Health Status, Health Care Use, Medication Use, and Medication Adherence Among Homeless and Housed People Living With HIV/AIDS

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
American Journal of Public Health (Impact Factor: 4.55). 01/2008; 97(12):2238-45. DOI: 10.2105/AJPH.2006.090209
Source: PubMed


We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS.
Data were obtained from a cross-sectional, multisite behavioral survey of adults (N=7925) recently reported to be HIV positive.
At the time interviews were conducted, 304 respondents (4%) were homeless. Self-ratings of mental, physical, and overall health revealed that the health status of homeless respondents was poorer than that of housed respondents. Also, homeless respondents were more likely to be uninsured, to have visited an emergency department, and to have been admitted to a hospital. Homeless respondents had lower CD4 counts, were less likely to have taken HIV anti-retroviral medications, and were less adherent to their medication regimen. Homeless respondents needed more HIV social and medical services, but nearly all respondents in both groups had received needed services. Housing status remained a significant predictor of health and medication outcomes after we controlled for potential confounding variables.
Homeless people with HIV/AIDS are at increased risk of negative health outcomes, and housing is a potentially important mechanism for improving the health of this vulnerable group.

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Available from: Richard J Wolitski, Oct 13, 2015
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    • "The personal health of each student and their family's Socioeconomic Status (SES) may affect their academic capabilities; in particular, they may experience illness more than their counterparts. SES is important to health at all levels of status an in general, the more advantage individuals are, the better their health, and the more disadvantaged individuals are, the greater their chances of increased morbidity and mortality(Alder, 1997; Kidder, 2007; Sanders Thompson, 2012; Zlotnick, 2009). "
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    • "Homeless persons also have higher risks of serious morbidity and mortality, with the most frequently reported causes of death being related to violence, HIV/AIDS, and substance misuse.22–26 Furthermore, homeless persons living with HIV have been found to be less likely to access and receive optimal regular HIV care.16,27–29 This may also related to healthcare associated barriers, given that prescribing physicians may be less likely to prescribe ART to these patients, although Bangsberg et al.30 demonstrated that providers inaccurately estimated ART adherence compared to structured patient report, which was more closely related to pill count among a sample of homeless or unstably housed HIV-infected persons. "
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    ABSTRACT: Homelessness is prevalent among HIV-infected injection drug users (IDU) and may adversely affect access and adherence to antiretroviral therapy (ART). There are limited descriptions of the effect of homelessness on adherence to ART in long-term cohorts of HIV-infected IDU. We used data from a community-recruited prospective cohort of HIV-infected IDU, including comprehensive ART dispensation records, in a setting where HIV care is free. We examined the relationship between the homelessness measured longitudinally, and the odds of ≥95% adherence to ART using generalized estimating equations logistic regression modeling adjusting for sociodemographics, drug use, and clinical variables. Between May 1996 and September 2008, 545 HIV-infected IDU were recruited and eligible for the present study. The median follow-up duration was 23.8 months (IQR 8.5-91.6 months) contributing 2,197 person-years of follow-up. At baseline, homeless participants were slightly younger (35.8 vs. 37.9 years, p = 0.01) and more likely to inject heroin at least daily (37.1% vs. 24.6%. p = 0.004) than participants who had housing. The multivariate model revealed that homelessness (adjusted odds ratio [AOR] 0.66; 95% CI: 0.53-0.84) and frequent heroin use (AOR 0.40; 95% CI: 0.30-0.53) were significantly and negatively associated with ART adherence, whereas methadone maintenance was positively associated (AOR 2.33; 95% CI: 1.86-2.92). Sub-optimal ART adherence was associated with homelessness and daily injection heroin use among HIV-infected IDU. Given the survival benefit of ART, it is critical to develop and evaluate innovative strategies such as supportive housing and methadone maintenance to address these risk factors to improve adherence.
    Journal of Urban Health 03/2011; 88(3):545-55. DOI:10.1007/s11524-011-9562-9 · 1.90 Impact Factor
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    • "Among HIV-infected persons, unstable housing has been associated with fewer ambulatory care visits [16], greater reliance on emergency departments [16-19], frequent or longer hospitalizations [16,17,19,20], and decreased use of antiretroviral therapy and prophylaxis against opportunistic illnesses [17,18,20,21]. Among homeless persons who have been prescribed antiretroviral therapy, adherence is suboptimal [17,22]. "
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    BMC Public Health 08/2009; 9(1):220. DOI:10.1186/1471-2458-9-220 · 2.26 Impact Factor
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