Viral suppression and health care utilization
Abstract Format : Louisiana’s Ryan White (RW) Part B program provides supports services to persons living with HIV (PLWH) who are residents of the state (excluding persons residing in the Baton Rouge Transitional Grant Area (TGA) and New Orleans Eligible Metropolitan Area (EMA)) and meet certain eligibility criteria. An important support service provided is housing assistance. The state as the grantee contracts with community-based organizations to provide housing services including facility based housing (FBH), permanent housing placement (PHP), short term rent mortgage and utility assistance (STRMU), and tenant-based rental assistance (TBRA). Research has demonstrated that lack of stable housing negatively impacts PLWH creating a barrier to obtaining viral suppression.
Methods : Viral suppression was monitored for persons who received PHP, STRMU and/or TBRA between 2014 and 2016. Viral suppression was documented at their first year of service and compared to viral suppression one year later. Clients were included if they received a specified housing service between 2014 and 2016 and were alive and living in Louisiana at the end of the following year. Chi square statistics were run for demographic variables to compare clients who received TBRA to clients who received PHP and/or STRMU.
Results : There were 572 clients who met the criteria. They received a housing service between 2014 and 2016 and were alive and living in Louisiana at the end of the following year. There were 276 clients who received PHP, 343 clients received STRMU and 106 clients received TBRA. During the 3 years monitored, clients who received TBRA increased viral suppression from 70% at their first year of service to 82% the following year. In comparison clients, who received STRMU increased viral suppression from 70% at their first year of service to 74% the following year. Viral suppression decreased from 70% to 68% the following year for clients who received PHP. No significant difference was found for clients who received TBRA versus clients who received another type of housing assistance for gender, race/ethnicity, age, federal poverty level, primary insurance or years since HIV diagnosis.
Conclusions : TBRA is a rental subsidy used to help participants obtain permanent housing in the private rental housing market that meets quality standards and is rent reasonable. The subsidy is portable, moving with the clients if they move to another unit. Additionally, the subsidy provides ongoing support for up to 24 months, which can be extended with a waiver requested by the case manager. The characteristics of TBRA when compared to other types of housing supports the general goal of moving clients to self-management and results in more clients virally suppressed.