Comparison of supportive housing models for HIV+ and at-risk chronically homeless

针对艾滋病毒和高危长期无家可归者的支持性住房模式比较

• 批准号: 8866382
• 负责人: Julia B Dickson-Gomez
• 金额: $ 62.27万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8866382
• 关键词: AIDS/HIV problem; Abstinence; Accident and Emergency department; Accounting; Acquired Immunodeficiency Syndrome; Adherence; Adoption; Affect; Alcohol or Other Drugs use; CD4 Lymphocyte Count; Characteristics; Chicago; Client; Data; Economics; Effectiveness; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Harm Reduction; Health; Homelessness; Housing; Human Resources; Imprisonment; Individual; Injection of therapeutic agent; Intervention; Intervention Studies; Interview; Life; Link; Literature; Mental Health; Mental disorders; Methods; Modeling; Outcome; Participant; Persons; Philosophy; Provider; Qualifying; Quality of life; Relative (related person); Reporting; Research; Research Personnel; Residencies; Risk; Services; Severities; Site; Substance Use Disorder; Symptoms; Time; Typology; Viral Load result; Work; antiretroviral therapy; base; comparative effectiveness; compare effectiveness; contextual factors; cost; cost effectiveness; disability; dissemination research; effectiveness research; experience; housing instability; implementation research; implementation science; improved; innovation; interest; physical conditioning; programs; research study; satisfaction; severe mental illness; social; supported housing; treatment adherence; treatment planning; voucher

DESCRIPTION (provided by applicant): The link between homelessness or housing instability and HIV is clear and indisputable, particularly among those with long or frequent episodes of homelessness who are also likely to suffer from substance use disorders and serious mental illness. Supportive housing-permanent, subsidized housing with supportive services-has been offered as a structural intervention to reduce HIV infection rates and improve health outcomes of HIV-positive persons. Supportive housing is preferentially offered to the "chronically homeless", or those with a homeless period lasting over one year or who have experienced four or more homeless episodes in the last three years and who have one or more qualifying disability including substance use, mental illness and HIV diagnosis. Still, the effects of different supportive housing models, or different program components within these models, and of contextual factors and resident characteristics on health outcomes have not been examined. Nor do we know about the relative cost-effectiveness of the various models. The proposed project will use qualitative and quantitative data to characterize and compare the effectiveness and economic efficiency of at least 20 different supportive housing programs in Chicago, serving over 2000 chronically homeless individuals. We have assembled a strong partnership of researchers at the Center for AIDS Intervention Research (CAIR) and the Center for Housing and Health (CHH), one of the largest providers of supportive housing in Chicago with partnerships with several other supportive housing agencies. Residents in these supportive housing include both HIV positive (approximately half) and HIV negative residents. The project has the following aims: 1) To develop a typology of supportive housing programs using qualitative interviews with program directors and personnel and to explore features of the social and organizational context that may affect the forms supportive housing programs take; 2) To use the developed typology to examine the effectiveness of different types of supportive housing programs on residents' sexual and injection risk, substance use, ART/treatment adherence, and housing satisfaction and stability; 3) To determine per- client housing costs associated with different types of housing programs and whether different types of programs are associated with significantly different per-client external (non-housing) costs; to identify the mot cost-beneficial program types, taking into account both housing and external costs; and to identify program characteristics and client-level factors that predict reduced external costs.

描述（由申请人提供）：无家可归或住房不稳定与艾滋病毒之间的联系是明确且无可争议的，特别是对于那些长期或频繁无家可归的人来说，他们也可能患有药物滥用障碍和严重的精神疾病。支持性住房——提供支持性服务的永久补贴住房——已作为结构性干预措施提供，以降低艾滋病毒感染率并改善艾滋病毒阳性者的健康状况。支持性住房优先提供给“长期无家可归者”，或无家可归期持续一年以上的人，或在过去三年内经历过四次或以上无家可归事件的人，以及患有一种或多种合格残疾（包括药物滥用、精神疾病）的人和艾滋病毒诊断。尽管如此，不同的支持性住房模式或这些模式中的不同计划组成部分以及背景因素和居民特征对健康结果的影响尚未得到研究。我们也不知道各种模型的相对成本效益。拟议项目将使用定性和定量数据来描述和比较芝加哥至少 20 个不同的支持性住房计划的有效性和经济效率，这些计划为 2000 多名长期无家可归的人提供服务。我们在艾滋病干预研究中心 (CAIR) 和住房与健康中心 (CHH) 建立了强大的研究人员合作伙伴关系，该中心是芝加哥最大的支持性住房提供商之一，并与其他几个支持性住房机构建立了合作伙伴关系。这些支持性住房中的居民包括艾滋病毒阳性（约一半）和艾滋病毒阴性居民。该项目有以下目标： 1) 通过对项目主管和人员的定性访谈，开发支持性住房计划的类型，并探索可能影响支持性住房计划所采取形式的社会和组织背景的特征； 2) 使用已开发的类型学来检验不同类型的支持性住房计划对居民的性和注射风险、物质使用、ART/治疗依从性以及住房满意度和稳定性的有效性； 3) 确定与不同类型住房计划相关的每客户住房成本，以及不同类型的计划是否与显着不同的每客户外部（非住房）成本相关；确定最有成本效益的计划类型，同时考虑住房和外部成本；并确定可预测外部成本降低的项目特征和客户层面因素。