Examining the Relationships between Temporary Housing Support Types and HIV and Cardiometabolic Health Outcomes Among People with HIV In Alabama.

Background: Housing is a critical social determinant of health, and support in accessing and maintaining housing is a key role of many social workers. Previous studies of people with HIV (PWH) demonstrate that unstable housing is significantly associated with decreased likelihood of viral suppression and treatment engagement. However, research on the association between housing and cardiometabolic outcomes for PWH is limited. Moreover, the research on the association between type of housing support, demographic factors, and health outcomes for PWH is sparse. Accordingly, this study examined the relationships between temporary housing support types, demographic factors, and HIV and cardiometabolic health outcomes among a sample of PWH receiving housing support in Alabama, United States.

Methods: Data came from electronic medical records for clients engaged in medical care and housing support through an academic medical and community partnership between the years 2020 and 2024 (N=435). Independent variables included age (in years), sex (male or female), race (Black, White, Latino, Multiracial), HIV risk factor (men who have sex with men sexual contact, intravenous drug use, heterosexual contact, unknown), housing program type (stabilization vs. housing), and time. Dependent variables, conceptualized as favorable outcomes (binary), included viral suppression (<200 copies of HIV/mL), kept HIV care visits, not having high cholesterol (Total chol <200mg/dL and LDL Chol < 130 mg/dl), not having diabetes (HbA1c <7.6 mmol/L), and not having hypertension (systolic BP < 140 aid Diastolic BP < 90). Longitudinal Binomial Generalized Linear Regression models were used to assess the association between favorable outcomes and study factors. Each model used the logit link function and included a random intercept to control for within-person correlation. Results were reported as adjusted odds ratios and 95% Confidence Intervals.

Results: Compared to those ages <50 years, participants ages 50+ years were significantly more likely to arrive at HIV care visits (aOR: 1.55, 95% CI: 1.18, 2.05) and significantly less likely to not have diabetes (aOR: 0.36, 95% CI: 0.17, 0.77). Participants in the more intensive housing program were significantly less likely to be virally suppressed (aOR: 0.55, 95% CI: 0.32, 0.97) or arrive to scheduled HIV care visits (aOR: 0.68, 95% CI: 0.52, 0.90), compared to those in stabilization. Among favorable cardiometabolic outcomes, housing participants were significantly more likely to not have high cholesterol (aOR: 1.85, 95% CI: 1.15, 2.98) compared to stabilization participants.

Conclusions: More intensive housing support was associated with a significantly lower likelihood of viral suppression and arrived HIV care visits. This may be indicative of the myriad barriers to healthcare faced by those in the more intensive program that could lead to disruptions in care and increase likelihood of viremia. Conversely, the significantly greater likelihood of viral suppression among those in the less intensive stabilization program suggests that providing temporary housing stabilization services may help individuals with HIV reduce barriers to continuity of care and maintain viral suppression. Additional research is needed to determine the mechanisms in housing programs of different intensities that may support achieving and maintaining desirable HIV and cardiometabolic health outcomes among PWH.