Despite the wide availability of antiretroviral therapy (ART) as an effective treatment option for HIV, a substantial portion of people with HIV (PWH) in the United States remain out of care or inconsistently take their medications, leading to an unsuppressed viral load despite diagnosis—a critical gap that undermines both individual health outcomes and public health objectives.

The factors that contribute to sub-optimal care engagement and frequent emergency department (ED) utilization may overlap. However, little is known about ED utilization patterns and social drivers of health (SDOH) among PWH who are sub-optimally engaged. In this study we examined ED visits among PWH with an unsuppressed viral load over a two-year period from January 1, 2021, to December 31, 2023, at a large, urban, academic ED. Among 198 PWH who were not virally suppressed, we found that almost half (45%) reported unstable housing or homelessness, 41% had a psychiatric diagnosis, and 64% reported using one or more substances. The average number of ED visits per individual during the study period was 7 and the median was 4 visits. Using a multivariate linear regression model, we found that housing instability, younger age, history of schizophrenia, total number of comorbidities and substance use were positively associated with higher ED utilization.

Understanding patterns of ED utilization among sub-optimally engaged PWH and SDOH affecting them will provide a foundation to create targeted interventions to improve the linkage of these individuals to care and to achieve sustained viral suppression.