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

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.