Assessment of a Hotel-Based Protective Housing Program for Incidence of SARS-CoV-2 Infection and Management of Chronic Illness Among Persons Experiencing Homelessness.
Assessment of a Hotel-Based Protective Housing Program for Incidence of SARS-CoV-2 Infection and Management of Chronic Illness Among Persons Experiencing Homelessness.
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DOI：
10.1001/jamanetworkopen.2021.38464
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发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Detmer WM
中科院分区：
文献类型：
--
作者：
Huggett TD;Tung EL;Cunningham M;Ghinai I;Duncan HL;McCauley ME;Detmer WM
在伊利诺伊州芝加哥，以酒店为基础的保护性住房干预是否与减少无家可归者中SARS-CoV-2感染的发生率有关？在这项对259名PEH的队列研究中，在研究期间，在全市范围内的避难所中，与PEH相比，配备保护性住房的PEH的SARS-CoV-2发病率显著降低。高血压和血糖控制方面的改善也被观察到；51%的人在离开时成功入住。这些发现表明，保护性住房干预可能会降低严重新冠肺炎风险增加的PEH患者中SARS-CoV-2的发病率。这项队列研究调查了以酒店为基础的保护性住房干预与伊利诺伊州芝加哥无家可归者中SARS-CoV-2感染的发生率之间的关系。无家可归者感染SARS-CoV-2和因新冠肺炎感染严重疾病的风险更高，这是因为他们与人之间的距离有限，而且潜在健康状况的负担更大。描述和评估一种基于酒店的保护性住房干预措施，以降低伊利诺伊州芝加哥PEH中因新冠肺炎而增加严重疾病风险的SARS-CoV-2感染的发生率。这项回溯性队列研究分析了在2020年4月2日至9月3日新冠肺炎大流行期间，在芝加哥市中心的各个酒店房间中提供保护性住房的人。参与者为高血压患者，严重新冠肺炎的风险增加，定义为(1)年龄至少60岁，无论健康状况如何，(2)年龄至少55岁，有任何潜在的健康状况构成风险增加，或(3)年龄在55岁以下，任何潜在的健康状况构成显著的风险增加(例如，艾滋病毒/艾滋病)。参与者被安置在个别酒店房间内，以降低感染SARS-CoV-2的风险；现场医护人员提供日常症状监测、定期SARS-CoV-2检测和慢性健康状况护理。其他现场服务包括精神健康和药物使用障碍的治疗以及社会服务。测量的主要结果是SARS-CoV-2发病率，通过食品和药物管理局授权紧急使用的任何聚合酶链式反应诊断分析，SARS-Cov2感染被定义为阳性的上呼吸道样本。次要结果是血压控制、血糖控制(由血红蛋白A1c测量)和出发时的住房安置。在芝加哥16个无家可归者收容所的259名参与者中，104名(40.2%)年龄至少65岁，190名(73.4%)男性，185名(71.4%)非西班牙裔黑人，49名(18.9%)非西班牙裔白人。在研究期间，在保护性住房队列中观察到的SARS-CoV-2发病率(54.7‰[95%CI，22.4‰/1000人])低于全市居住在庇护所的PEH发病率(137.1‰[95%CI，125.1-149.1‰]；P = .001)。与基线相比，−5.7 mm Hg(95%CI，−9.3至−2.1 mm Hg)的收缩压和−1.4%(95%CI，−2.4%至−0.4%)的Hb A1c也发生了调整变化。超过一半的参与者(51%[n = 132])离开了对某种住房(如支持性住房)的干预。这项队列研究发现，在芝加哥新冠肺炎大流行的第一波期间，保护性住房与高危人群中SARS-CoV-2感染的减少有关。这些发现表明，在适当的综合支持下(即，解决复杂需求的多部门服务)，这种住房干预可能会降低感染SARS-CoV-2的风险，改善非传染性疾病控制，并提供一条通往永久住房的途径。
Was a hotel-based protective housing intervention associated with reduced incidence of SARS-CoV-2 infection among persons experiencing homelessness (PEH) in Chicago, Illinois? In this cohort study of 259 PEH, a significant reduction in SARS-CoV-2 incidence was observed during the study period among PEH provided with protective housing compared with PEH in shelters citywide. Improvements in hypertension and glycemic control were also observed; 51% were successfully housed at departure. These findings suggest that protective housing interventions may reduce SARS-CoV-2 incidence among PEH at increased risk for severe COVID-19. This cohort study examines the association of a hotel-based protective housing intervention and the incidence of SARS-CoV-2 infection among persons experiencing homelessness in Chicago, Illinois. Persons experiencing homelessness (PEH) are at higher risk for SARS-CoV-2 infection and severe illness due to COVID-19 because of a limited ability to physically distance and a higher burden of underlying health conditions. To describe and assess a hotel-based protective housing intervention to reduce incidence of SARS-CoV-2 infection among PEH in Chicago, Illinois, with increased risk of severe illness due to COVID-19. This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID-19 pandemic from April 2 through September 3, 2020. Participants were PEH at increased risk for severe COVID-19, defined as (1) aged at least 60 years regardless of health conditions, (2) aged at least 55 years with any underlying health condition posing increased risk, or (3) aged less than 55 years with any underlying health condition posing substantially increased risk (eg, HIV/AIDS). Participants were housed in individual hotel rooms to reduce the risk of SARS-CoV-2 infection; on-site health care workers provided daily symptom monitoring, regular SARS-CoV-2 testing, and care for chronic health conditions. Additional on-site services included treatment of mental health and substance use disorders and social services. The main outcome measured was SARS-CoV-2 incidence, with SARS-Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration. Secondary outcomes were blood pressure control, glycemic control as measured by hemoglobin A1c, and housing placements at departure. Of 259 participants from 16 homeless shelters in Chicago, 104 (40.2%) were aged at least 65 years, 190 (73.4%) were male, 185 (71.4%) were non-Hispanic Black, and 49 (18.9%) were non-Hispanic White. There was an observed reduction in SARS-CoV-2 incidence during the study period among the protective housing cohort (54.7 per 1000 people [95% CI, 22.4-87.1 per 1000 people]) compared with citywide rates for PEH residing in shelters (137.1 per 1000 people [95% CI, 125.1-149.1 per 1000 people]; P = .001). There was also an adjusted change in systolic blood pressure at a rate of −5.7 mm Hg (95% CI, −9.3 to −2.1 mm Hg) and hemoglobin A1c at a rate of −1.4% (95% CI, −2.4% to −0.4%) compared with baseline. More than half of participants (51% [n = 132]) departed from the intervention to housing of some kind (eg, supportive housing). This cohort study found that protective housing was associated with a reduction in SARS-CoV-2 infection among high-risk PEH during the first wave of the COVID-19 pandemic in Chicago. These findings suggest that with appropriate wraparound supports (ie, multisector services to address complex needs), such housing interventions may reduce the risk of SARS-CoV-2 infection, improve noncommunicable disease control, and provide a pathway to permanent housing.
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