Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic.
BMC Health Serv Res
; 23(1): 494, 2023 May 16.
Artículo
en Inglés
| MEDLINE | ID: covidwho-2324349
ABSTRACT
BACKGROUND:
Mental health and substance use disorders disproportionately affect people with HIV (PWH), and may have been exacerbated during COVID-19. The Promoting Access to Care Engagement (PACE) trial was designed to assess the effectiveness of electronic screening for mental health and substance use in HIV primary care and enrolled PWH from October 2018 to July 2020. Our objective here was to compare screening rates and results for PWH before (October 2018 - February 2020) and early in the COVID-19 pandemic (March-July 2020).METHODS:
Adult (≥ 18 years) PWH from 3 large HIV primary care clinics in a US-based integrated healthcare system were offered electronic screening online or via in-clinic tablet computer every 6 months. Screening completion and results (for depression, suicidal ideation, anxiety, and substance use) were analyzed using logistic regression with generalized estimating equations to estimate prevalence ratios (PR) before and after the start of the regional COVID-19 shelter-in-place orders on March 17, 2020. Models adjusted for demographics (age, sex, race/ethnicity), HIV risk factors (men who have sex with men, injection drug use, heterosexual, other), medical center, and modality of screening completion (online or tablet). We conducted qualitative interviews with providers participating in the intervention to evaluate how the pandemic impacted patient care.RESULTS:
Of 8,954 eligible visits, 3,904 completed screenings (420 during COVID, 3,484 pre-COVID), with lower overall completion rates during COVID (38% vs. 44%). Patients completing screening during COVID were more likely to be White (63% vs. 55%), male (94% vs. 90%), and MSM (80% vs., 75%). Adjusted PRs comparing COVID and pre-COVID (reference) were 0.70 (95% CI), 0.92 (95% CI), and 0.54 (95% CI) for tobacco use, any substance use, and suicidal ideation, respectively. No significant differences were found by era for depression, anxiety, alcohol, or cannabis use. These results were in contrast to provider-reported impressions of increases in substance use and mental health symptoms.CONCLUSION:
Findings suggest PWH had modest declines in screening rates early in the COVID-19 pandemic which may have been affected by the shift to telemedicine. There was no evidence that mental health problems and substance use increased for PWH in primary care. TRIAL REGISTRATION NCT03217058 (First registration date 7/13/2017); https//clinicaltrials.gov/ct2/show/NCT03217058.Palabras clave
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
/
Trastornos Relacionados con Sustancias
/
Minorías Sexuales y de Género
/
COVID-19
Tipo de estudio:
Estudios diagnósticos
/
Estudio experimental
/
Estudio observacional
/
Estudio pronóstico
/
Investigación cualitativa
/
Ensayo controlado aleatorizado
Tópicos:
Covid persistente
/
Variantes
Límite:
Adulto
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
BMC Health Serv Res
Asunto de la revista:
Investigación sobre Servicios de Salud
Año:
2023
Tipo del documento:
Artículo
País de afiliación:
S12913-023-09477-6
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