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Housing Need, Housing Assistance, and Connection to HIV Medical Care

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Abstract

HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes.

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Notes

  1. Current standards recommend that HIV-infected patients should have follow-up visits at least every 3–4 months whether receiving antiretroviral (ARV) therapy or not, with more frequent visits at entry into care, when starting or changing ARV regimens, or for management of acute problems (AIDS Institute 2007). The number of visits per 6 months was selected as a minimal indicator, allowing for the occasional missed appointment or appointment delay for any clinical, provider, or logistical reason.

References

  • Abramson, D., Messeri, P., Sanger, N., & Aidala, A. (2003). The CHAIN retrospective: 1994—2002. Community health advisory and information network report. Columbia University: Mailman School of Public Health. Retrieved from http://www.nyhiv.org/pdfs/chain/CHAIN%20Retrospective%20Update%2047.pdf

  • Aday, L. (2001). At risk in America: The health and health needs of vulnerable populations in the United States. San Francisco, CA: Jossey-Bass Publishers.

    Google Scholar 

  • Aidala, A., Abramson, D., & Lekas, M. (1999). The unconnected revisited: Persons living with HIV who are outside the medical and social services system. Community Health and Advisory Information Network Briefing Paper #1. Columbia University: Mailman School of Public Health.

    Google Scholar 

  • Aidala, A., Messeri, P., Abramson, D., & Healton, C. (1995). The “Unconnected”—Service needs of HIV positive persons who are outside or marginal to the service delivery system. Community Health Advisory and Information Network Technical Report #9. Columbia University: Mailman School of Public Health.

    Google Scholar 

  • Aidala, A., Needham-Waddell, E., & Sotheran, J. (2005). Delayers, Drop-outs, the unconnected, and “Unmet Need.” Community Health Advisory and Information Network Report 2005–03. Columbia University: Mailman School of Public Health.

    Google Scholar 

  • Arno, P. S., Bonuck, K. A., Green, J., Bennett, C. L., Fahs, M. C., Maffeo, C., et al. (1996). The impact of housing status on health care utilization among persons with HIV disease. Journal of Health Care Poor Underserved, 7(1), 36–49.

    CAS  Google Scholar 

  • Berk, M. L., Maffeo, C., & Schur, C. L. (1993). Research Design and Analysis Objectives. AIDS Cost and Services Utilization Survey (ACSUS) Reports, No. 1. AHCPR Publication No. 93-0019. Rockville, MD: Agency for Health Care Policy and Research.

    Google Scholar 

  • Bhandari, A., & Wagner T. (2006). Self-reported utilization of health care services: Improving measurement and accuracy. Medical Care Research and Review, 63(2), 217–235.

    Article  PubMed  Google Scholar 

  • Conover, C. J., & Whetten-Goldstein, K. (2002). The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage. AIDS Care, 14(Suppl. 1), S59–S71.

    Article  PubMed  Google Scholar 

  • Conviser, R., & Pounds, M. B. (2002). Background for the studies on ancillary services and primary care use. AIDS Care, 14(Suppl. 1), S7–S14.

    Article  PubMed  Google Scholar 

  • Cunningham, W. E., Sohler, N. L., Tobias, C., Drainoni, M., Bradford, J., Davis, C., et al. (2006). Health service utilization for people with HIV infection: Comparison of a population targeted for outreach with the US population in care. Medical Care, 44(11), 1038–1047.

    Article  PubMed  Google Scholar 

  • Cunningham, C. O., Sohler, N. L., Wong, M. D., Relf, M., Cunningham, W. E., Drainoni, M., et al. (2007). Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care and STDs, 21(3), 177–186.

    Article  PubMed  Google Scholar 

  • D’Amore, J., Hung, O., Chiang, W., & Goldfrank, L. (2001). The epidemiology of the homeless population and its impact on an urban emergency department. Academic Emergency Medicine, 8(11), 1051–1055.

    Article  PubMed  CAS  Google Scholar 

  • Douaihy, A. B., Stowell, K. R., Bui, T., Daley, D., & Salloum, I. (2005). HIV/AIDS and homelessness, Part 1: Background and barriers to care. The AIDS Reader, 15(10), 516–520, 527.

    Google Scholar 

  • Douglass, R., Torres, R., Surfus, P., Krinke, B., & Dale, L. (1999). Health care needs and service utilization among sheltered and unsheltered Michigan homeless. Journal of Health Care for the Poor and Underserved, 10(1), 5–18.

    PubMed  CAS  Google Scholar 

  • Ewing, J. A. (1984). Detecting Alcoholism: The CAGE questionnaire. The Journal of American Medical Association, 252, 1905–1907.

    Article  CAS  Google Scholar 

  • Frankel, M. R., Shapiro, M. F., Duan, N., Morton, S. C., Berry, S. H., Brown, J. A., et al. (1999). National probability samples in studies of low prevalence diseases, part II: Designing and implementing the HIV Cost and Services Utilization Study. Health Services Research, 34(5), 969–992.

