Models of care for HIV positive adults with co-occurring conditions: Homelessness, substance abuse, and mental illness

Background: Homelessness, substance abuse, mental illness, and HIV complicate each other in ways that are not well understood. This presentation will examine the role of housing (unstable housing/homelessness) for people living with HIV/AIDS (PLWHA) who have co-morbid conditions and the associated health disparities.

Methods: Primary data were collected by a national multi-site evaluation of 21 demonstration projects serving 2120 homeless or unstably housed substance using adults, with high rates of psychiatric disorder. Qualitative data obtained from funding proposals, procedure manuals, evaluation plans, site visit reports were coded using categories developed in collaboration with an Advisory Group comprised of researchers, clinicians, service providers, policy experts, and consumers. Cluster analytical techniques were used to reduce multiple indicators depicting program differences into a smaller set of theoretically meaningful and empirically tractable variables.

Results: Episodes of unstable housing/ homelessness among PLWHA are common during the course of their illness. Service models that focus on addressing housing needs, emphasize care coordination at the client level, and include patient navigation and follow-up activities that take staff into the community appear to be more successful in connecting homeless multiply diagnosed PLWHA to drug treatment, mental health, and HIV medical services than service integration emphasizing formal links among providers.

Conclusions: The housing needs of PLWHA must be addressed in order to effectively treat their co-morbidities. Alternative approaches to defining models of care for use in outcome studies of housing-based interventions may be advantageous.