Top

Published in:

01-11-2007 | Original Paper

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

Authors: Daniel P. Kidder, Richard J. Wolitski, Scott Royal, Angela Aidala, Cari Courtenay-Quirk, David R. Holtgrave, David Harre, Esther Sumartojo, Ron Stall, for the Housing and Health Study Team

Published in: AIDS and Behavior | Special Issue 2/2007

Abstract

Homelessness and unstable housing have been associated with HIV risk behavior and poorer health among persons living with HIV/AIDS (PLWHA), yet prior research has not tested causal associations. This paper describes the challenges, methods, and baseline sample of the Housing and Health Study, a longitudinal, multi-site, randomized controlled trial investigating the effects of providing immediate rental housing assistance to PLWHA who were homeless or at severe risk of homelessness. Primary outcomes included HIV disease progression, medical care access and utilization, treatment adherence, mental and physical health, and risks of transmitting HIV. Across three study sites, 630 participants completed baseline sessions and were randomized to receive either immediate rental housing assistance (treatment group) or assistance finding housing according to local standard practice (comparison group). Baseline sessions included a questionnaire, a two-session HIV risk-reduction counseling intervention, and blood sample collection to measure CD4 counts and viral load levels. Three follow-up visits occurred at 6, 12, and 18 months after baseline. Participants were mostly male, Black, unmarried, low-income, and nearly half were between 40 and 49 years old. At 18 months, 84% of the baseline sample was retained. The retention rates demonstrate the feasibility of conducting scientifically rigorous housing research, and the baseline results provide important information regarding characteristics of this understudied population that can inform future HIV prevention and treatment efforts.

Income for HOPWA eligibility is 80% of the area median income, but was lower for the purposes of this study.

Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265.PubMedCrossRef

Allen, D. M., Lehman, S., Green, T. A., Lindegren, M. L., Onorato, I. M., Forrester, W., et al. (1994). HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS, 8, 1593–1598.PubMedCrossRef

Blankenship, K. M., Bray, S. J., & Merson, M. H. (2000). Structural interventions in public health. AIDS, 14, S11–S21.PubMedCrossRef

Boekeloo, B. O., Schiavo, L., Rabin, D., Conlon, R. T., Jordan, C. S., & Mundt, D. J. (1994). Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: Audio vs. written questionnaires. American Journal of Public Health, 84, 754–760.PubMed

Buchanan, D. R., & Miller, F. G. (2006). A public health perspective on research ethics. Journal of Medical Ethics, 32, 729–733.PubMedCrossRef

Burt, M., Aron, L. Y., & Lee, E. (2001). Helping America’s homeless: Emergency shelter or affordable housing? Washington, DC: Urban Institute Press.

Camasso, M. J. (2003). Quality of life perception in transitional housing demonstration projects: An examination of psychosocial impact. Brief Treatment and Crisis Intervention, 3, 99–118.CrossRef

Centers for Disease Control, Prevention. (2005). HIV/AIDS surveillance report, 2004 (Vol. 16). Atlanta, GA: US Department of Health and Human Services, CDC.

Centers for Disease Control & Prevention. (2006). Comprehensive risk counseling and services (CRCS) implementation manual. Retrieved January 22, 2007 from http://www.cdc.gov/hiv/topics/prev_prog/CRCS/resources/CRCS_Manual/index.htm.

Corsi, K. F., VanHunnik, B., Kwiatkowski, C. F., & Booth, R. E. (2006). Computerized tracking and follow-up techniques in longitudinal research with drug users. Health Services and Outcomes Research Methodology, 6, 101–110.CrossRef

Crepaz, N., Lyles, C., Wolitski, R., Passin, W., Rama, S., Herbst, J., et al. (2006). Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS, 20, 143–157.PubMedCrossRef

Culhane, D. P., Gollub, E., Kuhn, R., & Shpaner, M. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. Journal of Epidemiology and Community Health, 55, 515–520.PubMedCrossRef

Dail, P. W. (2001). Introduction and concluding observations: Special Issue on Homelessness. American Behavioral Scientist, 45(6), 6–13.CrossRef

