Discussion
ideation, PWH, anxiety, MSM, depression
LITTLE
In this study of PWH asked to complete substance use and mental health screening prior to regular HIV primary care appointments both before and after the onset of the COVID pandemic, overall mental health and substance use screening rates decreased. Self-reported suicidal ideation, tobacco use, and any substance use also decreased.One possible explanation for the decrease in screening rates is that the questionnaire was intended to be given prior to regularly scheduled primary care visits, many of which were cancelled or delayed due to COVID transmission risk, resulting in reduced care engagement by PWH. This may have resulted in lower completion rates for appointments that shifted from in-person visits to telemedicine. Similarly, other studies have also shown decreases in care during this time for the general population [Online completions required patients to have access to KP.org secure messaging to complete the questionnaire online prior to their appointment. Prior to COVID, the Oakland and Sacramento sites had similar rates for tablet (in-person) vs. online screening completion, while San Francisco skewed heavily towards online completions. During early COVID, the majority of completed appointments across all three sites shifted to a telemedicine (online) model. San Francisco was the only site that saw an increase in screening rates, which may indicate that their population was more comfortable with virtual care delivery, as compared with the other two sites.Across all three sites, PWH who completed the study questionnaire during early COVID were more likely to be White, male, and MSM as compared with pre-COVID. It is worth noting that the demographics of the San Francisco site reflect the older, White MSM who make up the population of PWH in the city, as compared with the Oakland and Sacramento sites, who are younger and include greater proportions of racial/ethnic minority PWH, women, and heterosexual PWH [No differences were found in self-reported levels of depression and anxiety. These results are in contrast to previous work showing increases in depression and anxiety in PWH during the early pandemic [Although no differences were found in reported depression and anxiety, we did find a decrease in potential suicidal ideation during early vs. pre-COVID. Little has been published on suicidality in PWH during the early pandemic. One mixed methods study of PWH in the United Kingdom (UK) during a similar time period (May-July 2020) found 19.8% reporting suicidal thoughts at any point. [Finally, we also noted decreases in tobacco use and any substance use, and no differences for alcohol or cannabis use. These findings are consistent with prior work showing that smoking and illicit drug use were lower in PWH during the pandemic. [Although reasons for the contrasting observations of clinicians and patient-reported symptoms are not clear, it is possible that concerns about patient well-being during the pandemic may have influenced provider’s perceptions, or that contact with a small number of higher-severity patients (including perhaps ones who did not complete screening) influenced their perceptions.