    PubMed  CAS  Google Scholar 

  • Gelberg, L., & Siecke, N. (1997). Accuracy of homeless adults’ self-reports. Medical Care, 35(3), 287–290.

    Article  PubMed  CAS  Google Scholar 

  • Gelberg, L., Gallacher, T., Andersen, R., & Koegel, P. (1997). Competing priorities as a barrier to medical care among homeless adults in Los Angeles. American Journal of Public Health, 87(2), 217–220.

    Article  PubMed  CAS  Google Scholar 

  • Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.

    PubMed  CAS  Google Scholar 

  • Goldman, D., & Bao, Y. (2004). Effective HIV treatment and the employment of HIV+ adults. Health Services Research, 39(6), 1691–1712.

    Article  PubMed  Google Scholar 

  • Health Resources and Services Administration (HRSA) (2006). Ryan White HIV/AIDS treatment modernization act. HRSA: HIV/AIDS Bureau. http://hab.hrsa.gov/treatmentmodernization/. Accessed 30 March 2007.

  • Hudson Planning Group (2005). An assessment of the housing needs of persons with HIV/AIDS: New York City Eligible Metropolitan Statistical Area. Final Report, January 2005. New York City Department of Health and Mental Hygiene.

  • Ikard, K., Janney, J., Hsu, L. C., Isenberg, D. J., Scalco, M. B., & Schwarcz, S., et al. (2005). Estimation of unmet need for HIV primary medical care: A framework and three case studies. AIDS Education and Prevention, 17(6 Suppl. B), 26–38.

    Article  PubMed  Google Scholar 

  • Kim, T. W., Kertesz, S. G., Horton, N. J., Tibbetts, N., & Samet, J. H. (2006). Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Services Research, 6(19), 1–10.

    Google Scholar 

  • Kuhn, R., & Culhane, D. P. (1998). Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: Results from the analysis of administrative data. American Journal of Community Psychology, 26(2), 207–232.

    Article  PubMed  CAS  Google Scholar 

  • Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285, 200–206.

    Article  PubMed  CAS  Google Scholar 

  • Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77.

    Article  PubMed  Google Scholar 

  • Lee, G. & Abramson, D. A. (2005). Baseline summary of NYC II Cohort. Community health advisory and information network report 2004–03. Columbia University: Mailman School of Public Health. Retrieved from http://www.nyhiv.org/pdfs/chain/CHAIN%20New%20Cohort%20Summary%202004_3.pdf

  • Lim, Y. W., Andersen, R., Leake, B., Cunningham, W., & Gelberg, L. (2002). How accessible is medical care for homeless women? Medical Care, 40(6), 510–520.

    Article  PubMed  Google Scholar 

  • Mariller, M., Abramson, D., & Sobieszczyk, M. (2004). The validity of self-reported clinical markers and medication regimens: A pilot study. Community Health Advisory and Information Network Report 2004–06. Columbia University: Mailman School of Public Health.

    Google Scholar 

  • Masson, C. L., Sorensen, J. L., Phibbs, C. S., & Okin, R. L. (2004). Predictors of medical service utilization among individuals with co-occurring HIV infection and substance abuse disorders. AIDS Care, 16(6), 744–755.

    Article  PubMed  CAS  Google Scholar 

  • McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical & mental health constructs. Medical Care, 31, 247–263.

    Article  PubMed  CAS  Google Scholar 

  • Messeri, P., Aidala, A., Abramson, D., Healton, C., Jones-Jessop, D., & Jetter, D. (1995). Recruiting rare & hard to reach populations: A sampling strategy for surveying NYC residents living with HIV/AIDS using agency recruiters. American Statistical Association, Proceedings of the Section on Survey Research Methods,, Vol. II, pp. 1064–1068.

  • Messeri, P., Abramson, D., Aidala, A., Lee, F., & Lee, G. (2002). The impact of ancillary HIV services on engagement in medical care in New York City. AIDS Care, 14(Suppl. 1), S15–S30.

    Article  PubMed  Google Scholar 

  • Messeri, P., Lee, G., Abramson, D., Aidala, A., Chiasson, M., & Jessop, D. (2003). Antiretroviral therapy and declining AIDS Mortality in New York City. Medical Care, 41(4), 512–521.

    Article  PubMed  Google Scholar 

  • Messeri, P., & Hart, B. (2007). Employment and economic well-being. Community Health Advisory and Information Network Report 2006–06. Columbia University: Mailman School of Public Health.

    Google Scholar 

  • Meyerson, B. E., Klinkenberg, W. D., Perkins, D. R., & Laffoon, B. T. (2007). Who’s in andwho’s out: Use of primary medical care among people living with HIV. American Journal of Public Health, 97(4), 744–749.

    Article  PubMed  Google Scholar 

  • Mkanta, W. M., & Ubhold, C. R. (2006). Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection. AIDS Patient Care and STDs, 20(4), 293–303.

    Article  PubMed  Google Scholar 

  • New York State AIDS Institute (1995). Protocols for the Primary Care of HIV/AIDS in Adults and Adolescents. Albany, NY: New York State Department of Health.

