Note: Not all Summit presenters used slides and some slide decks contained data that could not be posted online.

 

Plenary: Social Drivers of Health Disparities: A Bird's Eye View

Preventing and reducing health inequalities: Health in all policies

Debra Furr-Holden, Director, DIVE Studies Laboratory, Johns Hopkins Bloomberg School of Public Health

HIV disparities: A population perspective

Greg Millett, Vice President and Director, Public Policy, amfAR, The Foundation for AIDS Research Slides

The history that walks upon us – Looking to the past to better understand today's Native/Aboriginal People

Harlan Pruden, Two-Spirit Community Organizer and Member of the Presidential Advisory Council on HIV/AIDS

Pervasive social/structural drivers affecting the health of people living with HIV

Sean B. Rourke, Scientific and Executive Director, Ontario HIV Treatment Network Slides

 

Plenary: Social Drivers of HIV Health Disparities: Digging Deeper

Housing as a determinant of health for people with HIV: A systematic review of the literature

Angela Aidala, Study Director, Community Health Advisory & Information Network (CHAIN) Project, Mailman School of Public Health, Columbia University.

Food and nutrition services and HIV outcomes: Research, practice and policy

Karen Pearl, President and CEO, God's Love We Deliver Slides

Employment as a social determinant of health for persons with HIV/AIDS

Kenneth Hergenrather, Chair, Graduate School of Education and Human Development, George Washington University Slides

"As a black man, I got 99 problems & I sure ain't thinking about HIV at the end of the day": The social drivers of black men's sexual HIV risk and protective behaviors

Lisa Bowleg, Professor, Applied Social Psychology, George Washington University Slides

Mass incarceration, policing, and race disparities in HIV/AIDS

Kim Blankenship, Director, Center on Health, Risk and Society, American University Slides

 

Lunch Keynote: National HIV/AIDS Strategy for the United States: Updated to 2020

Douglas Brooks, Director, Office of National AIDS Strategy Slides

 

Incarceration: Impact and Interventions

HIV/HCV in Quebec's provincial detention centres: Prevalence, related risk factors, access to services and care. Comparing cross-sectional data from 2003 and 2014

Yohann Courtemanche, Centre de recherche, Centre Hospitalier Universitaire de Quebec Slides

Prisoners are a stigmatized, high-risk population for HIV and HCV infections. The last study on Quebec’s provincial prisoners from 2003 showed a high prevalence of HIV, HCV and risky behaviors. The aim of this study was to update the epidemiological data on HIV/HCV in Quebec’s inmate population, with a methodology allowing for optimal comparison with the 2003 study. Cross-sectional data were obtained from male and female prisoners in seven detention centers. 1362 men and 251 women participated in the 2014 study. HIV prevalence was lower in 2014 than in 2003 among both men (1.9% vs. 2.3%) and women (0.8% vs. 8.8%). HCV prevalence was also lower in 2014 than in 2003 for men (11.9% vs. 16.5%,) and women (19.6% vs. 29.1%). This presentation will discuss declines in HIV/HCV prevalence, treatment adequacy, access to services, and opportunities to increase testing, treatment and harm reduction strategies.

Male incarceration rates, spatial access to sexual health care, and sexually transmitted infections: A moderation analysis

Emily Dauria, Department of Psychiatry and Human/Health Behavior, Alpert Medical School, Brown University Slides

Compared to other regions of the country, the southern region of the US consistently has the highest burden of sexually transmitted infections. Incarceration rates have emerged as a potentially powerful determinant of the prevalence of newly-diagnosed STIs with the forceful removal of men en masse from neighborhoods potentially altering the local composition of sexual networks in ways that facilitate STI transmission. Multiple intersecting factors may help explain complex health outcomes like STIs. One up-stream factor that may be associated with poorer health outcomes and STI transmission is reduced spatial access to health care (i.e., increased distance and travel time to health care providers). Health care visits present critical opportunities for the testing and treatment of STIs. The aim of this cross-sectional study was to explore whether the relationship between male incarceration rates and newly-diagnosed STI prevalence is moderated by spatial access to health care facilities that offer STI treatment and prevention services. We hypothesized that greater spatial access to sexual health care will decrease the magnitude of the relationship between rates of male incarceration and the prevalence of newly-diagnosed STIs. This session will discuss our methods, results, and conclusions.

Transitional health care coordination: Linking incarcerated people living with HIV/AIDS to care and services in the community

Nilda Ricard, Director Health Services and Drop-In Center, The Fortune Society Slides

This presentation examines the Fortune Society's Drop-In Center program as a Service Delivery Model which provides pre- and post-release care to people living with HIV/AIDS who are currently incarcerated in New York City jails and New York state prisons. The Fortune Society is one of New York City's leading providers of social services for recently released prisoners and is a member of the Transitional Health Care Consortium. The Transitional Health Care Consortium works in collaboration with the New York City Department of Health and Mental Hygiene and the New York City Department of Corrections to link newly released people living with HIV to vital services in the community. We will discuss the process and methods of service delivery. These services include care coordination, intake assessment, care plan development, on-going non-medical case management, escort and maintenance in care, and other contract funded services. Post-release services such as client assistance, accompaniment, and outreach for patient re-engagement will also be discussed.

