The Health Impact of Supportive Housing for HIV-positive Homeless Patients: a Randomized Controlled Trial

Overview

Journal Am J Public Health

Specialty Public Health

Date 2009 Apr 18

PMID 19372524

Citations 81

Authors

David Buchanan

Romina Kee

Laura S Sadowski

Diana Garcia

Affiliations

Soon will be listed here.

Abstract

Objectives: We assessed the health impact of a housing and case management program, the Chicago Housing for Health Partnership, for homeless people with HIV.

Methods: HIV-positive homeless inpatients at a public hospital (n = 105) were randomized to usual care or permanent housing with intensive case management. The primary outcome was survival with intact immunity, defined as CD4 count > or = 200 and viral load < 100,000. Secondary outcomes were viral loads, undetectable viral loads, and CD4 counts.

Results: Outcomes were available for 94 of 105 enrollees (90%). Of 54 intervention participants, 35 (65%) reached permanent housing in program housing agencies. After 1 year, 55% of the intervention and 34% of the usual care groups were alive and had intact immunity (P = .04). Seventeen intervention (36%) and 9 usual care (19%) participants had undetectable viral loads (P = .051). Median viral loads were 0.89 log lower in the intervention group (P = .03). There were no statistical differences in CD4 counts.

Conclusions: Homelessness is a strong predictor of poor health outcomes and complicates the medical management of HIV. This housing intervention improved the health of HIV-positive homeless people.

Citing Articles

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References

Stefancic A, Tsemberis S . Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: a four-year study of housing access and retention. J Prim Prev. 2007; 28(3-4):265-79. DOI: 10.1007/s10935-007-0093-9. View

Hwang S . Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000; 283(16):2152-7. DOI: 10.1001/jama.283.16.2152. View

Moss A, Hahn J, Perry S, Charlebois E, Guzman D, Clark R . Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study. Clin Infect Dis. 2004; 39(8):1190-8. DOI: 10.1086/424008. View

Hibbs J, Benner L, KLUGMAN L, Spencer R, Macchia I, Mellinger A . Mortality in a cohort of homeless adults in Philadelphia. N Engl J Med. 1994; 331(5):304-9. DOI: 10.1056/NEJM199408043310506. View

PFEIFER R, Oliver J . A study of HIV seroprevalence in a group of homeless youth in Hollywood, California. J Adolesc Health. 1997; 20(5):339-42. DOI: 10.1016/S1054-139X(97)00038-4. View

Tsemberis S, Gulcur L, Nakae M . Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. 2004; 94(4):651-6. PMC: 1448313. DOI: 10.2105/ajph.94.4.651. View

Zolopa A, Hahn J, Gorter R, Miranda J, Wlodarczyk D, Peterson J . HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. JAMA. 1994; 272(6):455-61. View

Peter J, Sevall J . Molecular-based methods for quantifying HIV viral load. AIDS Patient Care STDS. 2004; 18(2):75-9. DOI: 10.1089/108729104322802506. View

Bucher J, Thomas K, Guzman D, Riley E, Dela Cruz N, Bangsberg D . Community-based rapid HIV testing in homeless and marginally housed adults in San Francisco. HIV Med. 2007; 8(1):28-31. DOI: 10.1111/j.1468-1293.2007.00423.x. View

10.

Milby J, Schumacher J, Vuchinich R, Wallace D, Plant M, Freedman M . Transitions during effective treatment for cocaine-abusing homeless persons: establishing abstinence, lapse, and relapse, and reestablishing abstinence. Psychol Addict Behav. 2004; 18(3):250-6. DOI: 10.1037/0893-164X.18.3.250. View

11.

Buchanan D, Doblin B, Sai T, Garcia P . The effects of respite care for homeless patients: a cohort study. Am J Public Health. 2006; 96(7):1278-81. PMC: 1483848. DOI: 10.2105/AJPH.2005.067850. View

12.

Zanis D, McLellan A, Cnaan R, Randall M . Reliability and validity of the Addiction Severity Index with a homeless sample. J Subst Abuse Treat. 1994; 11(6):541-8. DOI: 10.1016/0740-5472(94)90005-1. View

13.

Gelberg L, Gallagher T, Andersen R, Koegel P . Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997; 87(2):217-20. PMC: 1380797. DOI: 10.2105/ajph.87.2.217. View

14.

Robertson M, Clark R, Charlebois E, Tulsky J, Long H, Bangsberg D . HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004; 94(7):1207-17. PMC: 1448423. DOI: 10.2105/ajph.94.7.1207. View

15.

Surratt H, INCIARDI J . HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA. AIDS Care. 2004; 16(5):594-604. DOI: 10.1080/09540120410001716397. View

16.

Hahn J, Bangsberg D, McFarland W, Charlebois E, Clark R, Moss A . HIV seroconversion among the homeless and marginally housed in San Francisco: a ten-year study. J Acquir Immune Defic Syndr. 2004; 37(5):1616-9. DOI: 10.1097/00126334-200412150-00015. View

17.

Herndon B, Asch S, Kilbourne A, Wang M, Lee M, Wenzel S . Prevalence and predictors of HIV testing among a probability sample of homeless women in Los Angeles County. Public Health Rep. 2003; 118(3):261-9. PMC: 1497530. DOI: 10.1093/phr/118.3.261. View

18.

Hwang S, Orav E, OCONNELL J, Lebow J, Brennan T . Causes of death in homeless adults in Boston. Ann Intern Med. 1997; 126(8):625-8. DOI: 10.7326/0003-4819-126-8-199704150-00007. View

19.

Hwang S, Lebow J, Bierer M, OCONNELL J, Orav E, Brennan T . Risk factors for death in homeless adults in Boston. Arch Intern Med. 1998; 158(13):1454-60. DOI: 10.1001/archinte.158.13.1454. View

20.

Breakey W, Fischer P, Kramer M, Nestadt G, Romanoski A, Ross A . Health and mental health problems of homeless men and women in Baltimore. JAMA. 1989; 262(10):1352-7. View