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Supportive Housing Promotes AIDS-Free Survival for Chronically Homeless HIV Positive Persons with Behavioral Health Conditions

  • Gerod HallEmail author
  • Tejinder Singh
  • Sung woo Lim
Original Paper

Abstract

We assessed the influence of supportive housing, incarceration, and health service use on markers of HIV infection for people living with HIV and serious mental illness or substance use disorder (SUD) participating in a New York City supportive housing program (NY III). Using matched administrative data from 2007 to 2014, we compared survivor time without AIDS, achievement of undetectable viral load, and maintenance of viral suppression between NY III tenants (n = 696), applicants placed in other supportive housing programs (n = 333), and applicants not placed in supportive housing (n = 268). Inverse probability of treatment weights were applied to Cox proportional hazards regression models to account for confounding of observed variables. Individuals not placed in supportive housing had a significantly greater risk of death or AIDS diagnosis than NY III tenants [adjusted hazard ratio = 1.84 (1.40, 2.44), p < 0.001]. Incarceration and outpatient SUD treatment were significantly associated with negative short-term outcomes (time to undetectable viral load) but positive long-term outcomes (time to death or AIDS diagnosis). Supportive housing, SUD treatment, and incarceration were associated with prolonged survival without AIDS among supportive housing applicants living with HIV.