CARE+ CORRECTIONS TRIAL: Technology and the HIV-positive returning citizen: A qualitative evaluation

Claudia Trezza, Milken Institute School of Public Health, George Washington University Slides

Individuals recently released from the criminal justice system, locally referred to as "returning citizens," and diagnosed as HIV-positive experience significant challenges and barriers to linkage and engagement in community HIV care and services subsequent to release. Innovative efforts such as mHealth interventions (CARE+ Corrections) seek to optimize the reentry experience for HIV+ returning citizens to increase linkage to care and ancillary services. The CARE+ Corrections study is a randomized trial conducted in the District of Columbia. The two part intervention consists of: 1) an interactive one-session computerized motivational interview which provided counseling and linkage support, and 2) cell phone text messaging to support linkage and engagement in care and adherence to medications. A qualitative evaluation of the implementation of the CARE+ Corrections intervention also is being conducted among study participants. This paper will report on the evaluation's results to explore perceptions of the innovative mhealth technology and barriers to engaging in HIV care upon return to the community.

 

Food Security: Impact and Interventions

Spaces of care, spaces of risk: Mapping food as harm reduction

Christiana Miewald, Department of Geography, Simon Fraser University

People who use substances and who are also low-income have profound concerns when it comes to accessing nutritionally adequate, safe, and appropriate foods that they can consume in safe, nurturing spaces. Geographical research has highlighted the ways in which low-income people construct routes, pathways, and schedules through cities to access food. At the same time, understanding the geographies of food access that are constructed and experienced by low-income people living with HIV who use substances can play an important role in their health and well-being. Our project, Food as harm reduction: Documenting the health effects of food provision for people who use drugs, addresses the following questions: 1) in what ways do low-income people living with HIV who use substances experience food insecurity and greater risk of disease; 2) what is the distribution of knowledge and practice around food provision among harm reduction providers in Greater Vancouver; and 3) what are the geographies (routes, pathways, barriers and schedules) that low-income people living with HIV who use substances construct and experience as they access food each day? We will discuss the ways in which the geography of food access influences the daily lives and overall health of people living with HIV who use substances including encounters with spaces of care and risk.

Capacity building around food as harm reduction

Grace Dalgarno, Dr. Peter AIDS Foundation Slides

Food as harm reduction is a collaborative, community based research project between Simon Fraser University Geography Department and the Dr. Peter AIDS Foundation, funded by the Vancouver Foundation. Using a community-based research framework, the Food as Harm Reduction project explores the ways in which food provision can mitigate the physical, social, and psychological harms associated with substance use. The project is comprised of three parts: surveying 60 people living with HIV who use substances, half of whom use the Dr. Peter Centre and half of whom do not; mapping daily routines to learn about daily routes used to access food; and conducting qualitative interviews with harm reduction service providers. This session will describe the project and also address community involvement, lessons learned and recommendations.

Food is medicine: The Ryan White Food and Nutrition Services Program as a model for comprehensive food and nutrition services in the United States

Alissa Wassung, Director of Policy and Planning, God's Love We Deliver Slides

This session mirrors a chapter recently published in The Health of HIV Infected People: Food, Nutrition and Lifestyle with Antiretroviral Drugs. We reviewed significant research on food programs and health outcomes, demonstrating how access to adequate food and nutrition services helps accomplish the Triple Aim of national healthcare reform for people living with HIV: better health outcomes, lower cost of care and improved patient satisfaction. We examined the structure, funding and delivery methods for the Ryan White Food and Nutrition Services (FNS) Program, arguably the most robust FNS program in the country for people living with chronic illness, through the lens of improving health outcomes and implementing cost effectiveness. We used co-authored case studies from six FNS providers around the country to showcase the RW benefit in practice over the 30-year history of the providers and demonstrated how each agency has leveraged their core capacity to integrate with state-based healthcare reform efforts to expand coverage for people living with HIV and other populations. Analysis of the Ryan White FNS Program, in policy and practice, is then used to model how FNS, a relatively inexpensive benefit, could be incorporated into our nationwide healthcare delivery system to capitalize on the results evident in the outcomes of Ryan White for all people living with HIV and for people living with other chronic and severe illnesses.

