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

说明(申请人提供)：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辩的，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。支持性住房--带有支持性服务的永久性补贴住房--已被作为一种结构性干预措施，以降低艾滋病毒感染率并改善艾滋病毒阳性者的健康状况。支持性住房优先提供给“长期无家可归者”，或无家可归时间超过一年或在过去三年中经历过四次或四次以上无家可归经历的人，以及有一种或多种符合条件的残疾，包括药物使用、精神疾病和艾滋病毒诊断的人。尽管如此，不同的支持性住房模式或这些模式中的不同计划组成部分，以及背景因素和居民特征对健康结果的影响尚未被检查。我们也不知道各种模式的相对成本效益。拟议的项目将使用定性和定量数据来表征和比较芝加哥至少20个不同的支持性住房计划的有效性和经济效益，服务于2000多名长期无家可归的人。我们与艾滋病干预研究中心(CAIR)和住房与健康中心(CHH)的研究人员结成了强大的合作伙伴关系，该中心是芝加哥最大的支持性住房提供商之一，与其他几家支持性住房机构建立了伙伴关系。这些支持性住房中的居民包括艾滋病毒阳性(约一半)和艾滋病毒阴性居民。该项目的目标如下：1)通过对项目负责人和人员的定性访谈，建立支持性住房计划的类型，并探索可能影响支持性住房计划采取的形式的社会和组织背景的特征；2)使用开发的类型学来检验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、艺术/治疗依从性以及住房满意度和稳定性的有效性；3)确定与不同类型的住房计划相关的每位客户的住房成本，以及不同类型的计划是否与每位客户的外部(非住房)成本显著相关；确定MOT成本效益计划类型，同时考虑住房和外部成本；并确定预测外部成本降低的计划特点和客户层面因素。

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.