ABSTRACT
Background: Mental health complications are highly prevalent among people living with HIV. Left untreated mental health complications can negatively affect HIV treatment outcomes. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic. Lockdowns might induce or exacerbate mental health conditions and limit access to treatment. We studied the effect of the lockdown on mental health care use among HIV-positive beneficiaries of a South African private sector medical aid scheme. Methods: We performed an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of HIV-positive beneficiaries aged 18 years or older from a large private sector medical aid scheme. Weekly outpatient consultation and hospital admission rates were calculated for substance use disorders (ICD10 F10-F19), serious mental disorders (F20-F29, F31), depression (F32, F34.1, F54), anxiety (F40-F48), and any mental disorder (F00-F99). We estimated adjusted odds ratios (OR) for the effect of the lockdown on weekly hospital admission and outpatient consultation rates. Results: 61,873 adults living with HIV were followed up for a median of 151 weeks. Hospital admission rates (OR 0.38;95% CI 0.27-0.54) and outpatient consultation rates (OR 0.72;95% CI 0.64-0.82) for any mental disorder decreased substantially after the implementation of the lockdown in March 2020 and did not recover to pre-lockdown levels until June 1, 2020 (Figure). Substantial decreases were observed in hospital admissions rates for substance use disorders (OR 0.13;95% CI 0.02-0.73), depression (OR 0.30;95% CI 0.16-0.54), and serious mental disorders (OR 0.58;95%CI 0.17-2.02). Decreases in outpatient consultation rates were observed for substance use disorders (OR 0.21;95% CI 0.08-0.55), anxiety disorders (OR 0.64;95% CI 0.54-0.76), depression (OR 0.71;95% CI 0.62-0.82), and serious mental disorders (OR 0.85;95% CI 0.72-1.00). Conclusion: Reduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for people living with HIV and comorbid mental health complications. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.