 

(Un)Employment: Impact and Interventions

Employment and economic well-being of people living with HIV in the New York Eligible Metropolitan Area

Maiko Yomogida, Mailman School of Public Health, Columbia University Slides

The success of antiretroviral therapies has shifted the focus of HIV care from mere survival to quality of life. This study looks into an important dimension of quality of life for people living with HIV: economic wellbeing and labor force participation. Data are from the CHAIN study, an on-going prospective cohort study of people living with HIV in NYC and three northern counties (Tri-County; TC). The CHAIN study sample was designed to be representative of people living with HIV receiving medical and/or social services in the NY Eligible Metropolitan Area. Trends in employment and economic well-being were analyzed by pooling all 5,911 interviews completed with 1,869 CHAIN cohort members between 2001 and 2013. The analyses of factors associated with employment were restricted to data obtained from the interviews, completed between 2008 and 2013. Results showed that despite the widespread use of antiretroviral therapy and reduced mortality rates, CHAIN participants' labor force participation remained consistent over the 12-year period of this study and the reason most frequently noted for unemployment was poor health.

Foundations for living: An integrated HIV housing and employment intervention for people living with HIV

Liza Conyers, Penn State College of Education and National Working Positive Coalition Slides

This presentation will describe the development and implementation of the Foundations for Living integrated HIV/AIDS housing and employment services program model that provided housing assistance to people living with HIV who are interested in working or volunteering full or part-time, or advancing their education. This FFL model was funded by a Special Project of National Significance grant through HOPWA to CARES, Inc. who coordinated services in two distinct regions of upstate New York: Rochester (relatively rural) and Albany (major city). Fundamental to the implementation of the FFL model is recognition of both individualized and systems level interventions. While participants in FFL worked with a service coordinator to develop individualized service plans, resource identification staff worked with key stakeholders in both Rochester and Albany to identify and reduce systemic barriers to integrated housing and employment services. Housing, health and HIV prevention outcomes will be reported for a cohort of individuals who completed FFL in Albany and Monroe counties from January 2012 to December 2014.

Minimal to comprehensive: Strategies to increase employment opportunities and economic security of people living with or at greater risk for HIV

Mark Misrok, Board President, National Working Positive Coalition Slides

The National Working Positive Coalition is connected to and has been involved with implementation of a range of employment service models implemented and evaluated by HIV care and prevention programs in North America. This presentation describes how HIV care and prevention, housing and other supportive services can link and coordinate with a range of federal, state and local education and employment programs and resources to increase effective participation by people living with or at risk for HIV. Organizations and communities need to first assess their readiness and capacity, then review, select and implement strategies to adapt or revise their service delivery to better meet employment information and service needs of people living with or at greater risk for HIV. Goals for ending the epidemic, and a post-HIV landscape, need to prioritize addressing the economic and vocational vulnerability of survivors and communities disproportionately affected. Efforts to maximize available resources to increase employment opportunities need to be implemented now for sustained positive health and prevention outcomes in the years ahead.

I've fallen and I can't get back up

Vernita Perry, Community Health Worker, Positive Pathways with Sabrina Heard and Ronette Moton Slides

The goal of this session is to present the role of a Community Health Worker (CHW) and discuss the many roles we serve with members of our community. We will explain how CHWs help bridge the gap between clients and doctors, and we will focus on how CHWs work with community members who are HIV-positive and using drugs. CHWs reach out to members and meet them "where they are at." Some of our members have no support system and no one to help them. We listen, offer support and show members that we care. We want the audience to understand the significance of the CHW role, so that people can learn from our experiences and gain new tools for working with HIV-positive populations. We also welcome feedback from the audience, so that we can share our different methods and learn from each other.

From engagement to empowerment: Addressing the social drivers of HIV through peer employment in community-based research

James Watson, Coordinator, Community-Based Research and Peer Training, Ontario HIV Treatment Network and Lynne Cioppa, Bruce House, Ottawa, Ontario Slides

The episodic nature of HIV has isolated many people with HIV/AIDS (PHAs) from regular workforce participation, often resulting in their underemployment or reliance on government assistance. Research employment as peer engagement is an empowerment strategy that can benefit the health, well‐being and quality of life of PHAs. Through its employment of PHAs as Peer Research Associates (PRAs), the Ontario HIV Treatment Network pioneered a community‐based research (CBR) model that put peer engagement into action. CBR is a field where lived experience and a desire to build capacity are highly regarded. As part of its research efforts, the OHTN successfully implemented a series of mixed‐method CBR studies that collected extensive data on the social determinants of health of PHAs. Drawing on PRA experiences from three OHTN CBR studies (the Positive Space Healthy Places housing study, the Employment Change and Health Outcomes study, and the Impact of Food Security on Health Outcomes in People Living with HIV/AIDS Across Canada study) we will highlight the peer researcher role as an effective peer engagement empowerment intervention.

Common Threads: An integrated HIV prevention and vocational development intervention based upon the principles of trauma informed care

Margot Kirkland-Isaac, CBA Program Manager, DC CARE Consortium Slides

This presentation is designed to increase awareness and skills related to the need to implement trauma-informed vocational and HIV prevention interventions for African American women with HIV. Presenters will: (a) review the development of the Common Threads intervention, including a review of principles of trauma-informed care; (b) discuss the relationship between vocational development/employment and outcomes associated with the HIV Continuum of Care; (c) demonstrate the integration of a trauma informed care activity as a key component of the Common Threads intervention; and (d) share initial research findings that demonstrate some of the outcomes of this approach in facilitating vocational development and improving health and prevention outcomes. This presentation will utilize interactive activities to support an engaging and positive environment. For example, participants will be able to explore the impact of life experience through the development of a personal timeline, which is an activity of the Common Threads training. These activities will be used to help participants to develop strategies to infuse trauma informed care into vocational and HIV prevention services to better engage African American women in HIV care and prevention.