Keywords

Viral suppression Virologic failure Supportive housing Health services Jail 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Culhane DP, Gollup E, Kuhn R, Shpaner M. The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. J Epidemiol Commun Health. 2001;55:515–20.CrossRefGoogle Scholar
  2. 2.
    Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11(6 Suppl):101–15.CrossRefGoogle Scholar
  3. 3.
    Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97(12):2238–45.CrossRefGoogle Scholar
  4. 4.
    Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6 Suppl):85–100.CrossRefGoogle Scholar
  5. 5.
    Breakey WR, Fischer PJ, Kramer M, et al. Health and metal health problems of homeless men and women in Baltimore. JAMA. 1989;262:1352–7.CrossRefGoogle Scholar
  6. 6.
    Ferenchick GS. Medical problems of homeless and nonhomeless persons attending in inner-city clinic: a comparative study. Am J Med Sci. 1991;301(6):379.CrossRefGoogle Scholar
  7. 7.
    Krieger J, Higgins DL. Housing and health: Time again for public health action. Am J Public Health. 2002;92(5):758–68.CrossRefGoogle Scholar
  8. 8.
    Rosenheck RA, Kasprow WJ, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless person with mental illness. Arch Gen Psychiatry. 2003;60:940–51.CrossRefGoogle Scholar
  9. 9.
    Tsembris S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. 2004;94:651–6.CrossRefGoogle Scholar
  10. 10.
    Padgett DK, Gulcur L, Tsembris S. Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Res Soc Work Pract. 2006;16(1):74–83.CrossRefGoogle Scholar
  11. 11.
    Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults. JAMA. 2009;301(17):1771–8.CrossRefGoogle Scholar
  12. 12.
    Milloy MJ, Marshall BD, Montaner J, Wood E. Housing status and the health of people living with HIV/AIDS. Curr HIV/AIDS Rep. 2012;9(4):364–74.CrossRefGoogle Scholar
  13. 13.
    Aidala A, Wilson MG, Shubert V, et al. Housing status, medical care and health outcomes among people living with HIV/AIDS: a systematic reveiw. AJPH. 2016;106(95):e1–23.CrossRefGoogle Scholar
  14. 14.
    Fitzpatrick-Lewis D, Gannan R, Krishnarante S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systemic review. BMC Public Health. 2011;11:1.CrossRefGoogle Scholar
  15. 15.
    Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99(Suppl 3):S675–80.CrossRefGoogle Scholar
  16. 16.
    Wolitski RJ, Kidder DP, Pals SL, et al. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behav. 2010;14(3):493–503.CrossRefGoogle Scholar
  17. 17.
    Hawk M, Davis D. The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS. AIDS Care. 2012;24(5):577–82.CrossRefGoogle Scholar
  18. 18.
    Bowen EA, Canfield J, Moore S, Hines M, Hartke B, Rademacher C. Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing. AIDS Care. 2017;29(11):1458–62.CrossRefGoogle Scholar
  19. 19.
    Kaufman GR, Bloch M, Finlayson R, Zaunders J, Smith D, Cooper DA. The extent HIV-1-related immuodeficiency and age predict the long-term CD4 lymphocyte response to potent antiretroviral therapy. AIDS. 2002;16:359–67.CrossRefGoogle Scholar
  20. 20.
    Kaufmann GR. CD4 T-lymphocyte recovery in individuals with advanced HIV-1 infection receiving potent antiretroviral therapy for 4 years. Arch Intern Med. 2003;163:2187–95.CrossRefGoogle Scholar
  21. 21.
    Hunt PW, Deeks SG, Rodriguez B, et al. Continued CD4 cell count increases in HIV-infected adults experiencing 4 years of viral suppression on antiretroviral therapy. AIDS. 2003;17:1907–15.CrossRefGoogle Scholar
  22. 22.
    Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092–8.CrossRefGoogle Scholar
  23. 23.
    Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397–404.CrossRefGoogle Scholar
  24. 24.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefGoogle Scholar
  25. 25.
    Conigliaro J, Gordon AJ, McGinnis KA, Rabeneck L, Justice AC. How harmful is hazardous alcohol use and abuse in HIV infection: do health care providers know who is at risk? J Acquir Immune Defic Syndr. 2003;33:521–5.CrossRefGoogle Scholar
  26. 26.
    Samet JH, Cheng DM, Libman H, Nunes DP, Alperen JK, Saitz R. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr. 2007;46(2):194–9.CrossRefGoogle Scholar
  27. 27.
    Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retrovir. 2010;26(5):511–8.CrossRefGoogle Scholar
  28. 28.
    Celentano DD, Galai N, Sethi AK, et al. Time to initiating highly active antiretroviral therapy among HIV-infected injection drug users. AIDS. 2001;15:1707–15.CrossRefGoogle Scholar
  29. 29.
    Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV infection. J Acquir Immune Defic Syndr. 2001;27:251–9.CrossRefGoogle Scholar
  30. 30.
    Stein MD, Rich JD, Maksad J, et al. Adherence to antiretroviral therapy among HIV-infected methadone patients: effect of ongoing illicit drug use. Am J Drug Alcohol Abuse. 2000;26:195–205.CrossRefGoogle Scholar
  31. 31.
    Celentano DD, Vlahov D, Cohn S, Shadle VM, Obasanjo O, Moore RD. Self-reported antiretroviral therapy in injection drug users. JAMA. 1998;280:544–6.CrossRefGoogle Scholar
  32. 32.
    Strathdee SA, Palepu A, Cornelisse PG, et al. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280:547–9.CrossRefGoogle Scholar
  33. 33.
    Hicks PL, Mulvey KP, Chander G, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2010;19(9):1134–40.CrossRefGoogle Scholar
  34. 34.
    Palepu A, Horton NJ, Tibbetts N, Meli S, Samet JH. Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment. Addiction. 2004;99:361–8.CrossRefGoogle Scholar
  35. 35.
    Palepu A, Tyndall MW, Chan K, Wood E, Montaner JS, Hogg RS. Intiating highly active antiretroviral therapy and continuity of HIV care: the impact of incarceration and prison release on adherence and HIV treatment outcomes. Antiretrovir Therapy. 2004;9:713–9.Google Scholar
  36. 36.
    Ammon B, Iroh P, Tiruneh Y, et al. HIV care after jail: low rates of engagement in a vulnerable population. J Urban Health. 2018;95(4):488–98.CrossRefGoogle Scholar
  37. 37.
    Althoff AL, Zelenev A, Meyer JP, et al. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS Behav. 2012;17(S2):156–70.CrossRefGoogle Scholar
  38. 38.
    Torian LV, Xia Q. Achievement and mainetenance of viral suppression persons newly diagnosed with HIV, New York City 2006–2009: using population surveillance data to measure the treatment part of “test and treat”. J Acquir Immune Defic Syndr. 2013;63(3):379–86.CrossRefGoogle Scholar
  39. 39.
    Bang H, Robins JM. Doubly robust estimation in missing data and causal inference. Biometrics. 2005;61(4):962–73.CrossRefGoogle Scholar
  40. 40.
    New York City Department of Health and Mental Hygiene. HIV Surveillance Annual Report. 2016.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.New York City Department of Health and Mental HygieneOffice of School HealthQueensUSA
  2. 2.New York City Department of Health and Mental HygieneBureau of Epidemiology ServicesQueensUSA

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