Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort

Clemenzi-Allen, Angelo; Neuhaus, John; Geng, Elvin; Sachdev, Darpun; Buchbinder, Susan; Havlir, Diane V.; Gandhi, Monica; Christopoulos, Katerina

doi:10.1093/ofid/ofz148

Cited by 19 publications

(9 citation statements)

References 37 publications

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“…Both substandard and lack of housing are associated with a panoply of health conditions [35], and communities of colour in the US are more likely to experience poorer housing conditions [36]. A San Francisco‐based cross‐sectional study of 1222 people living with HIV found a direct relationship between high viral load and being homeless [37]. Another study reported that people diagnosed with HIV while homeless have a 27‐fold greater odds of death compared to those diagnosed with access to shelter [38].…”

Section: Discussionmentioning

confidence: 99%

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Millett

2020

J Int AIDS Soc

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Introduction The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative’s implementation. SARS‐COV‐2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID‐19 and HIV, and assesses challenges to EHE in a post‐COVID‐19 universe. Discussion One of the many common threads between HIV and COVID‐19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio‐economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re‐emerged in epidemiological studies of disproportionate COVID‐19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID‐19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID‐19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID‐19 (i.e. diverting HIV resources to address COVID‐19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID‐19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long‐term viability of EHE). Conclusions Racism and discrimination place communities of colour at greater risk for COVID‐19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.

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Section: Discussionmentioning

confidence: 99%

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Millett

2020

J Int AIDS Soc

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“…Two US studies from 2012 and 2014 found that being employed was associated with a reduced hospitalisation rate [ 14 , 19 ], while two other studies found no association with monthly income, [ 10 , 12 ] and results relating to education were inconsistent in PLHIV [ 10 , 12 , 14 , 19 ]. A US study found an association between unstable housing or homelessness and increased rate of hospitalisation in PLHIV [29] . To our knowledge, there are no recent European studies investigating the association of socioeconomic factors with hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6–7 year follow up in people living with HIV

Rein¹,

Smith²,

Chaloner³

et al. 2021

EClinicalMedicine

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Background Predictors of hospitalisation in people with HIV (PLHIV) in the contemporary treatment era are not well understood. Methods This ASTRA sub-study used clinic data linkage and record review to determine occurrence of hospitalisations among 798 PLHIV from baseline questionnaire (February to December 2011) until 1 June 2018. Associations of baseline social circumstance, socioeconomic, lifestyle, mental health, demographic and clinical factors with repeated all-cause hospitalisation from longitudinal data were investigated using Prentice-Williams-Peterson models. Associations were also assessed in 461 individuals on antiretroviral therapy (ART) with viral load ≤50 copies/ml and CD4 count ≥500 cells/ µl. Findings Rate of hospitalisation was 5.8/100 person-years (95% CI: 5.1–6.5). Adjusted for age, demographic group and time with diagnosed HIV, the following social circumstance, socioeconomic, lifestyle and mental health factors predicted hospitalisation: no stable partner (adjusted hazard ratio (aHR)=1.59; 95% CI=1.16–2.20 vs living with partner); having children (aHR=1.50; 1.08–2.10); non-employment (aHR=1.56; 1.07–2.27 for unemployment; aHR=2.39; 1.70–3.37 for sick/disabled vs employed); rented housing (aHR=1.72; 1.26–2.37 vs homeowner); not enough money for basic needs (aHR=1.82; 1.19–2.78 vs enough); current smoking (aHR=1.39; 1.02–1.91 vs never); recent injection-drug use (aHR=2.11; 1.30–3.43); anxiety symptoms (aHRs=1.39; 1.01–1.91, 2.06; 1.43–2.95 for mild and moderate vs none/minimal); depressive symptoms (aHRs=1.67; 1.17–2.38, 1.91; 1.30–2.78 for moderate and severe vs none/minimal); treated/untreated depression (aHRs=1.65; 1.03–2.64 for treated depression only, 1.87; 1.39–2.52 for depressive symptoms only; 1.53; 1.05–2.24; for treated depression and depressive symptoms, versus neither). Associations were broadly similar in those with controlled HIV and high CD4. Interpretation Social circumstance, socioeconomic disadvantage, adverse lifestyle factors and poorer mental health are strong predictors of hospitalisation in PLHIV, highlighting the need for targeted interventions and care. Funding British HIV Association (BHIVA) Research Award (2017); SMR funded by a PhD fellowship from the Royal Free Charity.

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“…Individuals experiencing housing instability have been shown to have higher rates of ED and acute care utilization than stably housed individuals. 27,28 Unaffordable housing has also been associated with increased odds of hypertension and cost-related healthcare non-adherence, as well as worse self-rated health compared to controls using propensity score analyses. 29 In our study, 28% of ED patients reported having unstable housing, suggesting that the ED may offer significant opportunities for homelessness prevention through linkage to legal and social services.…”

Section: Housing Instabilitymentioning

confidence: 99%

Prevalence and Temporal Characteristics of Housing Needs in an Urban Emergency Department

Fraimow-Wong¹,

Sun²,

Imani³

et al. 2021

W J Emerg Med

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Introduction: Our objective was to determine the proportion of patients in our emergency department (ED) who are unhoused or marginally housed and when they typically present to the ED. Methods: We surveyed patients in an urban, safety-net ED from June-August 2018, using a sampling strategy that met them at all times of day, every day of the week. Patients used two social needs screening tools with additional questions on housing during sampling shifts representing two full weeks. Housing status was determined using items validated for housing stability, including PRAPARE, the Accountable Health Communities Survey, and items from the United States Department of Health and Human Services. Propensity scores estimated differences among respondents and non-respondents. Results: Of those surveyed, 35% (95% confidence interval [CI], 31-38) identified as homeless and 28% (95% CI, 25-31) as unstably housed. Respondents and non-respondents were similar by propensity score. The average cumulative number of homeless and unstably housed patients arriving per daily 8-hour window peaks at 7 AM, with 46% (95% CI, 29-64) of the daily aggregate of those reporting homelessness and 44% (95% CI, 24-64) with unstable housing presenting over the next eight hours. Conclusion: The ED represents a low-barrier contact point for reaching individuals experiencing housing challenges, who may interact rarely with other institutions. The current prevalence of homelessness and housing instability among urban ED patients may be substantially higher than reported in historical and national-level statistics. Housing services offered within normal business hours would reach a meaningful number of those who are unhoused or marginally housed [West J Emerg Med. 2021;22(2)204-212.] significantly elevated rates of chronic disease, disability, and infection, making homelessness an issue of profound concern in public health and for health systems. 2-4 From a health systems standpoint, individuals experiencing homelessness have higher rates of emergency department (ED) utilization compared to those who are housed. 5-7 Previous data suggest that

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Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort

Cited by 19 publications

References 37 publications

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6–7 year follow up in people living with HIV

Prevalence and Temporal Characteristics of Housing Needs in an Urban Emergency Department

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