PROJECT SUMMARY Approximately half of all people with HIV (PWH) in the United States (US) have one or more mental health disorder. Ending the HIV Epidemic in the US requires addressing the mental health needs of, and improving HIV treatment outcomes for, PWH with mental health disorders. The goal of this project is to advance our understanding of the impact of the COVID-19 pandemic – a disruption to HIV research and care – on the mental health and HIV treatment outcomes of PWH in the US. The COVID-19 pandemic is a significant risk to mental health. Mental health symptoms among PWH have been exacerbated during the COVID-19 pandemic due to physical distancing restrictions, increased material hardship, decreased social support, concerns about COVID-19 exposure, infection and long COVID, and disruption to mental health services. Beyond symptoms, an important question remains unanswered: “Did COVID-19 increase the burden of diagnosed mental health disorders and/or psychiatric-related hospitalizations in PWH?” Mitigation policies to reduce the spread of SARS-CoV-2 led to restricted access to routine non-emergent healthcare, interfering with routine HIV monitoring and perhaps increasing hospitalizations particularly among PWH with mental health disorders, posing the question: “Was the frequency of unsuppressed HIV viral load and hospitalization different in PWH with (vs. without) diagnosed mental health disorders before and during the pandemic?” Our team consists of clinicians and epidemiologists with expertise in mental health, HIV, and COVID-19. We propose to leverage the research infrastructure of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), the largest and most diverse collaboration of longitudinal HIV cohorts in the US, to examine the COVID-19-related impact on mental health and HIV treatment outcomes. The specific aims for this 3-year project are: Aim 1: To examine trends and differences in the incidence rates of mental health diagnoses and psychiatric-related hospitalizations among PWH in the US before and during the COVID-19 pandemic. Aim 2. Aim 2. To evaluate the extent to which mental health- disparities in the rates of unsuppressed HIV viral load and all-cause hospitalization widened during the COVID-19 pandemic among PWH. This study directly addresses the priorities of the National Institute of Mental Health in the funding opportunity Urgent Award: COVID-19 Mental Health Research (PAR-22-113). Our aims will rapidly generate critical evidence of the impact of the COVID-19 pandemic on the mental health and HIV treatment outcomes among PWH in the US (overall and within 9 key subgroups), inform strategies to mitigate such impacts on PWH during and after the COVID-19 pandemic, and improve preparedness for future public health emergencies.

PROJECT NARRATIVE An estimated 50% of people with HIV (PWH) in the United States (US) have one or more mental health disorders, and the COVID-19 pandemic is likely to have increased and exacerbated this burden. This research will advance understanding of the impact of the COVID-19 pandemic – a worldwide disruption to HIV research and care – on the mental health diagnoses and HIV treatment outcomes of PWH with (compared to without) mental health disorders. Our findings will clarify the impact of the COVID-19 pandemic on (a) new diagnoses of mental health disorders, (b) psychiatric-related hospitalizations, (c) HIV suppression efforts necessary for Ending the HIV Epidemic in the US, (d) hospitalization for any cause, and inform the development of strategies to mitigate such impacts on PWH during and after future pandemics or other public health emergencies.