Difference in healthcare utilization trends associated with suicide death in people living with and without HIV in British Columbia, Canada, from 1998 to 2020

People living with HIV (PLWH) face disproportionate rates of suicide death despite improvements in quality of life with antiretroviral therapy. Effective preventative efforts necessitate an understanding of healthcare utilization trends prior to suicide death for PLWH to facilitate the identification of areas for improvement in screening and prevention. The present study aimed to identify patterns of healthcare utilization in PLWH who died by suicide using a population-based cohort design. Administrative datasets from British Columbia, Canada were analyzed using unadjusted and adjusted logistic regression models to assess healthcare utilization in the 90-day period prior to suicide death for 98 PLWH and 170 age- and sex-matched people without HIV (PWoH). PLWH were found to have greater rates of healthcare engagement prior to suicide death, with increased likelihood of any healthcare visit and a greater median count of total healthcare visits compared to controls. Despite this, no significant difference in degree of engagement with mental healthcare and self-harm healthcare services was observed between PLWH and PWoH. These findings suggest that PLWH who die by suicide engage with the healthcare system more than their counterparts without HIV, and point to the importance of differential screening and prevention strategies for PLWH on antiretroviral therapy.