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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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References

  1. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bhunu CP. Assessing the impact of homelessness on HIV/AIDS transmission dynamics. Cogent Math. 2015;2(1):1021602.

    Article  Google Scholar 

  3. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hall HI, Tang T, Westfall AO, Mugavero MJ. HIV care visits and time to viral suppression, 19 U.S. jurisdictions, and implications for treatment, prevention and the national HIV/AIDS strategy. PLoS ONE. 2013;8(12):e84318.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Gray KM, Cohen SM, Hu X, Li J, Mermin J, Hall HI. Jurisdiction level differences in HIV diagnosis, retention in care, and viral suppression in the United States. J Acquir Immune Defic Syndr. 2014;65(2):129–32.

    Article  PubMed  Google Scholar 

  6. Barnighausen T. The HIV treatment cascade and antiretroviral impact in different populations. Curr Opin HIV AIDS. 2015;10:391–4.

    PubMed  Google Scholar 

  7. Bobat R, Archary M, Lawler M. An update on the HIV treatment cascade in children and adolescents. Curr Opin HIV AIDS. 2015;10(6):411–9.

    Article  CAS  PubMed  Google Scholar 

  8. Buskin SE, Kent JB, Dombrowski JC, Golden MR. Migration distorts surveillance estimates of engagement in care: results of public health investigations of persons who appear to be out of HIV care. Sex Transm Dis. 2014;41(1):35–40.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Edun B, Iyer M, Albrecht H, Weissman S. The South Carolina HIV cascade of care. South Med J. 2015;108(11):670–4.

    Article  PubMed  Google Scholar 

  10. Horberg MA, Hurley LB, Klein DB, Towner WJ, Kadlecik P, Antoniskis D, et al. The HIV care cascade measured over time and by age, sex, and race in a large national integrated care system. AIDS Patient Care STDS. 2015;29(11):582–90.

    Article  PubMed  Google Scholar 

  11. Iroh PA, Mayo H, Nijhawan AE. The HIV care cascade before, during, and after incarceration: a systematic review and data synthesis. Am J Public Health. 2015;105(7):e5–16.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lessells RJ, Swaminathan S, Godfrey-Faussett P. HIV treatment cascade in tuberculosis patients. Curr Opin HIV AIDS. 2015;10(6):439–46.

    Article  PubMed  Google Scholar 

  13. Mangal JP, Rimland D, Marconi VC. The continuum of HIV care in a Veterans’ affairs clinic. AIDS Res Hum Retrovir. 2014;30(5):409–15.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Maulsby C, Charles V, Kinsky S, Riordan M, Jain K, Holtgrave D. Positive charge: filling the gaps in the U.S. HIV continuum of care. AIDS Behav. 2015;19(11):2097–107.

    Article  PubMed  Google Scholar 

  15. Milloy MJ, Montaner JS, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment-as-prevention. Curr HIV/AIDS Rep. 2014;11(3):308–16.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nijhawan AE. Infectious diseases and the criminal justice system. Am J Med Sci. 2016;352(4):399–407.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Phelps BR, Ahmed S, Amzel A, Diallo MO, Jacobs T, Kellerman SE, et al. Linkage, initiation and retention of children in the antiretroviral therapy cascade: an overview. AIDS. 2013;27(Suppl 2):S207–13.

    Article  PubMed  Google Scholar 

  18. Risher K, Mayer KH, Beyrer C. HIV treatment cascade in MSM, people who inject drugs, and sex workers. Curr Opin HIV AIDS. 2015;10(6):420–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Saghayam S, Wanke C. The impact of nutritional status and nutrition supplementation on outcomes along the HIV treatment cascade in the resource-limited setting. Curr Opin HIV AIDS. 2015;10(6):472–6.

    Article  CAS  PubMed  Google Scholar 

  20. Santos GM, Wilson EC, Rapues J, Macias O, Packer T, Raymond HF. HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sex Transm Infect. 2014;90(5):430–3.

    Article  PubMed  Google Scholar 

  21. Shaw S, Amico KR. Antiretroviral therapy adherence enhancing interventions for adolescents and young adults 13–24 years of age: a review of the evidence base. J Acquir Immune Defic Syndr. 2016;72(4):387–99.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tanser F, Barnighausen T, Vandormael A, Dobra A. HIV treatment cascade in migrants and mobile populations. Curr Opin HIV AIDS. 2015;10(6):430–8.

    Article  PubMed  Google Scholar 

  23. Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review : alcohol and the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(4):421–36.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol use and human immunodeficiency virus (HIV) infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res. 2016;40(10):2056–72.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Terzian AS, Irvine MK, Hollod LM, Lim S, Rojas J, Shepard CW. Effect of HIV housing services on engagement in care and treatment, New York City, 2011. AIDS Behav. 2015;19(11):2087–96.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. Aidala A, Lee G, Abramson D, Messeri P, Sigeler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11(Suppl):S101–15.

