Viral suppression and health care utilization
Policy, Program, Intervention or other types of research evaluation
Issues : Research demonstrates stable housing increases a person’s ability to engage in health care and adhere to HIV treatment regimes. This directly impacts their ability to achieve viral suppression and eliminate the risk of sexual HIV transmission. As such, providing stable housing for PLWHA is essential to ending the HIV epidemic. Monitoring rates of viral suppression for participants in HOPWA or Permanent Supportive Housing programs, however, can be a challenge. Using multiple methods of collection and integrating data across systems can overcome some of the barriers to tracking viral suppression outcomes. This data has important implications for both direct program service provision as well as policy around housing and HIV interventions.
Description : The AIDS Foundation of Chicago (AFC) constructed a treatment cascade for HIV-positive participants in HOPWA and Housing First Permanent Supportive Housing (PSH) programs. AFC operates over 650 units of housing for to People Living with HIV/AIDS (PLWHA) in partnership with twelve different subcontracted agencies. As non-medical providers, AFC and its partners have historically struggled to collect reliable viral suppression data on its housing participants. By linking client records in AFC’s case management database with the Illinois Department of Public Health (IDPH) database for Ryan White case management services, AFC was able to obtain laboratory data for HOPWA and PSH clients to supplement data entered by housing case managers. This resulted in vast improvements in both the volume and quality of viral suppression data for clients across AFC’s HOPWA and PSH network.
Lessons learned : Integrating laboratory data accessed through the Ryan White system with HOPWA and PSH case management data resulted in obtaining viral load records for 457 (78.9%) of the 579 currently enrolled residents. The data indicate that of these 457 clients, 364 (83.5%) are on ART and 334 (76.6%) have achieved viral suppression (<=200 copies/mL). This compares to a 45% viral suppression rate for all PLWHA in the Chicago region. Efforts should be made to obtain laboratory data on the 122 clients with missing records to provide a more complete picture of the impact of housing on viral suppression.
Recommendations : AFC is developing a quality improvement protocol for filling in data gaps across these different systems. AFC will also be sharing dashboards with subcontracted partner agencies on a quarterly basis to provide snapshots of their performance related to resident viral suppression, as well as key indicators and factors impacting this particular health outcome. In addition, AFC plans to apply more advanced analytics to resident demographic, case management, and laboratory data to inform more targeted interventions for participants unable to achieve and maintain viral suppression.