Stable housing is a direct pathway to viral suppression, a prospective study and path analysis among 471 unstably housed PLWH enrolled in the HRSA/SPNS Homeless Initiative navigation intervention showed. Results were published in PLOS One.
The intervention employed mobile, interdisciplinary teams of navigators and clinicians. Navigation activities were not directly related to achieving housing stability, likely because navigators addressed other unmet needs (e.g., mental health or substance use treatment) before tackling housing. Nonetheless, those activities were found to be related to viral suppression.
Increased self-efficacy at gaining assistance was associated with stable housing, as was more recent homelessness, less food insecurity, and being virally suppressed at baseline. Self-efficacy, along with a more recent HIV diagnosis and fewer unmet needs, was also associated with retention in care at 12 months. More intense navigation services were related to lower odds of viral suppression, possibly because more pressing needs than adherence counseling had to be addressed first.
Of note, transgender participants (n=18) were less likely to be stably housed than their cisgender counterparts.
Navigation programs should assess clients’ needs and develop a person-centered care plan, train staff in culturally sensitive care for transgender people and in promoting client self-efficacy, and enhance systems coordination, study authors recommended.