    Article  Google Scholar 

  29. Aidala A, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106(1):95.

    Article  PubMed Central  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Friedman MS, Marshal MP, Stall R, Kidder DP, Henny KD, Courtenay-Quirk C, et al. Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care. 2009;21(6):692–700.

    Article  PubMed  Google Scholar 

  32. Kidder DP, Wolitski RJ, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave DR, et al. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11(6 Suppl):149–61.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Royal SW, Kidder DP, Patrabansh S, Wolitski RJ, Holtgrave DR, Aidala A, et al. Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV. AIDS Care. 2009;21(4):448–55.

    Article  PubMed  Google Scholar 

  35. Wolitski R, Kidder D, Pals S, Royal S, Aidala A, Stall R, 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.

    Article  PubMed  Google Scholar 

  36. Wolitski R, Kidder D, Fenton K. HIV, homelessness, and public health: critical issues and a call for increased action. AIDS Behav. 2007;11(6 Suppl):167–71.

    Article  PubMed  Google Scholar 

  37. Thakarar K, Morgan JR, Gaeta JM, Hohl C, Drainoni M-L. Homelessness, HIV, and incomplete viral suppression. J Health Care Poor Underserved. 2016;27(1):145–56.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Khanijow K, Hirozawa A, Ancock B, Hsu LC, Bamberger J, Schwarcz SK. Difference in survival between housed and homeless individuals with HIV, San Francisco, 2002–2011. J Health Care Poor Underserved. 2015;26(3):1005–18.

    Article  PubMed  Google Scholar 

  39. Dowshen N, Nguyen GT, Gilbert K, Feiler A, Margo KL. Improving transgender health education for future doctors. Am J Public Health. 2014;104(7):e5–6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lim S, Harris TG, Nash D, Lennon MC, Thorpe LE. All-cause, drug-related, and HIV-related mortality risk by trajectories of jail incarceration and homelessness among adults in New York City. Am J Epidemiol. 2015;181(4):261–70.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lennon CA, Pellowski JA, White AC, Kalichman SC, Finitsis DJ, Turcios-Cotto V, et al. Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations. AIDS Care. 2013;25(9):1083–91.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Marshall BD, Elston B, Dobrer S, Parashar S, Hogg RS, Montaner JS, et al. The population Impact of eliminating homelessness on HIV viral suppression among people who use drugs. AIDS. 2015;30:933.

    Article  Google Scholar 

  44. Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.

    Article  PubMed  Google Scholar 

  45. Mugavero M, Westfall A, Zinski A, Davila J, Drainoni M, Gardner L, et al. Measuring retention in HIV care: the elusive gold standard. J Acquir Immune Defic Syndr. 2012;61(5):574–80.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Blair JM, McNaghten AD, Frazier EL, Skarbinski J, Huang P, Heffelfinger JD. Clinical and behavioral characteristics of adults receiving medical care for HIV infection: medical monitoring project, United States, 2007. MMWR Surveill Summ. 2011;60(11):1–20.

    PubMed  Google Scholar 

  47. Mugavero M, Davila J, Nevin C, Giordano T. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gardner LI, Giordano TP, Marks G, Wilson TE, Craw JA, Drainoni ML, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014;59(5):725–34.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Enriquez M, Farnan R, Cheng AL, Almeida A, Del Valle D, Pulido-Parra M, et al. Impact of a bilingual/bicultural care team on HIV-related health outcomes. J Assoc Nurses AIDS Care. 2008;19(4):295–301.

    Article  PubMed  Google Scholar 

  50. Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016;106(1):e1–23.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Stone MM, Hager MA, Griffin JJ. Organizational characteristics and funding environments: a study of a population of United Way–affiliated nonprofits. Public Adm Rev. 2001;61(3):276–89.

    Article  Google Scholar 

  52. Cornelius T, Jones M, Merly C, Welles B, Kalichman MO, Kalichman SC. Impact of food, housing, and transportation insecurity on ART adherence: a hierarchical resources approach. AIDS Care. 2017;29(4):449–57.

    Article  PubMed  Google Scholar 

  53. The 2016 Annual Homeless Assessment Report (AHAR) to Congress. The U.S. Department of Housing and Urban Development Office of Community Planning and Development; 2016.

  54. Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15(3):753–60.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the US HIV epidemic. Am Psychol. 2013;68(4):197–209.

    Article  PubMed  PubMed Central  Google Scholar 

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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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Correspondence to Mary Hawk.

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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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