 

Legal Systems: Impact and Interventions

Legal interventions that can reduce health disparities

Scott A. Schoettes, Senior Attorney and HIV Project National Director, Lambda Legal, and Member of the U.S. Presidential Advisory Council on HIV/AIDS

Administrative, regulatory and litigation advocacy for people living with HIV

Carmel Shachar, Clinical Instructor of Law, Centre for Health Law and Policy Innovation, Harvard Law School Slides

The Affordable Care Ac (ACA) is an existing framework that contains a number of provisions to increase preventive care and to address social determinants of health; however, State adoption of these initiatives are optional, resulting in fragmented implementation. Resources and tools within the ACA, such as integrated health care homes and free preventive services, have the potential to improve care received by people living with HIV. States now have the opportunity to take advantage of existing proven programs with flexibility for local innovation. Adopting the full range of ACA opportunities available, including Medicaid expansion, reduced elimination of cost sharing for many preventive services, and Medical Health Home programs, would allow States to increase the value of health care by adopting a preventative, early-intervention based health care delivery system and advance health of low-income, vulnerable populations nationwide including those living with HIV. This presentation will suggest several ways to reshape health care for low-income vulnerable populations through ACA-based tools.

Legal services: A critical innovation in HIV/AIDS continuums of care

Patrice Paldino, Supervising Attorney, Legal Services, Broward County, Florida

The provision of legal services is critical to the success of interdisciplinary continuums of care. People living with HIV face a number of legal issues which directly impact their stability and mental and physical health. For three years, the HOPWA program at Legal Aid Service of Broward County has provided free legal services to help HOPWA clients maintain or acquire safe and affordable housing and to assist them in transitions to self-sufficiency. This presentation will address the necessity of a holistic model of direct legal services to overcome systemic barriers to stable housing and the resolution of root cause issues which impact housing so that people living with HIV can achieve improved mental and physical health.

Providing holistic support for LGBT and HIV/AIDS activists fleeing their countries due to persecution

Audu Kadiri, Housing Works Inc.

The Housing Works Asylum Project provides lifesaving assistance to HIV-positive and other LGBT activists from target countries around the world who are facing political persecution for their sexual orientation, gender identity and activism. Asylum Project participants receive housing, medical and mental health care, case management, legal representation, financial assistance, job training and other vital services as they apply for asylum and assimilate into U.S society, as well as tools to continue their work as advocates in their home countries. This session will provide an overview of the project, as well as lessons learned and recommendations.

 

Plenary: Policies to Impact Social Drivers: Successes and Challenges

Tim Foran, Director, Homelessness Partnering Strategy, Employment and Social Development, Canada Slides

Janet Hope, Assistant Deputy Minister, Municipal Affairs and Housing, Ontario Slides

Ann Oliva, Deputy Assistant Secretary, Special Needs Assistance Programs, U.S. Department of Housing and Urban Development

Ron Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases and Director, Office of HIV/AIDS and Infectious Diseases Policy, U.S. Department of Health and Human Services

Wayne Duffus, Associate Director for Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention Slides

 

Doing Better for Key Populations in the HIV Response: Now is the Time

Chris Beyrer, Director, Johns Hopkins Center for Public Health and Human Rights and President, International AIDS Society Slides

 

Plenary: Intimate Partner Violence: Prevalence, Impact and Interventions

Structural determinants of gender-based violence and HIV among marginalized women

Kate Shannon, Director, Gender & Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS Slides

The role of violence in stimulant use among homeless and unstably housed adult women living in a U.S. urban setting

Elise Riley, Associate Professor, Epidemiology, Department of Medicine, University of California, San Francisco Slides

Intimate partner violence in diverse populations: Implications for HIV treatment and prevention

Conall O'Cleirigh, Associate Director, Behavioral and Social Science Core, Harvard University Center for AIDS Research

Implementing an intimate partner violence screening protocol in HIV care

John Gill, Professor, University of Calgary and Medical Director, Southern Alberta HIV Clinic Slides

 

Tackling Social Drivers: Social and Structural Interventions

Reducing homelessness among people with HIV who use drugs key to increasing population-level viral suppression

Brandon Marshall, Department of Epidemiology, Brown University Slides

Who are the Undetectables? An innovative model of community-based adherence support that includes financial incentives

Stephen Nolde, Housing Works, and Toorjo Ghose, School of Social Policy and Practice, University of Pennsylvania Slides

Promising social and structural interventions for people leaving prison

James Peterson, Milken Institute of Public Health, George Washington University

Opportunities in the Affordable Care Act tbenjamio improve health care coordination and delivery for people living with HIV

