Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic

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

Diets, Food Choices and Environmental Impacts across an Urban-Rural Interface in Northern Vietnam

Human diets and their associated environmental impacts differ across segments of the population. There is evidence that consumer choices of food intake can also affect the overall environmental impacts of a food system. This paper analyzes the environmental impact of diets and food choices across a rural–urban transect in Northern Vietnam by using mixed survey data from 619 adult respondents. The average greenhouse gas emissions (GHGE) resulting from producing the daily food intake of adults in the urban and peri-urban districts were similar, while the average in the rural district was lower. Although starchy staples contributed the most to energy intake, pork and beef were the largest contributors to GHGE. Metrics of blue water use were higher for diets of males than those of females in all three districts. Interestingly, the difference in mean diet diversity score between urban and rural households was significant, and females’ diets were more diverse than those of males. As expected, urban households were more likely to buy food, while rural households often produced their own foods. Urban households reported prioritizing personal health and the natural content of food and would increase seafood and fruits if their income were to increase. In rural regions, interventions aimed at reducing undernutrition should address improving diet quality without significant increases to diet-related environmental impacts