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HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort

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Abstract

Though housing instability is linked to poor HIV health outcomes, studies that assess the HIV treatment cascade by housing status are limited. Using data from a multi-site Retention in Care initiative we constructed HIV treatment cascades for participants (n = 463) of five grantee sites. We found no significant differences in viral suppression at follow-up among participants who were unstably housed at enrollment (49%) as compared to those who were stably housed at enrollment (54%). Among participants with available data at 6- or 12-month follow-up, 94% were engaged in care, 90% were retained in, 94% were on ART, and 71% had suppressed viral load. Some site-level differences were noted; at two of the sites participants who were stably housed were more likely to be retained in care and on ART. Overall, findings demonstrated that participants moved successfully through the HIV treatment cascade regardless of housing status at enrollment, suggesting that evidence-based support and services to help people living with HIV/AIDS can help mitigate barriers to engagement in care associated with lack of stable housing.

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Acknowledgements

The authors would like to express their gratitude to the Retention in Care sites and their dedicated staff who participated in this project, and especially to Dr. Maria Caban from BOOM! Health for her help conceptualizing this paper.

Bradley Boekeloo, Ph.D., Sc.M., Prevention Research Center, School of Public Health Room 0228, Building #255 Valley Drive, University of Maryland, College Park, MD, 20742; Abby Charles, Institute for Public Health Innovation, 1301 Connecticut Avenue NW, Washington, DC 20036; Maria Caban, Ph.D., Director of Evaluation, BOOM Health, 540 East Fordham Rd, Bronx, NY, 10458; Rebecca Dillingham, M.D., M.P.H., Director, Center for Global Health, School of Medicine, University of Virginia,  345 Crispell Drive, Room 2520, Charlottesville, VA 22908-1379; Erin C. Falvey, Ph.D., Associate Executive Director and Clinical Director, Christie’s Place, 2440 Third Avenue, San Diego, CA 92101; Tanya Geiger, Ph.D., Prevention Research Center, School of Public Health Room 0228, Building #255 Valley Drive, University of Maryland, College Park, MD, 20742; Mary Hawk, DrPH, LSW, Assistant Professor, University of Pittsburgh, Graduate School of Public Health, Department of Behavioral and Community Health Sciences, 6124 Parran Hall – 130 DeSoto Street, Pittsburgh, PA, 15261; Sarah G. Solomon, MPH, Research Manager, Cardea, 1809 Seventh, Avenue, STE 600, Seattle, Washington, 98101.

Funding

This study was funded by AIDS United in partnership with the MAC AIDS Fund. Dr. Maulsby’s effort on the preparation of this manuscript was supported in part by a Grant from National Institute of Mental Health (1K01MH111388-01A1).

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Authors and Affiliations

  1. Department of Behavioral and Community Health Sciences, Evaluation Institute for Public Health, University of Pittsburgh Graduate School of Public Health, 6124 Public Health - 130 DeSoto Street, Pittsburgh, PA, 15261, USA

    Mary Hawk & Mary Hawk

  2. Department of Health, Behavior, and Society, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Catherine Maulsby

  3. John Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Blessing Enobun

  4. UPMC Center for High-Value Health Care, Pittsburgh, PA, USA

    Suzanne Kinsky

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  1. Mary Hawk
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  2. Catherine Maulsby
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  3. Blessing Enobun
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  4. Suzanne Kinsky
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Consortia

The AIDS United Retention in Care Intervention Team

  • Bradley Boekeloo
  • , Abby Charles
  • , Maria Caban
  • , Rebecca Dillingham
  • , Erin C. Falvey
  • , Tanya Geiger
  • , Mary Hawk
  •  & Sarah G. Solomon

Corresponding author

Correspondence to Mary Hawk.

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Conflict of interest

The authors declare that they have no conflicts 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

All data collection activities by sites independently underwent IRB review prior to execution. Evaluation activities conducted by the institution overseeing evaluation activities were determined to be non-human subjects research.

Additional information

A list of the AIDS United Retention in Care Intervention Team is given in Acknowledgements section.

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Hawk, M., Maulsby, C., Enobun, B. et al. HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort. AIDS Behav 23, 765–775 (2019). https://doi.org/10.1007/s10461-018-2295-y

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