Carmel Shachar, Clinical Instructor of Law, Center for Health Law & Policy Innovation, Harvard Law School Slides

A case story of Shelter and Settlements Alternatives, Uganda

Dorothy Baziwe, Executive Director, Shelter & Settlements Alternatives: Uganda Human Settlements Network Slides

Private sector engagement in housing for LGBT youth

Ed Clark, former CEO of TD Bank Group. Based in Toronto, TD owns TD Bank, America’s Most Convenient Bank Video

 

Supportive housing and access to HIV prevention

Suzanne Wenzel, Director, Homelessness, Housing & Social Environment Research Cluster, School of Social Work, University of Southern California Slides

 

Impact of Housing Interventions on Viral Suppression and Other Health Outcomes

Viral suppression trends among HIV-positive housing clients, New York City, 2008- 2013

Ellen Wiewel and John Rojas, Division of Disease Control, New York City Department of Health and Mental Hygiene Slides

In recent years, US HIV treatment guidelines have recommended progressively earlier antiretroviral therapy. In 2007, guidelines recommended ART at CD4 counts <350 cells; by 2012, it was recommended that all persons with HIV be considered for ART initiation, regardless of CD4 count. New York City is an epicenter of the US HIV epidemic, where the infection disproportionately affects poor people and persons of color. Low-income NYC residents with HIV are eligible for subsidized or free housing through Housing Opportunities for Persons with AIDS (HOPWA). To better understand the impact of changing treatment guidelines and HOPWA priorities, we measured trends in viral suppression among NYC HOPWA clients between 2008 and 2013, overall and by demographic and clinical characteristics. NYC DOHMH-administered HOPWA enrollment data were merged with the DOHMH HIV surveillance registry to obtain demographics, clinical status, and viral load test results for persons receiving HOPWA services during 2008-2013. Persons who matched to the surveillance registry and were enrolled in DOHMH-administered HOPWA programs in a given year between 2008 and 2013 ranged from 1,739 to 2,131 annually. We found that viral suppression increased markedly among NYC HOPWA clients from 2008 to 2013, particularly among clients with HIV only, potentially resulting from changes to federal treatment guidelines and an emphasis within HOPWA on suppression.

Antiretroviral therapy exposure and adherence and transitions out of homelessness among people living with HIV/AIDS who use illicit drugs in a Canadian setting

Lindsey Richardson, British Columbia Centre for Excellence in HIV/AIDS and Department of Sociology, University of British Columbia

The consequences of housing instability on engagement and retention in HIV care and clinical outcomes for people living with HIV/AIDS who use illicit drugs are increasingly well documented. However, very little is known about the potential benefits of exposure and adherence to antiretroviral therapy on the housing status of HIV-positive people who use drugs. We used longitudinal data from the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS), a long-running prospective cohort of community recruited HIV-positive people who use drugs in Vancouver. Participant data were linked to comprehensive HIV clinical monitoring and ART dispensation records provided by the centralized provincial ART dispensary and HIV clinical monitoring laboratory at the British Columbia Centre for Excellence in HIV/AIDS. Between December 2005 and November 2013, 755 participants were eligible for analyses of ART exposure with 128 (17.0%) initiating ART for the first time during the study period, and 724 participants were eligible for analyses of ART adherence, with 463 (64.0%) individuals becoming ≥95% adherent to ART at least once during the study period. In final multivariate models, new exposure to ART was positively and significantly associated with transitions out of homelessness (AOR: 2.24, 95% CI: 1.50-3.35) although this statistical relationship did not hold when the relationship was examined using a lagged ART exposure variable. ART adherence was significantly and positively associated with a transition out of homelessness in both unlagged and lagged models. These findings suggest that, in addition to supporting the clinical management of HIV infection, initiating ART and becoming adherent to ART may have significant and positive impacts on the housing status of HIV-infected PWUD

Impact of unstable housing on HIV infections control in northern British Columbia

Robert Milligan, Regional HIV/HCV Navigator, Northern Health Authority, Prince George BC Slides

Current research strongly links housing status as a key determinant of worsening HIV health disparities. The objective of our study was to examine the link between unstable housing and engagement in primary care and HIV viral suppression among clients of Central Interior Native Health (CINHS) in Northern British Columbia. HIV viral load levels and primary care encounter history were audited from April 2013 – May 2012 using the electronic medical record at CINHS. Housing status (stable or unstable) was determined for each patient by CINHS staff. We found that patients at CINHS who were unstably housed were not as engaged with primary care and did not experience the same level of viral load suppression as clients who were stably housed. This session will present our methods, findings and conclusions.

