An intensive program to provide case management and rapid rehousing for HIV-positive people experiencing homelessness in New York City was associated with a higher rate of stable housing and a greater increase in viral suppression in a recent study, aidsmap reports.
Publishing their findings in AIDS and Behavior, researchers conducted a study of 236 people living with HIV who lacked housing. The participants were recruited from homeless shelters in New York City between 2012 and 2013.
The study members were randomized to receive one of two interventions. The first intervention included 12 months of intensive, tailored case management and support to overcome barriers—including factors related to substance use disorders and mental health—to obtaining stable housing and achieving or maintaining an undetectable viral load. The control intervention was the standard of care, defined as referral to a New York City organization contracted by city authorities to find housing for HIV-positive residents.
Ten participants died during the study’s 12-month follow-up period. Researchers were unable to match one person to the HIV registry databases they used to conduct their analysis of the participants’ housing and health outcomes. This left a final study group of 225 people.
A majority of those in the study group were: male, Black or Latino, 40 years old or older, medically unfit for work and in chronic need of housing. More than three in four participants had a history of incarceration, more than half had a mental health diagnosis and more than 80% reported using drugs during the 12 months prior to enrollment in the study. Nearly all participants were linked to medical care for the virus. However, at the study’s outset, just 40% had a fully suppressed viral load and most had a CD4 count lower than 350.
Those who were randomized to the intensive intervention had a higher rate of placement in stable housing within 12 months compared with those in the standard-of-care group: 45% versus 32%. The time it took for one quarter of each group to achieve a stable-housing status was a respective 150 days and 243 days. The rate of housing placement after one year was 80% higher among those in the intensive intervention group compared with the standard-of-care group.
A the 12-month mark, 97% of the members of each group were in HIV care.
The study was limited by the fact that, despite the randomization, those in the intensive intervention group started with a much lower rate of viral suppression than those in the standard-of-care group: 28% versus 52%. These rates increased to 47% and 57% after 12 months, meaning that the viral suppression rate increased at a 2.1-fold higher rate in the intensive intervention group compared with the standard-of-care group.
To read the aidsmap article, click here.
To read the study abstract, click here.