1. 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

2. 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

3. 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

4. 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

5. 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

6. 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%

7. Survival with intact immunity P = 0.04

8. CD4 (T Cell) Counts Patients CD4 Counts - higher is better P = 0.23

9. HIV Viral Loads Patients Viral Loads - lower number is better P = 0.03 for trend

10. Viral Load (Mean) P = 0.03 Mean Viral Load

11. CHHP HIV Outcomes Summary CHHPUsual CareP-Value Survival with intact immunity 55%34%0.04 CD4 Counts (mean) 2712460.23 Viral Loads39K69K0.03 Undetectable VL40%21%0.051