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Randomized Trial of the Effects of Housing Assistance on the Health and Risk Behaviors of Homeless and Unstably Housed People Living with HIV

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Abstract

Homelessness affects HIV risk and health, but little is known about the longitudinal effects of rental assistance on the housing status and health of homeless and unstably housed people living with HIV/AIDS. Homeless/unstably housed people living with HIV/AIDS (N = 630) were randomly assigned to immediate Housing Opportunities for People with AIDS (HOPWA) rental assistance or customary care. Self-reported data, CD4, and HIV viral load were collected at baseline, 6, 12, and 18 months. Results showed that housing status improved in both groups, with greater improvement occurring in the treatment group. At 18 months, 51% of the comparison group had their own housing, limiting statistical power. Intent-to-treat analyses demonstrated significant reductions in medical care utilization and improvements in self-reported physical and mental health; significant differential change benefiting the treatment group was observed for depression and perceived stress. Significant differences between homeless and stably housed participants were found in as-treated analyses for health care utilization, mental health, and physical health. HOPWA rental assistance improves housing status and, in some cases, health outcomes of homeless and unstably housed people living with HIV/AIDS.

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Acknowledgments

We would like to thank the many people who made this study a success. In addition to the authors of this paper, the Housing and Health Study members (in alphabetical order) include Arturo Bendixen (AIDS Foundation of Chicago), Kate Briddell (City of Baltimore, Department of Housing and Community Development), Shahry Deyhimy (City of Los Angeles Housing Department), Paul Dornan (HUD), Myrna Hooper (Housing Authority of the City of Los Angeles), Jennafer Kwait (Research Triangle Institute, RTI), Fred Licari (RTI), Shirley Nash (City of Chicago Department of Public Health), William Rudy (HUD), Esther Sumartojo (CDC), and David Vos (HUD). We would also like to acknowledge the contributions of Rusty Bennett, Maria Caban, Sylvia Cohn, Lynne Cooper, Jay Cross, Maria DiGregorio, Clyde Hart, Kirk Henny, Kelly Kent, Lee Lam, Joyce Moon Howard, Noelle Richa, Danny Ringer, Randy Russell, Ruth Schwartz, Tom Spira, and Jun Zhang. Dr Wolitski and Dr Pals had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Sumartojo, Stall, Aidala, and Harre initially conceptualized the study. All of the authors made substantial contributions to the design of the study, assessment instruments, and intervention protocols. Kidder was the CDC technical monitor for the study. Royal oversaw data collection. Pals designed (with input from all authors) and conducted the statistical analyses. Wolitski drafted the manuscript. All of the authors provided input into the interpretation of results and provided critical review of drafts of the manuscript for important intellectual content. Funding for the research study was provided by the Centers for Disease Control and Prevention to RTI under contract 200-2001-0123, Task 9 and funding for permanent supportive housing rental assistance was provided by the Department of Housing and Urban Development. Data collection was approved by the Office of Management and Budget (0920-0628).

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Correspondence to Richard J. Wolitski.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Department of Housing and Urban Development.

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Wolitski, R.J., Kidder, D.P., Pals, S.L. 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 14, 493–503 (2010). https://doi.org/10.1007/s10461-009-9643-x

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