    Google Scholar 

  • New York State AIDS Institute (2003). Criteria for the medical care of adults with HIV infection. Albany, NY: New York State Department of Health.

    Google Scholar 

  • New York State AIDS Institute (2007). The primary care approach to the HIV-infected patient. Albany, NY: New York State Department of Health.

    Google Scholar 

  • Pelletiere, D., Wardrip, K., & Crowley, P. (2006). Out of Reach 2006. Washington, DC: National Low Income Housing Coalition.

    Google Scholar 

  • Phelan, J. C., & Link, B. G. (1999). Who are the homeless? Reconsidering the stability and composition of the homeless population. American Journal of Public Health, 89(9), 1334–1338.

    PubMed  CAS  Google Scholar 

  • Pulvirenti, J. J., Glowacki, R., Muppiddi, U., Surapaneni, N., Gail, C., Kohl, B., et al. (2003). Hospitalized HIV-infected patients in the HAART era: A view from the inner city. AIDS Patient Care and STDs, 17(11), 565–573.

    Article  PubMed  Google Scholar 

  • Rabkin, J. G., McElhiney, M., Ferrando, S. J., Van Gorp, W., & Lin, S. H. (2004). Predictors of Employment of Men With HIV/AIDS: A longitudinal study. Psychosomatic Medicine, 66, 72–78.

    Article  PubMed  Google Scholar 

  • Robertson, M., & Cousineau, M. (1986). Health status and access to health services among the urban homeless. American Journal of Public Health, 76, 561–563.

    PubMed  CAS  Google Scholar 

  • Shinn, M. (1997). Family homelessness: State or trait? American Journal of Community Psychology, 25(6), 753–769.

    Article  Google Scholar 

  • Smith, M. Y, Rapkin, B. D, Winkel, G., Springer, C., Chhabra, R., & Feldman, I. (2000). Housing status and health care service utilization among low-income persons with HIV/AIDS. Journal of General Internal Medicine, 15, 731–738.

    Article  PubMed  CAS  Google Scholar 

  • Song, J. (1999). HIV/AIDS and homelessness: Recommendations for clinical practice and public policy. Nashville, TN: Healthcare for the Homeless Clinician Network, National Health Care for the Homeless Council Inc.

    Google Scholar 

  • Stewart, K. E., Cianfrini, L. R., & Walker, J. F. (2005). Stress, social support and housing are related to health status among HIV-positive persons in the deep south of the United States. AIDS Care, 17(3), 350–358.

    Article  PubMed  CAS  Google Scholar 

  • US Department of Housing and Urban Development (HUD) (2006). Housing Opportunities for Persons with AIDS Factsheet. HUD Office of HIV/AIDS Housing, November 2006. Retrieved from http://www.hud.gov/utilities/intercept.cfm?/offices/cpd/aidshousing/library/factsheet2006.pdf

  • Uphold, C. R., & Mkanta, W. N. (2005). Use of health services among persons living with HIV infection: State of the science and future directions. AIDS Patient Care and STDs, 19(8), 473–485.

    Article  PubMed  Google Scholar 

  • Weissman, J. S., Levin, K., Chasan-Taber, S., Massagli, M. P., Seage, G. R. IIIrd, & Scampini, L. (1996). The validity of self-reported health-care utilization by AIDS patients. AIDS, 10, 775–783.

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Acknowledgments

The CHAIN Project provides systematic data from the perspective of persons living with HIV used for policy and program planning by the Health and Human Services Planning Council of New York and the NY Department of Health and Mental Hygiene Office of AIDS Policy and Community Planning. A Technical Review Team (TRT) provides oversight for the CHAIN Project. In addition to Peter Messeri, Ph.D. and Angela Aidala, Ph.D. of Columbia University’s Mailman School of Public Health, current members include Mary Ann Chiasson, DrPH, MHRA (chair); Lucia Torian, Ph.D., NYCDOHMH; Jan Carl Park, MPA, Nina Rothschild, DrPH, Office of AIDS Policy and Community Planning; Clarissa Silva, MSW, and Daniel Weglein, MD, Office of Evaluation and Quality Assurance, JoAnn Hilger, NYCDOHMH; Julie Lehane, Ph.D., Westchester County DOH; Roberta Scheinmann, MPH, MHRA. This research was supported by grant number H89 HA 0015–15 from the US Health Resources and Services Administration (HRSA), HIV/AIDS Bureau with the support of the HIV Health and Human Services Planning Council, through the New York City Department of Health and Mental Hygiene and the Medical and Health Research Association of New York City Inc. Its contents are solely the responsibility of the researchers and do not necessarily represent the official views of the US Health Resources and Services Administration, the City of New York, or the Medical and Health Research Association of New York.

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Aidala, A.A., Lee, G., Abramson, D.M. et al. Housing Need, Housing Assistance, and Connection to HIV Medical Care. AIDS Behav 11 (Suppl 2), 101–115 (2007). https://doi.org/10.1007/s10461-007-9276-x

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