Chicago Housing for Health Partnership:

HIV OutcomesDavid Buchanan MD MS, Romina Kee MD MPH,

Laura Sadowski MD MPH, Diana Garcia MPH

North American Housing &

HIV/AIDS Research Summit

June 4, 2009

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

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

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

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 > 200 and Viral Load < 100K

• 2º Endpoints– CD4 Counts

– HIV viral loads

– Undetectable viral loads

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%

Survival with intact immunity

55%

34%

0%

10%

20%

30%

40%

50%

60%

Survival with CD4>200 andVL<100K

InterventionUsual Care

P = 0.04

CD4 (T Cell) Counts

0

5

10

15

20

25

<50 50-199

200-500

>500

InterventionUsual Care

Patients

CD4 Counts - higher is better

P = 0.23

HIV Viral Loads

0

2

4

6

8

10

12

14

16

18

<75 75-9K 10K-100K

>100K

Intervention

Usual Care

Patients

Viral Loads - lower number is better

P = 0.03 for trend

Viral Load (Mean)

39K

69K

0

10000

20000

30000

40000

50000

60000

70000

InterventionUsual Care

P = 0.03

MeanViral Load

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