Telemental Healthcare and HIV Care: A National Study of US Veterans with HIV during COVID-19

People with HIV often experience mental health disorders that can hinder engagement in HIV care. Mental health symptoms can be exacerbated during disruptive events such as the COVID-19 pandemic. Telemental healthcare (i.e., synchronous audio/visual mental health treatment) expanded rapidly within the Veterans Health Administration in response to pandemic-related barriers and may play a role in facilitating HIV care engagement. This study examined whether receipt of telemental healthcare was associated with engagement in HIV care among Veterans with HIV (VWH) before and during the first two years of the COVID-19 pandemic. This retrospective cohort study analyzed national Veterans Health Administration data (March 2019-March 2022) for 11,953 VWH. HIV care engagement was defined as attending at least one HIV care encounter per 12-month period. Telemental healthcare was defined as attending a video telehealth mental health encounter. Cross-lagged path models tested autoregressive, concurrent, and cross-lagged relationships among telemental healthcare and HIV care engagement across three time periods: pre-pandemic (Time 1), first pandemic year (Time 2), and second pandemic year (Time 3). The proportion of mental healthcare delivered via video telehealth rose from 3% before the pandemic, to greater than 35% by Time 2 and Time 3. Path analyses did not demonstrate that pre-pandemic telemental healthcare increased subsequent HIV care engagement. However, there were significant concurrent associations. Telemental healthcare may help VWH remain connected to HIV care during major disruptions such as the COVID-19 pandemic. Findings underscore the importance of offering flexible, integrated treatment modalities to promote continuous healthcare engagement among vulnerable populations.