Housing & Homelessness

Workbooks describing ways to help connect people living with HIV/AIDS to medical care. Estos cuadernos describen la manera de asistir a conectar personas que viven con VIH/SIDA con el sistema médico.  

HHOME is a mobile care and systems intervention that helps connect vulnerable and homeless individuals in San Francisco to rapid HIV treatment.

KC Life 360 is an employment-focused intervention that utilizes the intersection between employment services, HIV care and treatment, and housing to improve health outcomes of people with HIV.

Collection of implementation guides on evidence-informed best practices in HIV care delivery.

COVID-19 adjustments developed by Ryan White HIV/AIDS Program recipients.

Best practices (and extensive resource links) for integrating into medical care teams the non-medical staff called Navigators.

Review of strategies for housing vulnerable populations in tight housing markets.

Insights from a HRSA SPNS initiative on care coordinator/patient navigation interventions for vulnerable populations.

Study examining models of integration and coordination of housing assistance services and HIV care.

Avenue 360 Health & Wellness offers a medical home for patients and AIDS Foundation Houston coordinates employment training and resources. These agencies believe that coordination is the key to breaking down barriers to health care in their community.

SSRP is a client, provider, and system levels intervention to rapidly connect PLWH recently released from jail/prison to medical, housing, and employment services using a Peer Community Reengagement Specialist model.

Coordination of client services for six months and transitioning clients to the jurisdiction's case management system after completion of the program. Acuity scores determine clients’ case management paths.

Short-term intensive case management services to link clients to housing, employment, and health care services provided by a team comprised of a Peer Care Navigator, Housing Navigator, and an Employment Navigator.

Smart Care Management data-driven/IT model (e.g., patient portal, real-time dashboard for agencies) to enhance utilization of existing health, housing, and employment services.

Coordination of health care with housing and employment services through regular meetings, formal agreements, and a Linkage Coordinator.

Partnership between employment services and Ryan White HIV/AIDS Program providers to foster case coordination among medical care and social service providers, including a screening and referral system for housing and employment needs and services individualized for specific patient needs. 

Care coordination to link clients to services by assessing client needs, barriers, and stages of change, guided by electronic health records and a modified stages of change tool used to assess housing & employment stages of change.

KC Life 360’s same-day intake, informed consent, and one-on-one with an Employment Career Specialist generates awareness of services and benefits across provider networks.

The Leveraging Housing Opportunities to Promote Retention in Care for People with HIV program in New York City offers three types of housing-related supportive services.

Housing first model to help people with HIV address their housing instability while working towards obtaining employment and maintaining consistent medical care. Every patient completes an individual service plan, developed in partnership with their case manager.

Clients are enrolled into a low barrier program that provides immediate and critical housing crisis intervention, including in-housing employment services and ongoing intervention services to secure permanent housing and maintain access to HIV primary care.

Housing and employment services include a Job Club to provide a supportive environment and training for participants. 

Intervention using three interconnected approaches to improve retention in HIV care: housing first, harm reduction, and Motivational Interviewing.

Information and training resources for various community development programs under the auspices of HUD, including HOPWA, Housing Opportunities for Persons with AIDS.

Medical case management acuity tool to assess severity of needs of clients living with HIV in various areas of functioning and categories of severity.

Review of the impact of unstable housing and homelessness on each step of the HIV care continuum and insights on improving care engagement and health outcomes at each stage. 

Webinars and briefs on delivery of HIV care to persons with unstable housing.

Webinars on HRSA HAB policy notices and program letters for RWHAP recipients.

Webinar series featuring HIV care innovations developed under the HRSA HIV/AIDS Bureau’s Special Projects of National Significance (SPNS) program. Sessions share insights on how to replicate SPNS interventions. 

Highlight of two programs that successfully engaged in HIV care clients who are hard-to-reach and serve via delivery of HIV primary care, behavioral health, and housing.

Learn how two successful programs are addressing homelessness and housing instability and behavioral health disorders, improving client engagement and retention in care, and observing improved rates of viral suppression.

Insights on understanding and leveraging of existing housing service systems to better serve people with HIV experiencing unstable housing.

Review of research on the impact of unstable/lack of housing on HIV care outcomes.