The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting

Abstract

The social-structural challenges experienced by people living with HIV (PHA) have been shown to contribute to increased use of the Emergency Department (ED). This study identified factors associated with frequent and non-urgent ED use within a cohort of people accessing antiretroviral therapy (ART) in a Canadian setting. Interviewer-administered surveys collected socio-demographic information; clinical variables were obtained through linkages with the provincial drug treatment registry; and ED admission data were abstracted from the Department of Emergency Medicine database. Multivariate logistic regression was used to compute odds of frequent and non-urgent ED use. Unstable housing was independently associated with ED use (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.24–3.04]), having three or more ED visits within 6 months of interview date [AOR: 2.03 (95% CI: 1.07–3.83)] and being triaged as non-urgent (AOR=2.71, 95% CI: 1.19–6.17). Frequent and non-urgent use of the ED in this setting is associated with conditions requiring interventions at the social-structural level. Supportive housing may contribute to decreased healthcare costs and improved health outcomes amongst marginalized PHA.

Behavioral Intervention Improves Treatment Outcomes Among HIV-Infected Individuals Who Have Delayed, Declined, or Discontinued Antiretroviral Therapy: A Randomized Controlled Trial of a Novel Intervention

“…However, interval estimates of effect sizes indicate the HTH intervention overall was promising, particularly in its impact on the important outcomes of biological measures of ART adherence and HIV viral suppression. Data on engagement in HIV care lacked detail, and the study may have under-estimated engagement in HIV care by focusing on HIV primary care, when participants may have received HIV care from other types of providers and/or in emergency departments [110, 111]. Indeed, Mugavero and colleagues have noted the “fractured” nature of the health care delivery system, and called for integrated systems that provide feedback about patients system-wide as they move back and forth along the HIV care continuum [51].…”

Understanding the impact of a residential housing program for people living with HIV/AIDS: results from a realist evaluation

“…Our study emphasised the effectiveness of a harm-reduction residential programme and how a resident-oriented approach is valuable to programme evaluation. The study also reinforced the intrinsic link between unstable housing, stigma and poor health outcomes for PLHIV, 3 28 81 82 and how residential housing programmes for PLHIV can increase adherence to antiretroviral therapy, 25 26 and improve overall physical and mental health. 20 24 28 The mechanisms identified in this study complement each other through classic theories on motivation, self-regulation, self-esteem/self-worth and theories associated with the negative influences of growing up in marginalised communities where individuals become alienated, socially excluded, mistrustful of others and disempowered at multiple levels.…”

How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective

“…Implementation of those harm reduction interventions in the context of emergency departments (EDs) hold particular promise. The ED is a source of both urgent and primary care for people who use unregulated substances, who often resort to the ED due to gaps in primary care and appropriate wraparound services in the community setting [39,40]. In addition, an alarming 5.5% of individuals treated for non-fatal opioid overdose in EDs die within one year of their visit, of whom, 20.5% die within the first month [41].…”