Methods
depression, PWH, anxiety, ideation
The PACE trial combined mental health and substance use screening measures into a single, self-report questionnaire systematically administered via online secure message or in-clinic tablets. The questionnaire was offered every 6 months to PWH, in connection with their regular primary care appointments. [The questionnaire combined several measures into a single instrument that was sent to the patient prior to their visit: The Tobacco, Alcohol, Prescription medication and other Substance use (TAPS) instrument [We compared the proportion of eligible visits with a completed screen, and the proportion of positive screens for depression, suicidal ideation, anxiety, and substance use before and after the start of regional COVID-19 shelter-in-place orders on March 17, 2020. We estimated adjusted prevalence ratios (aPRs) using generalized estimating equations (GEE) with robust standard errors to account for multiple visits contributed by patients. Models were adjusted for demographics (age, sex, self-reported race/ethnicity); HIV risk factors (men who have sex with men [MSM], injection drug use [IDU], Heterosexual, Other); Medical Center (Oakland, Sacramento, San Francisco); and screening modality (online, tablet). Analyses were performed using Proc Genmod in SAS v. 9.4 (Cary, NC).To evaluate how the COVID-19 pandemic impacted patient care, particularly screening and treatment for mental health and substance use, we also conducted interviews with an HIV care provider from each site (including authors JF and MNL). We used convenience sampling to select a participating HIV provider at each study site after the onset of the pandemic. Verbal informed consent was obtained from providers, who did not receive compensation for participation. Interviews lasted approximately 30 min and were audio recorded and transcribed.We used a thematic approach to analyze qualitative interview data, combining deductive and inductive reasoning, for coding and analysis. [All study procedures were approved by the Kaiser Permanente Northern California and University of California, San Francisco Institutional Review Boards and carried out in accordance with required guidelines and regulations.