Supportive housing common measures: Baseline findings

Keith Hambly, Executive Director, Fife House Foundation Slides

Six Ontario housing providers identified a need to show the impact of their housing services for people living with HIV. Sites recognized that there was little consistency in the data collected by each partner, and there was a need to develop a common set of indicators to measure changes in their clients' health outcomes and well-being. To this end, HIV housing providers from across Ontario came together to develop the Common Measures evaluation tool. It is based on common service data collected by the housing providers and validated measures used in similar research studies that look at the health outcomes of supportive housing for people living with HIV. This is a 5-year longitudinal study that collects baseline data for clients when they enter the housing program and at 1-year intervals thereafter. The Common Measures Questionnaire contains 17 modules that are completed through client self-report. Modules look at client demographics, housing history and housing need, connection to care, other health conditions (co-morbidities), mediation adherence, alcohol and drug use, connection with the justice system, mental health, social support, quality of life, sense of belonging and mastery. This session will describe our process, findings and recommendations/next steps.

Building a dream: Recommendations for sustainable and evolving housing partnerships

Keith Hambly, Executive Director, Fife House Foundation Slides

This presentation documents the unique partnership between WoodGreen, the Wellesley Institute and Fife House to form and operate the Wellesley Central Residences Inc. (WCRI) in Toronto, Canada. Opened in 2008, Wellesley Central Residences is a unique affordable, supportive and not-for-profit housing complex for individuals living with HIV/AIDS and frail seniors. It has 112 apartment units: 56 for people living with HIV/AIDS and operated by Fife House; and 56 for seniors and operated by WoodGreen Supportive Housing. An informal study was conducted over 6 months to document key factors in the development and maintenance of the WCRI. Interviews and focus groups were conducted with key stakeholders (board members, management, staff, and politicians) to understand key historical events as well as facilitating factors for successful housing partnership development. Using the WCRI as a case study, the presentation identifies key factors for the success of the WCRI partnership, including: navigating different cultures and articulating shared values; passionate leadership; a facilitated process; financial and political sustainability; integration and communication; and clear agency roles and expertise.

Project S.H.O.P.: Comparison of supportive housing models for HIV-positive and atrisk chronically homeless

Julia Dickson-Gomez, Center for AIDS Intervention Research, Medical College of Wisconsin Slides

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. However, supportive housing is an umbrella term that is used in the literature to describe programs that differ in many factors that could make large differences in health outcomes and housing stability. The purpose of our research was to describe and measure differences in supportive housing models, and to examine the effectiveness and cost-effectiveness of supportive housing models on housing stability and health outcomes. We conducted 50 in-depth interviews with directors and front-line service providers of over 23 different supportive housing programs in the Chicago metropolitan area. Participants were asked to describe their program in terms of the clients they serve, eligibility criteria, the number and types of housing units they have, and how long the program has been in operation. This session will discuss results, conclusions and feedback from supportive housing providers.

Models for integrating behavioral health, HIV health care and housing support for multiply diagnosed HIV homeless/unstably housed populations

Carole Hohl, Boston Health Care for the Homeless and Massachusetts General Hospital Slides

Nine clinic and community based organizations and one multisite coordinating center are funded by the Health Resources & Services Administration, HIV/AIDS Bureau through its Special Programs for National Significance (SPNS) to implement and evaluate service delivery models aimed at building a medical home for multiply diagnosed HIV homeless/unstably housed populations. Models include: 1) strengthening internal systems of care by integrating behavioral health staff into the HIV care team; 2) the use of patient navigators to connect homeless patients to external behavioral health services and obtain housing in the HIV team; and 3) the use of mobile interdisciplinary teams to provide necessary medical and behavioral health care. Preliminary results of this SPNS Initiative have found that consistent, regular team communication, having a key staff member to maintain regular communication with clients, and building strong external partnerships with housing, behavioral health and HIV providers is critical for HIV-positive homeless and unstably housed populations. These models are helping to engage clients in their health care, remove barriers to care, and improve the patient experience of care.

 

Building Housing, Health and Other Partnerships for Client-Centred Care

Breaking barriers, creating access, nurturing recovery

Eleshia Fahy, Coordinator, McEwan Housing and Support Services/Loft Community Services Slides

The Positive Service Coordination Program based at LOFT Community Services in Toronto provides short- and medium-term intensive case management for people living with HIV who cycle through the health and judicial systems as a result of being homeless, living with a mental illness, using substances and/or experiencing a physical or mental health crisis. The program is supported and guided by the Advisory Committee, comprised of our membership/clients. Case managers work with members and community partners in collaboration with 17 cross-sectoral agencies to find permanent, stable housing; ensure members have appropriate identification documents and are receiving their maximum social assistance benefit; engage members in HIV-specific care, primary care and mental health care; and make active linkages to appropriate community organizations. This session will describe the program and discuss partnerships, access to primary care providers, member involvement and other issues.

HIV Addiction Supportive Housing (ASH): Successes of a Housing First model within a continuum of care

Kay Roesslein, Program Director, McEwan Housing and Support Services/Loft Community Services and Michael Blair, Director of Residential Programs, Fife House Foundation Slides

The HIV Addiction Supportive Housing Program was developed to address gaps in service for homeless people living with HIV in Toronto experiencing health, mental health and severe substance use challenges, and cycling in and out of hospitals, prisons and withdrawal management units. The program aims to: 1) increase the health and social outcomes of people living with HIV who have problematic substance use issues and frequent emergency room and hospitalizations, and 2) increase access to and the quality of care and support services for people living with HIV who have problematic substance use issues. This talk will address lessons and key recommendations learned from implementing the program.

