"Choose the People Who Know": How Patient-Centered Medical Homes Reduce Disclosure Anxiety for People Living with HIV and Experiencing Homelessness.

While public and medical perceptions of HIV and those living with HIV have shifted to be more accepting, many individuals still report stigmatizing experiences in clinical and non-clinical settings. Interviews with 40 people living with HIV, homelessness, substance use, and mental illness participating in a patient-centered medical home (PCMH) were conducted in seven sites across the U.S. to assess experiences with stigma in social and clinical spheres. The most salient themes of the study were: 1) how current and past experiences of stigma-in interactions with friends, family, and providers-informed clients' relationships with disclosure, and 2) how, through coordinated and confidential systems of care, the PCMH minimized the necessity to disclose HIV status, thereby reducing the anxiety associated with it.

Mobile Multidisciplinary HIV Medical Care for Hard-to-Reach Individuals Experiencing Homelessness in San Francisco.

The San Francisco, California-based HIV Homeless-Health Outreach Mobile Engagement (HHOME) program aims to improve health and housing outcomes for multiply diagnosed people experiencing chronic homelessness whom the HIV care system has failed to reach. From 2014 to 2017, HHOME's mobile multidisciplinary team served 106 clients. Viral suppression increased from 23.6% to 60%, and 73.8% obtained permanent supportive housing (n = 61). System-level changes included the adoption of city-wide standardized acuity assessment tools HIV Care Coordination Taskforce by community partners. This article highlights HHOME's core components and its public health implications.

The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness.

Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017.Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervention. HIV outcomes included linkage and retention in care, antiretroviral therapy prescription, and viral suppression collected via chart review.Results. In the 12 months after the intervention, 59.6% transitioned to more stable housing. Compared with those who became or remained unstably housed, participants with greater stability achieved significantly higher rates of retention (adjusted odds ratio [AOR] = 2.12; 95% confidence interval [CI] = 1.11, 4.05), were more likely to be prescribed antiretroviral therapy (AOR = 2.06; 95% CI = 1.62, 2.63), and had higher rates of viral suppression (AOR = 1.62; 95% CI = 1.03, 2.55).Conclusions. The use of patient navigators to create a network of services for PLWH who are unstably housed can improve housing stability and lead to improvements in HIV-related outcomes.