Dodd, R. Y. (2004). Current safety of the blood supply in the United States. International Journal of Hematology, 80, 301–305.PubMedCrossRef

Estebanez, P. E., Russell, N. K., Aguilar, M. D., Beland, F., & Zunzunegui, M. V. (2000). Women, drugs and HIV/AIDS: Results of a multicentre European study. International Journal of Epidemiology, 29, 734–743.PubMedCrossRef

Fournier, A. M., Tyler, R., Iwasko, N., LaLota, M., Shultz, J., & Greer, P. J. (1996). Human immunodeficiency virus among the homeless in Miami: A new direction for the HIV epidemic. American Journal of Medicine, 100, 582–584.PubMedCrossRef

Holtgrave, D. R., Briddell, K., Little, E., Bendixen, A. V., Hooper, M., Kidder, D. P., Wolitski, R. J., Harre, D., Royal, S., Aidala, A., for the Housing and Health Study Team (this issue). Cost and threshold analysis of housing as an HIV prevention intervention. AIDS and Behavior (this issue).

Hwang, S. W., Tolomiczenko, G., Kouyoumdjian, F. G., & Garner, R. E. (2005). Interventions to improve the health of the homeless: A systematic review. American Journal of Preventive Medicine, 29(4), 311–319.PubMedCrossRef

Janssen, R. S., Holtgrave, D. R., Valdiserri, R. O., Shepherd, M., Gayle, H. D., & De Cock, K. M. (2001). The Serostatus approach to fighting the HIV epidemic: Prevention strategies for infected individuals. American Journal of Public Health, 91(7), 1019–1024.PubMedCrossRef

Kamb, M. L., Fishbein, M., Douglas, J. M., Rhodes, F., Rogers, J., Bolan, G., et al. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. Journal of the American Medical Association, 280, 1161–1167.PubMedCrossRef

Kidder, D. P., Wolitski, R. J., Campsmith, M. L., & Nakamura, G. V. (in press). Health status, health care use, medication use, and medication adherence in homeless people living with HIV/AIDS. American Journal of Public Health.

Kissinger, P., Rice, J., Farley, T., Trim, S., Jewitt, K., Margavio, V., et al. (1999). Application of computer-assisted interviews to sexual behavior research. American Journal of Epidemiology, 149, 950–954.PubMed

Knowlton, A., Arnsten, J., Eldred, L., Wilkinson, J., Gourevitch, M., Shade, S., et al. (2006). Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. Journal of Acquired Immune Deficiency Syndromes, 41(4), 486–492.PubMedCrossRef

Kurth, A. E., Martin, D. P., Golden, M. R., Weiss, N. S., Heagerty, P. J., Spielberg, F., et al. (2004). A comparison between audio computer-assisted self-interviews and clinician interviews for obtaining the self history. Sexually Transmitted Diseases, 31, 719–726.PubMedCrossRef

Mercier, C., Fournier, L., & Peladeau, N. (1992). Program evaluation of services for the homeless: Challenges and strategies. Evaluation and Program Planning, 15, 417–426.CrossRef

Mofenson, L. M. (2002). U.S. Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1 infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. MMWR Morbidity and Mortality Weekly Report, 51, 1–38.

Mowbray, C. T., Cohen, E., & Bybee, D. (1993). The challenge of outcome evaluation in homeless services: Engagement as an intermediate outcome measure. Evaluation and Program Planning, 16, 337–346.CrossRef

Newman, J. C., Des Jarlais, D. C., Turner, C. F., Gribble, J., Cooley, P., & Paone, D. (2002). The differential effects of face-to-face and computer interview modes. American Journal of Public Health, 92, 294–297.PubMed

Orwin, R. G., Scott, C. K., & Arieira, C. R. (2003). Transitions through homelessness and factors that predict them: Residential outcomes in the Chicago Target Cities treatment sample. Evaluation and Program Planning, 26, 379–392.CrossRef

O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., Freyder, P. J., Conde, A. M., & Fine, M. J. (2004). Self-reported changes in drug and alcohol use after becoming homeless. American Journal of Public Health, 94, 830–835.PubMed

