142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

306358
Housing stability and HIV health among HIV-positive homeless persons placed into supportive versus independent housing

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:30 AM - 8:50 AM

Rachel Johnson, MPH , Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, Long Island City, NY
Laura McAllister-Hollod, MPH , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, NY
Sung woo Lim, MA, MS , Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, NY
Mary Irvine, DrPH , Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, Queens, NY
John Rojas, MPA , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, NY
Homeless persons living with HIV (PLWH) in New York City (NYC) commonly cycle between emergency shelters and stable housing, despite access to rental assistance and permanent housing placement. Housing stability is an essential structural factor for health among PLWH. Supportive housing programs include services to enhance management of HIV and co-morbidities. Using longitudinal administrative data and HIV surveillance data, we assessed whether placement in supportive versus independent housing was associated with improved housing stability and HIV health outcomes over 18 months.

We identified 792 homeless PLWH who obtained supportive (N=232) or independent (N=427) housing in 2010-11. At 6, 12 and 18 months we examined housing stability (housed at end of period), HIV care (≥1 HIV laboratory test, prior 6 months), and viral suppression (latest viral load ≤200). We performed optimal full matching using propensity scores predicted by baseline variables. Using a two-step estimation method, we conducted conditional logistic regression accounting for repeated measures and stratification due to propensity score matching.

At 18 months, 86% of PLWH were stably housed, 90% were engaged in HIV care, and 55% were virally suppressed. Compared to independent housing, supportive housing was associated with improved housing stability over 18 months (mOR 1.62, 95% CI 1.13–2.33). There was no difference in care or suppression.

In this population, supportive (versus independent) housing significantly predicted maintaining housing over time. Overall, engagement in care is high; viral suppression lags behind. These findings can inform the design of programs targeted to enhance housing stability and health among homeless PLWH.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe differential long-term housing and health outcomes experienced over eighteen months, by homeless persons living with HIV who were placed into either independent or supportive housing. Design studies to evaluate longitudinal outcomes between groups experiencing two different types of housing interventions, using propensity score matching and longitudinal modeling techniques. Discuss the benefits of the novel use of data from multiple databases to evaluate longitudinal outcomes of an intervention, including administrative and disease surveillance data.

Keyword(s): HIV/AIDS, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Monitoring and Evaluation for Housing Services at the NYC Department of Health and Mental Hygiene. In this role, I oversee the evaluation of HOPWA and Ryan White-funded housing programs as well as overseeing a longitudinal study on housing and homelessness in NYC.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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