Evidence Strategies and Practical tools for inclusion of social and structural interventions such as housing, employment, and food security in plans to end the epidemic
Policy, Program, Intervention or other types of research evaluation
Issues : Following the release of New York State’s Ending the Epidemic (EtE) Blueprint—NY State’s strategy to end AIDS by 2020—the New York City Department of Health & Mental Hygiene (NYC DOHMH) began to explore how to enhance the role HIV housing providers in improving viral suppression outcomes for persons living with HIV/AIDS (PWH) who receive subsidized housing assistance. The NYC DOHMH administers the U.S. Department of Housing and Urban Development’s Housing Opportunities for Persons with HIV/AIDS (HOPWA) grant, a federal housing program for PWH. To expand the role of HIV/AIDS housing providers in EtE efforts, the NYC DOHMH launched the Getting to 90 initiative to strengthen the role of HOPWA-funded housing agencies in reducing barriers to viral suppression and improving electronic documentation of viral load outcomes among HOPWA consumers.
Description : Achieving viral suppression is important for both individual and community-level health, as those with very low concentration of HIV in their blood (i.e., viral load less than 200 copies/mL) enjoy better health and cannot transmit HIV to others. By setting a 90% suppression goal, the Getting to 90 initiative delivered a programmatic, data-driven approach to help thirteen (13) HOPWA-funded permanent supportive housing providers and one (1) long-term rental assistance provider introduce changes that would increase viral suppression rates among their consumers. Using consumer-level data from eCOMPAS—an RDE Systems’ web-based reporting platform for NYC HOPWA data—DOHMH equipped HOPWA providers with rates of care engagement and viral suppression via quarterly HOPWA dashboards. Over the course of 15 months, HOPWA providers participated in a kickoff community forum to introduce the initiative; attended a two-day eCOMPAS systems training to enhance their electronic documentation of viral suppression outcomes; developed quarterly work plans tailored to address the needs of their unsuppressed consumers; participated in five quarterly phone interviews with DOHMH staff to identify technical assistance needs; and received a total of six quarterly HOPWA dashboards.
Lessons learned : After 15 months of the Getting to 90 intervention, DOHMH found agency-reported HIV care engagement rates increased by 7%, from 88% to 95%. Additionally, documented viral suppression rates increased by 9%, from 73% to 82%. HOPWA providers reported that the HOPWA dashboards played a meaningful role in equipping them with the data necessary to develop targeted interventions that resulted in more actionable measures to identify, connect, and support out of care and/or unsuppressed consumers. Of the 14 participating HOPWA providers, 10 achieved an increase in the proportion of their consumers with documented viral suppression. To highlight the types of activities housing providers can implement, this session will feature the work of Institute for Community Living (ICL), an NYCHOPWA provider who delivers supportive housing services to 25 homeless single adults and families with a history of substance abuse and/or mental illness. With the support of DOHMH, ICL deployed various interventions to improve viral suppression outcomes among their consumers, which resulted in a 32% increase in documented viral suppression, from 48% to 80%. At the session, ICL will showcase their “best practices” on how housing providers can increase viral suppression rates among the consumers they house and serve.
Recommendations : By coupling data with personalized technical assistance, DOHMH’s Getting to 90 initiative enhanced the role of HOPWA housing providers in EtE efforts. The HOPWA dashboards served as a catalyst for providers to assess, record and track consumer HIV care and suppression rates. These activities, in turn, informed consumer-level interventions for those who were out of care and/or unsuppressed. The encouraging results from the Getting to 90 initiative underscore how HIV housing providers are strategically positioned to address consumer barriers to care and treatment, paving the way for more providers to get involved in ending the epidemic.