Paris, N. M., East, R. T., & Toomey, K. E. (1996). HIV seroprevalence among Atlanta’s homeless. Journal of Health Care for the Poor and Underserved, 7, 83–93.PubMed

Parker, R. G., Easton, D., & Klein, C. H. (2000). Structural barriers and facilitators in HIV prevention: A review of international research. AIDS, 14, S22–S32.PubMedCrossRef

Perlis, T. E., Des Jarlais, D. C., Friedman, S. R., Arasteh, K., & Turner, C. F. (2004). Audio-computerized self-interviewing versus face-to-face interviewing for research data collection at drug abuse treatment programs. Addiction, 99, 885–896.PubMedCrossRef

Riley, E. D., Robnett, T. J., Vlahov, D., Vertefeuille, J., Strathdee, S. A., & Chaisson, R. E. (2000). Computer-assisted self-interviewing for HIV and tuberculosis risk factors among injection drug users participating in a needle exchange program. American Journal of Epidemiology, 151, S55.

Schutt, R. K., Rosenheck, R. E., Penk, W. E., Drebing, C. E., & Seibyl, C. L. (2005). The social environment of transitional work and residence programs: Influences on health and functioning. Evaluation and Program Planning, 28, 291–300.CrossRef

Shlay, J. C., Blackburn, D., O’Keefe, K., Raevsky, C., Evans, M., & Cohn, D. L. (1996). Human immunodeficiency virus seroprevalence and risk assessment of a homeless population in Denver. Sexually Transmitted Diseases, 23, 304–311.PubMedCrossRef

Sumartojo, E. (2000). Structural factors in HIV prevention: Concepts, examples, and implications for research. AIDS, 14, S3–S10.PubMedCrossRef

Toro, P. A. (2006). Trials, tribulations, and occasional jubilations while conducting research with homeless children, youth, and families. Merrill-Palmer Quarterly, 52(2), 343–364.CrossRef

Torres, R. A., Mani, S., Altholtz, J., & Brickner, P. W. (1990). Human immunodeficiency virus infection among homeless men in a New York City shelter: Association with Mycobacterium tuberculosis infection. Archives of Internal Medicine, 150, 2030–2036.PubMedCrossRef

U.S. Department of Housing and Urban Development (2000). National evaluation of the housing opportunities for persons with AIDS program (HOPWA). Washington, DC: HUD Office of Policy Development and Research.

Walters, A. S. (1999). HIV prevention in street youth. Journal of Adolescent Medicine, 25, 187–198.

Wright, J. D., Allen, T. L., & Devine, J. A. (1995). Tacking non-traditional populations in longitudinal studies. Evaluation and Program Planning, 18, 267–277.CrossRef

Zolopa, A. R., Hahn, J. A., Gorter, R., Miranda, J., & Wlodarczyk, D. (1994). HIV and tuberculosis infection in San Francisco’s homeless adults. Journal of the American Medical Association, 272, 455–461.PubMedCrossRef

Title: 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
Authors: Daniel P. Kidder
Richard J. Wolitski
Scott Royal
Angela Aidala
Cari Courtenay-Quirk
David R. Holtgrave
David Harre
Esther Sumartojo
Ron Stall
for the Housing and Health Study Team
Publication date: 01-11-2007
Publisher: Springer US
Published in: AIDS and Behavior / Issue Special Issue 2/2007
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-007-9249-0

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 2/2007

Homelessness Prevention: The Effect of a Shallow Rent Subsidy Program on Housing Outcomes among People with HIV or AIDS

Moving from Fact to Policy: Housing is HIV Prevention and Health Care

The Effects of Housing Status on Health-Related Outcomes in People living with HIV: A Systematic Review of the Literature

Unstable Housing as a Factor for Increased Injection Risk Behavior at US Syringe Exchange Programs

Sexual Risk among Impoverished Women: Understanding the Role of Housing Status

Safe Living: The Impact of Unstable Housing Conditions on HIV Risk Reduction Among Female Drug Users

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials