Comparison of supportive housing models for HIV+ and at-risk chronically homeless

无家可归或住房不稳定与艾滋病毒之间的联系是明确和无可争议的，特别是在那些长期或频繁无家可归的人中，他们也可能患有药物使用障碍和严重的精神疾病。支助性住房-有支助服务的永久性补贴住房-已作为一种结构性干预措施提供，以降低艾滋病毒感染率，改善艾滋病毒阳性者的健康状况。支助性住房优先提供给“长期无家可归者”，或无家可归时间超过一年的人，或在过去三年中经历过四次或四次以上无家可归事件的人，以及有一种或多种合格残疾的人，包括使用药物、精神疾病和艾滋病毒诊断。尽管如此，不同的支持性住房模式，或这些模式中的不同方案组成部分，以及环境因素和居民特征对健康结果的影响尚未得到研究。我们也不知道各种型号的相对成本效益。拟议的项目将使用定性和定量数据来描述和比较芝加哥至少20个不同的支持性住房计划的有效性和经济效率，为2000多名长期无家可归的人提供服务。我们在艾滋病干预研究中心（CAIR）和住房与健康中心（CHH）建立了强大的研究人员伙伴关系，该中心是芝加哥最大的支持性住房提供者之一，并与其他几个支持性住房机构建立了伙伴关系。这些支助性住房的居民包括艾滋病毒阳性（约一半）和艾滋病毒阴性的居民。该项目有以下目标：1）通过对方案负责人和工作人员的定性访谈，开发支助性住房方案的类型学，并探索可能影响支助性住房方案形式的社会和组织背景特征; 2）使用发达的类型学来检查不同类型的支持性住房计划对居民的性和注射风险，物质使用，ART/治疗依从性，以及住房满意度和稳定性; 3）确定与不同类型的住房计划相关的每位客户住房成本，以及不同类型的计划是否与显着不同的每位客户外部需求相关。（非住房）费用;确定最不发达国家的成本效益方案类型，同时考虑到住房和外部费用;并确定预测外部成本降低的项目特征和客户层面因素。

DESCRIPTION (provided by applicant): The link between homelessness or housing instability and HIV is clear and indisputable, particularly among those with long or frequent episodes of homelessness who are also likely to suffer from substance use disorders and serious mental illness. Supportive housing-permanent, subsidized housing with supportive services-has been offered as a structural intervention to reduce HIV infection rates and improve health outcomes of HIV-positive persons. Supportive housing is preferentially offered to the "chronically homeless", or those with a homeless period lasting over one year or who have experienced four or more homeless episodes in the last three years and who have one or more qualifying disability including substance use, mental illness and HIV diagnosis. Still, the effects of different supportive housing models, or different program components within these models, and of contextual factors and resident characteristics on health outcomes have not been examined. Nor do we know about the relative cost-effectiveness of the various models. The proposed project will use qualitative and quantitative data to characterize and compare the effectiveness and economic efficiency of at least 20 different supportive housing programs in Chicago, serving over 2000 chronically homeless individuals. We have assembled a strong partnership of researchers at the Center for AIDS Intervention Research (CAIR) and the Center for Housing and Health (CHH), one of the largest providers of supportive housing in Chicago with partnerships with several other supportive housing agencies. Residents in these supportive housing include both HIV positive (approximately half) and HIV negative residents. The project has the following aims: 1) To develop a typology of supportive housing programs using qualitative interviews with program directors and personnel and to explore features of the social and organizational context that may affect the forms supportive housing programs take; 2) To use the developed typology to examine the effectiveness of different types of supportive housing programs on residents' sexual and injection risk, substance use, ART/treatment adherence, and housing satisfaction and stability; 3) To determine per- client housing costs associated with different types of housing programs and whether different types of programs are associated with significantly different per-client external (non-housing) costs; to identify the mot cost-beneficial program types, taking into account both housing and external costs; and to identify program characteristics and client-level factors that predict reduced external costs.