142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Effect of supportive housing on CD4-cell count among homeless adults in supportive housing

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Sarah Dobbins, MPH, CPH , Direct Access Housing, San Francisco Department of Public Health, san francisco, CA
Josh Bamberger, MD, MPH , Housing and Urban Health, San Francisco Department of Health, San Francisco, CA
Lindsey Abt , Housing and Urban Health, San Francisco Department of Health, San Francisco, CA
Marissa Cruz, RN , University of California San Francisco School of Nursing, San Francisco, CA
Saima Shah , Housing and Urban Health, San Francisco Department of Health, San Francisco, CA
Cameron Adams , Housing and Urban Health, San Francisco Dept of Public Health, SAN FRANCISCO, CA
INTRO: The San Francisco Department of Public Health funds 1710 permanent supportive units in 43 buildings. Our permanent supportive housing consists of on-site case management & property management, and on-site nursing care in 10 of these buildings, which all target chronically homeless adults. While homelessness alone results in higher rates of mortality and morbidity, the combination of HIV infection and homelessness further increases mortality. In previous studies, we have shown that homeless people with AIDS have an 80% higher mortality rate than housed people with AIDS and have also shown that this disparity is eliminated by moving homeless people into supportive housing.  In this study, we report on the impact of housing on CD4-cell counts among homeless people with HIV who have moved into supportive housing. 

METHODS: We used a nest case-cohort design to examine CD4-cell results for HIV positive adults who were placed in housing between 2007-2013. Triple-diagnosis was defined as an HIV diagnosis and co-occurring axis-1 mental health diagnosis and substance abuse or dependence.  All those in the study received their diagnosis of HIV/AIDS before the DAH housing referral was made. 

RESULTS: 15.4% of the individuals housed had HIV (n=243). 64% of HIV+ individuals had mental-health diagnoses; 74% had a substance abuse disorder and 49% had triple diagnoses.  The average CD4 cell count one year before housing was 340 (SD: 234); after six months in housing the CD4 count was 371 (SD: 231), after twelve months it was 407 (SD: 209).  Among triply diagnosed individuals placed in units with on-site nursing the mean CD4-cell count increased 53%. 

DISCUSSION/CONCLUSION:   It’s critical to acknowledge the difficulties that HIV-positive homeless patients with co-occurring illnesses face in getting and retaining care. Supportive housing should be prioritized towards homeless people with HIV to improve mortality and immune functioning.  Placing triply diagnosed individuals in buildings with on-site nursing has a significant impact on CD4-cell count, presumably through improved adherence to anti-retroviral medication.

Learning Areas:

Advocacy for health and health education
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health or related public policy

Learning Objectives:
Describe the effect of a housing intervention on people living with HIV/AIDS; the learner will also be able to discuss the added positive effect of nursing for those with triple diagnoses.

Keyword(s): Homelessness, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a research assistant for SFDPH, working on projects with Housing and Urban Health.
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.