Connection between social determinants and viral suppression
Policy, Program, Intervention or other types of research evaluation
Issues : One in 2 black men who have sex with men (MSM) and 1 in 4 Hispanic MSM will acquire HIV in their lifetimes. Nationally, in 2011, among all young men who have sex with men (YMSM) aged 13 to 24 years, an estimated 58% were black and 20% were Hispanic. YMSM of color have far worse viral suppression outcomes in Texas compared with other age groups or ethnicities. This workshop explains how to use the HIV Housing Care Continuum to improve viral suppression among homeless young men of color entering a permanent supportive housing program. Project TEXT MSG (Teaching Empowerment to eXit Transitional Housing by Managing Secure Goals) is a housing program for young adults between the ages of 18 and 24 years who are living with HIV. Nationally, LGBTQ youth represent 40% of all youth who are homeless but only an estimated 7% of the total youth population. According to Houston Health Department 2015 statistics, people younger than 24 years represent 6% of all people living with HIV but 24% of new HIV diagnoses. In Houston, black MSM and MSM younger than 24 years have the lowest viral suppression outcomes, at 50% and 44% respectively. These 2 groups attend their first clinic visit but are not successfully retained in care.
Description : TEXT MSG is Houston’s first permanent housing program geared to address the unique needs of 30 HIV-positive young adults between the ages of 18 and 24 years. TEXT MSG is a clustered-site housing program that uses the Housing First model to tend to the immediate need for shelter. The program then helps young adults navigate life with a chronic life-threatening disease through support services and resources that will improve their skills and income and transition them into independent living. AIDS Foundation Houston (AFH) program staff identified the need to improve viral suppression within our housing programs. Phase 1 of our initiative included leadership training designed to support and actively guide AFH toward developing and improving our organizational processes and internal performance measurement around viral suppression. The training consisted of 4 workshops covering the following topics: Viral Suppression: A Call to Action, Organizational Assessment: Current Structure and Processes, Creating a Work Plan, Program Evaluation and Reporting, and a review of the HIV Housing Care Continuum webinars provided by the US Department of Housing and Urban Development. Phase 2 of the project included a viral suppression training for all staff at AFH to ensure everyone supported the need to switch the focus with their clients from medication adherence/attending appointments to viral suppression. Also during Phase 2, AFH staff conducted viral suppression training with all housing clients utilizing a visual aid on the value of viral suppression to guide the discussion. Phase 3 of the project included data collection and analysis. The last phase of the project, Phase 4, included implementation of strategies targeted to improve viral suppression.
Lessons learned : Staff training and buy-in are critical to successful implementation of viral suppression initiatives. Participants who are not virally suppressed should receive additional strategies to support viral suppression during case management sessions. It is important to implement expedited strategies to address indirect challenges (housing, stress, employment) and direct challenges (transportation, health literacy, perception of urgency) to ensure medical compliance.
Recommendations : It is important for AIDS service organizations and housing providers to: Understand their role in ending new HIV diagnoses, create their own HIV care continuum utilizing the Housing Opportunities for People With AIDS (HOPWA) HIV continuum of care workbook and webinar to improve patient outcomes, and develop strategies that focus on the ultimate goal of viral suppression through housing as a structural intervention.