Housing, HIV outcomes, and related comorbidities in persons living with HIV in Washington, DC

ABSTRACT

Housing instability can hinder the ability of people with HIV (PWH) to maintain engagement in care, adhere to antiretroviral (ART) regimens, and achieve viral suppression. This analysis examined the association between housing instability and HIV outcomes, as well as the association between housing status and substance use disorders, mental health disorders, and sexually transmitted infections. Multivariable logistic regressions were performed using data from the DC Cohort, a longitudinal cohort of PWH. Among 8622 PWH, unstably housed PWH were significantly more likely to be prescribed ART (aOR: 1.4; 95%CI: 1.1, 1.8) yet were significantly less likely to be virally suppressed (aOR: 0.6; 95%CI: 0.5, 0.8). Unstably housed PWH were also significantly more likely to have a substance use or mental health disorder, which may inhibit PWH's ability to achieve viral suppression. Efforts to end the HIV epidemic should address housing to ensure treatment is optimized for key populations.

KEYWORDS:

• HIV
• housing
• mental health disorders
• substance use disorders

Acknowledgments

The authors would like to acknowledge the DC Cohort Study participants for their contribution to the analysis. Data in this manuscript were collected by the DC Cohort Study Group with investigators and research staff located at: Children’s National Medical Center Adolescent (Lawrence D’Angelo) and Pediatric (Natella Rakhmanina) clinics; the Senior Deputy Director of the DC Department of Health HAHSTA (Michael Kharfen); Family and Medical Counseling Service (Michael Serlin); Georgetown University (Princy Kumar); The George Washington University Biostatistics Center (Tsedenia Bezabeh, Susan Reamer, Alla Sapozhnikova, Marinella Temprosa, Nisha Grover, Greg Strylewicz, Kevin (Jiayang) Xiao); The George Washington University Department of Epidemiology (Morgan Byrne, Alan Greenberg, Maria Jaurretche, Paige Kulie, James Peterson) and Department of Biostatistics and Bioinformatics (Yan Ma); The George Washington University Medical Faculty Associates (Hana Akselrod); Howard University Adult Infectious Disease Clinic (Ronald Wilcox, Jhansi Gajjala) and Pediatric Clinic (Sohail Rana); Kaiser Permanente Mid-Atlantic States (Michael Horberg); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Annick Hebou); National Institutes of Health (Henry Masur); Washington Health Institute (Jose Bordon); Unity Health Care (Gebeyehu Teferi); Veterans Afairs Medical Center (Debra Benator); Washington Hospital Center (Maria Elena Ruiz); and Whitman-Walker Health (Stephen Abbott).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

George Washington University Institutional Review Board IRB# 071029.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data.

Authors’ contribution

RH and AC contributed to the study conception and design. Data analysis was performed by RH and MB. The first draft of the manuscript was written by RH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Data availability statement

The data and code used in this study are not publicly available. For additional information about the DC Cohort Study and contact information for inquiries, please visit the website: https://publichealth.gwu.edu/projects/dc-cohort-longitudinal-hiv-study.

Additional information

Funding

The DC Cohort is funded by the National Institute of Allergy and Infectious Diseases: [Grant Number 1R24AI152598-01].