Pathways to housing stability and viral suppression for people living with HIV/AIDS: Findings from the Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations initiative

Abstract

Background People with HIV with co-occurring substance use and mental health diagnoses who are unstably housed have poorer outcomes for retention in care and viral suppression. Navigation models are a potential strategy to help this vulnerable population obtain the necessary medical and non-medical services across multiple service systems. The Health Resources and Services Administration's Special Projects of National Significance: "Building a Medical Home for Multiply-Diagnosed HIV-positive Homeless Populations initiative 2012-2017 found that navigation models may be an effective intervention to support people with HIV with unstable housing improve HIV health outcomes. However, there is limited information about the mechanisms by which this intervention works. In this article, we explore the participant and program factors for achieving stable housing at 6 months and how these factors influence HIV health outcomes. Methods and findings This was a prospective study of 471 unstably housed people with HIV enrolled in a navigation intervention across nine sites in the United Stated from 2013-2017. All sites provided HIV primary medical care. Eight sites were located in urban areas and one site served a

Outcomes of the KC life 360 intervention: Improving employment and housing for persons living with HIV

“…Most participants of this study were able to achieve a more stable housing situation than at baseline, with nearly 75% of people reporting stable housing after one year. These results are supported by other studies that suggest client navigation may be a potential intervention to improve housing [10,11].…”

“…There is emerging evidence that suggests client navigation and care coordination interventions can improve housing stability and HIV health outcomes for PLWH who are experiencing homelessness [10,11]. In a national study of PLWH experiencing homelessness and cooccurring mental health and substance use disorders, participants who received navigation services to obtain stable housing increased their viral suppression rates from 49% to 77% [10].…”

Does resource insecurity drive HIV‐related stigma? Associations between food and housing insecurity with HIV‐related stigma in cohort of women living with HIV in Canada

“…Time since diagnosis was associated with reduced HIV‐related stigma, aligning with the status course timescale, whereby persons can acquire stigma resilience, coping, self‐esteem, self‐efficacy and social support over time [48]. It is plausible that housing insecure participants at baseline were housed over time, as prior research documented that help‐seeking self‐efficacy and time living with HIV were associated with attaining stable housing over time [49]. Increased social support over time can also result in stigma reduction and assistance meeting housing needs [50].…”

Coordinating Systems of Care for HIV and Opioid Use Disorder: A Systematic Review of Enablers and Barriers to Integrated Service Access, and Systems and Tools Required for Implementation

“…Prioritization of RWHAP providers for buprenorphine trainings may further facilitate access ( Chavis et al, 2020 ). Client-level enablers include assigning patient navigators for clients with HIV and OUD who are unstably housed ( Rajabiun et al, 2020 ). Given opioid abstinence also facilitates HIV/OUD service access, open access models that provide rapid access to methadone treatment initiation should be considered ( Madden et al, 2018 ).…”