history of COVID-19 infection, demographic factors, pre-existing chronic conditions (e. g. , hypertension, diabetes), and socioeconomic status. Results Among 4, 575 PLWH, the annual number of mental health care visits decreased significantly during the pandemic period (March 2020 – March 2022) compared to the pre-pandemic period (March 2018 – February 2020) (IRR = 0. 89, p 35, 000), had lower mental health care utilization. Meaning Our study highlights the diverse and unequal experiences of PLWH during the pandemic, with variations in mental health care utilization over time and across different disadvantaged subgroups. These findings underscore the need for timely and targeted mental health care services and delivery in future public health crises.