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The study investigates how mental healthcare utilisation among people living with HIV was affected during the COVID-19 pandemic compared to before it.

February 12, 2026Open Access

Changes in Mental Health Care Utilisation Before and During the COVID-19 Pandemic Among People Living With HIV In the USA: A Retrospective Cohort Study Using the All of US Dataset

Key Points

The study investigates how mental healthcare utilisation among people living with HIV was affected during the COVID-19 pandemic compared to before it.
Retrospective cohort design using data from the All of Us programme.
Identified 4575 people living with HIV from March 2018 to March 2022.
Compared yearly counts of mental healthcare visits between pre-pandemic (2018–2020) and during the pandemic (2020–2022).
Applied Poisson generalised linear mixed models to assess associations with mental healthcare utilisation.
Mental healthcare visits among people living with HIV significantly decreased during the pandemic compared to pre-pandemic (IRR=0.89, p<0.001).
Higher visit counts were linked to COVID-19 infection (IRR=1.35, p<0.001), one or more comorbidities, and Medicaid insurance.
Middle-aged individuals (30-39 years: IRR=2.35; 40-49 years: IRR=3.49; 50-64 years: IRR=2.07) had notably higher visit numbers versus younger individuals.
Black or African American individuals and those with certain types of insurance had fewer visits compared to white individuals.

Abstract

Introduction Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic. Methods Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared between pre-pandemic (2018–2020) and during the pandemic (2020–2022). Incidence rate ratios (IRRs) from the Poisson generalised linear mixed models were used to examine associations between mental healthcare utilisation, history of COVID-19 infection, demographic factors, pre-existing chronic conditions and socioeconomic status. Results Annual number of mental healthcare visits among PLWH decreased significantly during the pandemic compared with pre-pandemic (IRR=0.89, p< 0.001). COVID-19 infection (IRR=1.35, p< 0.001), pre-existing comorbidities (one comorbidity: IRR=5.49; two or more: IRR=10.4, p< 0.001) and Medicaid health insurance (IRR=1.29, p=0.007) were associated with a higher number of visits. Middle-aged group participants (aged 30–39: IRR=2.35, p=0.002; 40–49: IRR=3.49, p< 0.001 and 50–64: IRR=2.07, p=0.004) had higher visit numbers compared with the youngest group (18–29 years). Compared with white participants, black or African American (IRR=0.71, p=0.002) and those with employer-sponsored or union-sponsored insurance (IRR=0.54, p< 0.001) had fewer visits. Conclusion This study reveals a decrease in mental healthcare utilisation and diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. Addressing these disparities is crucial, particularly during public health emergencies.

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