The New York City Department of Health and Mental Hygiene implemented Enhanced Housing Placement Assistance (EHPA), an evidence-based intervention that seeks to rapidly re-house people with HIV. EHPA was implemented at 22 New York City shelters for homeless adults with HIV and was associated with significant improvements in viral suppression. The New York City Department of Health and Mental Hygiene supports its housing services with funds from Ryan White HIV/AIDS Program (RWHAP) Part A and Housing Opportunities for Persons with AIDS (HOPWA).
New York, NY
For people with HIV, homelessness and unstable housing are associated with suboptimal health outcomes and greater risk of mortality.1 Lack of stable, secure, and adequate housing is a significant barrier to achieving and sustaining improved HIV-related outcomes.2 Rapid re-housing initiatives such as EHPA have been championed by housing policy experts as an effective was to reduce homelessness,3 including for people with HIV.4EHPA aims to improve housing placement and viral suppression by combining rapid re-housing and ongoing intensive housing stabilization services.
“Due to the demands of HIV treatment and other related health issues, it may be harder for low-income people with HIV to find stable housing.”
Eligible people with HIV who were residing at any of New York City’s 22 HIV emergency single adult shelters were assigned to a case manager who worked to identify affordable housing as quickly as possible. Rent and move-in assistance were also provided. A comparison group of clients received ‘usual care’ (i.e., were not enrolled in EHPA) and did not receive a case manager immediately. They were instead referred to a community-based organization to receive existing housing placement services.
Two case managers provided ongoing housing stabilization services, typically for up to 12 months after enrollment into EHPA. Case managers would visit clients at the emergency shelter on a weekly basis, or more frequently as needed. They would also transport and accompany clients to housing and benefits-related appointments, and address any barriers that may destabilize housing such as substance use, a mental health condition, or financial management challenges. Clients receiving usual care (not enrolled in EHPA) did not receive direct case management services. Usual care clients were eligible to receive only other support (such as financial assistance), which was terminated three months post-enrollment, and they had to travel to the organization’s office to receive such support.
“The EHPA program focused primarily on housing people with HIV who have significant barriers to housing by delivering placement services to clients in a way that maximizes accessibility and shortens time to placement.”
EHPA was evaluated using a randomized controlled trial study design. From 2012 to 2014, 236 participants were randomized to receive EHPA (n=119) or usual care (n=117), meaning clients were referred to existing housing placement programs. Clients in EHPA were more likely to be stably housed at 12 months, were likely to obtain stable housing more quickly, and had greater improvements in viral suppression, than clients in traditional housing assistance programs.
|Evaluation data||Viral suppression data from NYC HIV Surveillance Registry, living situation history and housing placement data from HOPWA/RWHAP data submitted to the New York City Department of Health and Mental Hygiene|
* statistically significant
Source: Towe VL, Wiewel EW, Zhong Y, Linnemayr S, Johnson R, Rojas J. A randomized controlled trial of a rapid re-housing intervention for homeless persons living with HIV/AIDS: Impact on housing and HIV medical outcomes. AIDS Behav. 2019;23(9):2315-2325. doi:10.1007/s10461-019-02461-4
Staffing. EHPA was developed and implemented by the New York City Department of Health and Mental Hygiene, which has an established housing assistance program for people with HIV. Two case managers were hired to support EHPA clients by providing rapid re-housing and ongoing housing stabilization services.
Participant recruitment. Existing homeless shelter staff were used to identify, screen, and recruit participants into EHPA. All recruitment efforts were tracked, and staff returned to shelters multiple times, at different times of the day to increase their recruitment rate. Participants received a $20 food voucher upon enrollment. The New York City Department of Health and Mental Hygiene then leveraged existing housing funds to place people into permanent housing and to provide them with rent and move-in assistance.
- EHPA was developed and implemented by the New York City Department of Health and Mental Hygiene without additional funding. The intervention activities and evaluation were funded under the department’s existing budget. The department receives funding from HOPWA and RWHAP Part A.
- For jurisdictions seeking to replicate EHPA, personnel and activities may be eligible for funding under HOPWA and/or RWHAP.
- EHPA delivered rapid re-housing services to clients directly in the emergency shelters, rather than making clients travel to offices of community-based organizations for the same services. The intervention team feel that this may have resulted in significantly higher levels of housing placement than traditional service delivery methods.
- Rapid re-housing recommendations from the National Alliance to End Homelessness suggest moving clients into permanent housing within 30 days.5 For EHPA participants, the average time to placement was 143 days. The intervention team recommended considering the impact of HIV and other comorbid conditions when establishing benchmarks for evaluation.
“Refining best practices for rapid re-housing and addressing barriers to housing will allow housing providers to set and meet aggressive benchmarks to reduce chronic homelessness.”
- Aldridge RW, Story A, Hwang SW, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis. The Lancet. 2018;391(10117):241-250. doi:10.1016/S0140-6736(17)31869-X
- Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. Am J Public Health. 2016 Jan;106(1):e1-e23. doi: 10.2105/AJPH.2015.302905. Epub 2015 Nov 12. PMID: 26562123; PMCID: PMC4695926
- Byrne T, Huang M, Nelson RE, Tsai J. Rapid rehousing for persons experiencing homelessness: A systematic review of the evidence. Housing Studies, 2021:1-27. doi:10.1080/02673037.2021.1900547
- Clemenzi-Allen AA, Hickey M, Conte M, et al. Improving care outcomes for PLWH experiencing homelessness and unstable housing: A synthetic review of clinic-based strategies. Curr HIV/AIDS Rep. 2020; 17(3):259-267. doi: 10.1007/s11904-020-00488-0
- National Alliance to End Homelessness. Rapid Re-Housing: Performance Evaluation and Improvement Toolkit. Published online 2016.