Chicago Housing for Health Partnership: HIV Outcomes

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Chicago Housing for Health Partnership HIV
Outcomes
David Buchanan MD MS, Romina Kee MD MPH, Laura
Sadowski MD MPH, Diana Garcia MPH North American
Housing HIV/AIDS Research Summit June 4, 2009
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What is the root cause of poor health among
homeless patients?

• Does homelessness lead to poor health?
• Providing housing would improve health
• Do other social factors lead to both poor health
  and homelessness?
• Providing housing would not help much

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Health Outcomes Why HIV?

• Top qualifying medical illness
• Effective treatments for HIV exist
• Housing stability may impact the effectiveness of
  HIV treatment
• Markers for HIV Disease progression

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HIV Outcomes Hypothesis

• Providing permanent housing and intensive case
  management to hospitalized HIV homeless patients
  will improve their survival with an intact immune
  system one year later

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HIV Outcomes Methods

• Inclusion Enrolled at Stroger Hospital, HIV
• 1 year later - CD4 count Viral load
• 1º Endpoint Survival with intact immunity
• Alive with CD4 gt 200 and Viral Load lt 100K
• 2º Endpoints
• CD4 Counts
• HIV viral loads
• Undetectable viral loads

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HIV Outcomes Data Sources

• 105 Eligible (HIV Stroger Hosp enrollees)
• 66 Visited Reference Lab or Died - 63
• 28 Labs - Outpatient usual care - 27
• 11 No labs not deceased - 10

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Survival with intact immunity
P 0.04
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CD4 (T Cell) Counts
P 0.23
Patients
CD4 Counts - higher is better
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HIV Viral Loads
P 0.03 for trend
Patients
Viral Loads - lower number is better
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Viral Load (Mean)
P 0.03
MeanViral Load
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CHHP HIV Outcomes Summary
CHHP Usual Care P-Value
Survival with intact immunity 55 34 0.04
CD4 Counts (mean) 271 246 0.23
Viral Loads 39K 69K 0.03
Undetectable VL 40 21 0.051