Housing as Healthcare
Policy, Program, Intervention or other types of research evaluation
Issues : The World Health Organization recommends that 90% of persons diagnosed with HIV be engaged in care and 90% of those achieve viral suppression (“suppression”) in order to control the epidemic. The US National HIV/AIDS Strategy and Centers for Disease Control and New York State’s Ending the Epidemic initiative prioritize increasing care and suppression among low-income and racial/ethnic minority persons. More than one-third of New York City’s (NYC) persons with HIV receive subsidized housing assistance, but many remain unsuppressed. The “Getting to 90” initiative was developed to help HIV housing agencies reduce barriers to suppression. We evaluated the impact of this initiative.
Description : In August 2016, the NYC Department of Health and Mental Hygiene (DOHMH), a grantee for the US Housing and Urban Development’s Housing Opportunities for Persons with HIV/AIDS (HOPWA) program, launched “Getting to 90” for 14 HOPWA-funded agencies, which serve low-income and predominantly racial/ethnic-minority persons with HIV. DOHMH and technical staff established a 90% suppression goal; streamlined collection of consumer care and suppression information in the NYC HOPWA data system (eCOMPAS); matched eCOMPAS with NYC HIV surveillance data; analyzed factors associated with non-suppression among HOPWA consumers; and provided agencies with analysis results, customized care- and suppression-rate dashboards, and monitoring and technical assistance.
Lessons learned : At baseline, 88% of NYC HOPWA consumers were documented in eCOMPAS as being in care and 73% suppressed. During the initiative, agencies participated in eCOMPAS training and received six quarterly dashboards, five quarterly technical assistance calls, and lists and epidemiologic profiles of their unsuppressed consumers. Non-clinical professionals successfully incorporated suppression into routine work, supervision, team meetings, and in-house trainings, and had timely awareness of their housing consumers’ suppression status. Agency-reported care engagement rates from baseline to 15 months increased to 95%. Suppression rates increased at 10 of 14 agencies and to 82% overall.
Recommendations : Local health departments can play an important role in providing data and technical assistance to agencies responsible for providing services and increasing suppression among persons with HIV. “Getting to 90” advanced innovative use of program and jurisdictional surveillance data to strengthen suppression efforts among HOPWA agencies.