Increasing Access to Care and Support Services for HIV-Positive Homeless Individuals: A Harlem-based Model Implementation

Engagement in Primary Care for people living with HIV/AIDS (PLWH/A) contributes to better health outcomes. Unfortunately, structural barriers such as stigma, discrimination based on race/ethnicity or socio-economic factors, prevent PLWH/A from being retained in care. Given these challenges, employing appropriate interventions is essential.

In 2010, Harlem United (HU), a community-based organization in Harlem, New York, conducted a study on factors affecting retention in care (RIC) and found that a patient navigation system increases patients' likelihood to be linked and retained in care. Hence, HU developed Access to Care (ATC) program targeting PLWH/A, high-risk homeless individuals, high utilizers of emergency rooms and detox facilities to promote linkage and RIC, provide supportive services, and facilitate re-entry into care. The program offers supportive case management, patient navigation and re-engagement, support groups, psychosocial assessments, health education, treatment adherence counseling, housing placement assistance, and benefits/insurance enrollments.

To evaluate ATC program effectiveness, a cross-sectional study was conducted comparing RIC among patients who received ATC services (ATC group) and those who did not (non-ATC group). Sample size and patients' characteristics in each group were matched to ensure comparability. Crosstab analysis revealed 89% of patients in ATC group were retained, compared to 75% in non-ATC group. Chi-square test yields ÷2(1, N=158) = 5.11, p=.024, indicating that despite similar characteristics distribution, RIC among ATC and non-ATC groups was significantly different, implying ATC program efficacy in retaining HU's target population.

Through Continuous Quality Improvement model, the ATC program systematically evaluates quality of services to increase pathways to care.