Background: The National Strategic Plan to End the Epidemic by 2030 targets many communities disproportionately affected by HIV/AIDS in the South. However, an excess burden of social determinants of health, such as homelessness and poverty, continue to challenge the performance of HIV prevention and treatment programs.

Methods: The purpose of this retrospective study is to determine to what extent homelessness affects HIV treatment programs in an underserved urban area of Middle Tennessee between 2014 and 2019. We extracted data from medical records of HIV-positive patients attending an AIDS Center of Excellence Clinic. We analyzed the trend of a pool of descriptive variables: gender, race/ethnicity, and age group, HIV risk factors, insurance status, and homelessness, poverty level, CD4 cell count and plasma viral load. We will apply χ2 test for association between pairs of categorical variables and use a multivariable logistic regression to find out the effect of homelessness on viral load suppression, controlling for the variables: age, race/ethnicity, and HIV risk factor, CD4 count, gender, and FPL, type of medical insurance, and number of clinic visits.

Results: Study findings show a significant association between homelessness (OR 1.97, 95% CI 1.31-2.96; p = 0.001), poverty (OR 1.002, 95% CI 1-1.004; p = 0.036), number of clinic visits (OR 1.031; 95% CI 1.012-1.050; p = 0.001), and CD4 count (OR 4.65; 95% CI 3.17-6.83; p <0.001), and HIV viral suppression.

Conclusion: The study results confirm the negative effect of homelessness, poverty, retention, and immune status on viral suppression.