Lessons learned and recommendations from the implementation of a multi-agency cross-sector collaboration addressing the needs of people living with HIV experiencing aging-related illnesses, accelerated aging, complex care and cognition issues

Michael Blair, Director of Residential Programs, Fife House Foundation Slides

The HIV/AIDS Complex Care Pilot Project (CCPP) is a multi-agency pilot project aimed at increasing cross-sector collaboration and partnerships that address gaps in the service, care and support needs of people living with HIV who are experiencing aging related illnesses, accelerated aging, complex care and cognition issues. Ten separate partner agencies offered coordinated wraparound clinical and community support services, and a new high-support housing model. This presentation outlines some of the lessons learned and recommendations about implementing a collaborative project. Key recommendations include: the leadership of a "backbone organization" that can provide the structure and guidance for the development of the partnership; taking an improvement approach by continuously monitoring for challenges and conducting an ongoing review of implementation; and creating space and time for the interdisciplinary care team to articulate goals, tasks, roles, leadership, decision-making, communication, conflict resolution, role definitions and scope.

Translating research data into new funding opportunities: "Cashing in on the value of an AIDS or support housing unit"

Arturo Bendixen, Executive Director, AIDS Foundation of Chicago Slides

A group of AIDS and supportive housing providers in Chicago and Cook County organized themselves into a collaborative representing almost 80% of all funded units in the area. From this position of strength and value, the collaborative, now named Better Health Through Housing (BHH), is engaging and negotiating with managed and accountable care organizations administering Medicaid funds in Illinois. Using published research data, as well as recently acquired Medicaid claims data of homeless individuals who are high users of health care services, BHH has negotiated for health dollars to help complement HUD and HOPWA funds for housing the homeless. As the value of an AIDS or supportive housing unit is recognized by health care payers, and as the demand continues to be greater than the available supply of existing units, mostly paid for by HUD and HOPWA dollars, health care payers are becoming an important funding source for units especially serving high users. The presentation will describe such a model in Chicago.

Integrating for impact: The origins and practice of the Structural Interventions Working Group of the Federal AIDS Policy Partnership

Suraj Madoori, Manager, HIV Prevention Justice Alliance, AIDS Foundation Chicago Slides

In 2014, the head of the National AIDS Housing Coalition and the Federal AIDS Policy Partnership's (FAPP) Housing Working Group, Nancy Bernstein, recognized that in order to address the needs of people living with HIV, advocacy efforts would need to incorporate more than just housing. Working with other advocacy leaders, she expanded the FAPP working group to include these interventions, making it the Structural Interventions (SI) Working Group. This panel will examine the genesis of SI, and the lessons and best practices learned over the last year. The panel will discuss the merits of our combined advocacy efforts, relative to those we have engaged in separately. The implications of our integration will be highlighted at the local, state and federal level. The panel will also touch on the challenges of being in a mixed coalition, such as messaging to internal and external constituencies, rallying support from Boards of Directors, and shared decision making.

 

Housing First: Innovations and Lessons Learned

Unprotected sex among homeless adults with mental illness participating in a Housing First randomized controlled trial

Milad Parpouchi, Faculty of Health Sciences, Simon Fraser University

High rates of HIV have been found among various homeless populations. Structural interventions, such as the provision of housing, are becoming increasingly prevalent. Housing First (HF) is one such type of supported housing intervention involving a combination of permanent housing and various health and social supports. Our study sought to investigate the effect of HF on unprotected sex among homeless mentally ill adults. Data for the study was obtained from the Vancouver At Home Study, which involves an RCT investigating the effect of HF on various health and social outcomes. Participants were sexually active homeless or precariously housed adults with a mental disorder (n=241). Recruitment was conducted via referral from community agencies, with 24 months of follow-up. Results showed that, compared to treatment as usual, HF was not associated with unprotected sex in a multivariable model, though past-month amphetamine use, cohabitating with a partner, and having less than high school completion were independently associated with unprotected sex. This is the first RCT of its kind. Findings, limitations and implications for future research will be discussed.

The housing cascade provider perspective on using supportive housing data to evaluate health outcomes for people living with HIV

Danielle Strauss, Managing Director, Housing Programs, Harlem United Slides

Since the inception of supportive housing for people living with HIV, Harlem United has been at the forefront of addressing health disparities by recognizing the need for harm reduction services for clients with HIV/AIDS plus other co-occurring disorders (e.g. substance abuse and mental health). Within our supportive housing programs, individuals are provided with stable housing in addition to harm reduction services with a full continuum of medical, mental health and social support services to stabilize health. This presentation will discuss our Housing First model and evaluation strategies to demonstrate how housing as an intervention for unstably housed people living with HIV successfully links clients to medical treatment, helps them remain in care, and assists them with treatment adherence to improve health outcomes. For this presentation the HIV Care Cascade was adopted to create a Housing Cascade for clients enrolled in our supportive housing programs. Data will be presented to provide an example of client progress through the continuum of care following placement in supportive housing.

