Methods: A mixed-method study was conducted using a community-based participatory research (CBPR) approach to address the following main research question (RQ) is: (1) What is the association between housing, case management and HIV health outcomes, specifically HIV treatment adherence, mental health, immune function, and health-related quality of life among PLWH? The study was approved by the University Institutional Review Board and each participant gave their informed consent. Participants were recruited using flyers at community events for PLWH, AIDS Service Organizations, and HIV clinics. Computerized surveys were conducted with 100 PLWH and individual, qualitative interviews were conducted with 28 of the participants. Participants completed a demographic survey and questionnaires about residential mobility, housing quality, sense of community, neighborhood ecology, engagement and retention in HIV care, HIV medication adherence. Participants also reported on last CD4 cell count and HIV viral load. Quantitative data was analyzed using SPSS version 23 and descriptive statistics, Chi-square tests, and analysis of variance (ANOVA) analyses conducted. Qualitative data was analyzed using NVivo version 11 software and content and thematic analysis.
Results: 100 PLWH participated in the study. 55.4% were male and 44.6% were female. Participants’ ages ranged from 25-76 years, and the average age was 51.5±8.9 years. Mean years of living with HIV was 17.1±8.6 years. Mean CD4 cell count was 699.9±298.0. On average, participants lived in their current housing for 4.6±5.7 years. Majority of participants were African American (88%), unemployed or on disability (12.0% and 73.5%, respectively), and single (59% never married, 35% separated, divorced or widowed). Majority of participants identified housing as very important (97.6%). 66.3% were very satisfied, 16.9% somewhat satisfied, and 14.5% somewhat or very dissatisfied. A little more than half of the sample (60.2%) reported their housing needs as completely met, whereas, 25% with somewhat or mostly met housing needs and 2.4% were homeless. Almost half (43.4%) of the sample reported having challenges related to housing and 37.3% received housing assistance. Satisfaction with housing was significantly associated with engagement in HIV care (X2=12.9, p=.01) such that those who reported being dissatisfied with their housing also reported not being currently in HIV care. The people not in HIV Care mostly lived in rural areas. Of the few people not currently on HIV meds, all reported having housing challenges and one reported not being in HIV care. There were no significant differences in mean CD4 cell counts based on gender, housing satisfaction, rurality, or receipt of HIV case management services.
Conclusions: Housing factors are important to PLWH and some housing factors are associated with poor HIV-related health outcomes. Therefore, it is important to consider the impact of a PLWH’s housing situation on their HIV care, HIV medication adherence and HIV outcomes. These findings have implications for nurse educators, health care providers, nurses and case managers who work with PLWH and for policy makers.