Connection between social determinants and viral suppression
Policy, Program, Intervention or other types of research evaluation
Issues : Evidence in literatures and practice has demonstrated that safe and stable housing is a critical element in the effective management of HIV and other chronic diseases. However, many housing providers and systems currently lack the data or the capacity to track client’s medical outcomes. CDC reported that across New York City (NYC), only 44% of individuals who were ever diagnosed were virally suppressed. In comparison, the viral load suppression (VLS) rate among individuals living in housing funded by NYC Housing Opportunities for Persons with AIDS (HOPWA) was 62% (source: http://www.nyc.gov/html/doh/html/data/epi-surveillance.shtml). Despite the socio-economic barriers that the HOPWA clients experience, they demonstrate higher VLS rate because the program emphasizes promoting HIV medical visits and participation in DOHMH quality improvement initiatives.
Description : Due to the success of HOPWA’s “getting to 90” initiative (i.e. improving treatment adherence so that 90% of participants are virally suppressed), Harlem United is implementing a similar initiative for all of its supportive housing programs for HIV positive clients. The project entails constructing a housing-wide HIV care cascade to identify gaps in care and monitoring outcomes. In addition, it involves employing a Continuous Quality Improvement (CQI) framework to investigate root causes of the care cascade data gaps and identifying and testing out effective solutions, which may include best practices from HOPWA “getting to 90” initiative. The presentation will focus on step-by-step guide of how to construct a housing-wide care cascade, data collection methods, and using CQI methods to develop appropriate action plans based on data.
Lessons learned : Preliminary finding from Harlem United's internal HOPWA program shows that the VLS rate increased from 72% at baseline to a current rate of 80%. Housing-wide HIV care cascade data points will be presented to illustrate client progress through the continuum of care. The data will include both aggregate and individual program data for comparison. In addition, successful strategies to address gaps in the care continuum will be discussed.
Recommendations : Based on successful strategies identified among Harlem United housing programs, best practices will be presented to replicate and disseminate to other similar programs.