Housing as a harm reduction strategy: Health, safety and respect

Robert Desarmia, Intensive Case Management Program Coordinator, Sandy Hill Community Health Centre Slides.

The purpose of this session is to illustrate that housing is the best way to empower people who use drugs to make healthier choices. The session will demonstrate the effectiveness of the Housing First Approach as a Harm Reduction strategy. Focusing on housing allows us to see drug users as people with dreams, goals, hobbies, skills and personalities—instead of only focusing on their drug use. The session will give the participants the concrete tools needed to implement a Housing First Intervention in their communities.

Housing First and harm reduction practices

Suzanne Moore, Housing Services Manager, Caracole, Chrissy Rademacher, Clinical Supervisor, Caracole Slides

The Shelter Plus Care housing program at Caracole is a harm reduction, housing first model, focused primarily on keeping our clients safe and in housing. Two years into this new model, we have powerful data to support that our clients are experiencing decreased viral loads, fewer arrests and overdoses, and increased housing stability. The Caracole housing team includes case management, specialized housing support, and optional mental health services. The team is connected to our local syringe exchange program, Planned Parenthood for testing and HIV101 education, medicated assisted treatment programs, mental health and substance abuse treatment agencies, shelters, outreach workers, and other housing programs. We are proud of our client's successes and look forward to sharing not only our data, but continued barriers, implementation, outcomes, staff challenges, and client response.

 

Interventions for Person-Centered Care

The Cedar Project WelTel mHealth Study: A text message intervention for HIV prevention and treatment among young Indigenous people who use illicit drugs – successes and challenges to date

Kate Jongbloed, School of Population and Public Health, University of British Columbia Slides

The Cedar Project WelTel mHealth study was initiated in September 2014 to explore whether a culturally-safe two-way supportive text message intervention in a community-based setting has the potential to support HIV prevention and treatment among 150 young Indigenous people who use drugs. Participants receive a package of supports, including a mobile phone and long-distance plan, weekly two-way supportive text messaging, and support from Cedar Advocates. Preliminary results suggest that participants use study phones to connect with family and loved ones, housing, work opportunities and services. Weekly "how's it going?" texts to each participant allow them to set their own goals and priorities for support from Cedar Advocates. To date we have received diverse requests, including help to navigate access to addictions treatment, counseling, housing and cultural supports. This presentation will discuss preliminary findings, as well as successes and challenges to date in implementing the Cedar Project WelTel mHealth program.

A multidisciplinary approach to engagement in care of HIV-infected individuals with unstable housing and HIV infection risk in homeless participants in community popup clinics

Syune Hakobyan, Vancouver Infectious Diseases Research and Care Centre Society Slides

Ongoing improvements in antiretroviral treatment have transformed HIV into a chronic, manageable condition, but this benefit may be mitigated in vulnerable individuals with unstable housing. There are insufficient data in the medical literature to quantify this association. People living with HIV included in our analysis consisted of individuals who have been attending an inner city clinic on a regular basis for management of their HIV since 2013. Since May 2013, 430 PLHIV were stably engaged in care at the clinic and receiving medical and other multidisciplinary care. In total, 52 (12.1%) of PLHIV were homeless or precariously housed. Among the people who had unstable housing, 51 were on ARV, and 30 had undetectable HIV plasma viral load measures, while 11 had virologic 'blips' with 10 others having less favorable virologic responses. Immunologic responses in the homeless/precariously housed was good, with an increase in median CD4 count from 420 to 520 cells/mm3 being documented. Despite multiple competing social and medical issues, people living with HIV with many vulnerabilities and housing instability can be engaged in health care and manage HIV and HCV infections.

Unstable housing is mediated by social support leading to reductions in healthrelated quality of life among former or current injection drug users on ART in Baltimore, Maryland

Sarina Isenberg, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health Slides

Housing stability likely has an effect on the health-related quality of life (HRQoL) of persons living with HIV who are low-income, urban, former or current drug users and primarily African American, living in Baltimore, Maryland. In this study we used structural equation modelling to understand the role of social factors in HRQoL. We hypothesized that housing instability is associated with a decreased HRQoL among former or current injection drug users on ART. Data were from the baseline data of the BEACON (Being Active and Connected) study, an observational study with assessments at three points in time, which examined social environmental factors associated with health outcomes and well-being among disadvantaged people living with HIV and their informal caregivers (N = 258 dyads). We found that, while having stable housing was not directly associated with HRQoL, it had a direct effect on having supportive network members and caregiving cessation risk.

Moving in, moving up and moving forward: Developing an assessment tool to identify potential graduates from permanent supportive housing programs serving persons with disabilities

Andrew Timleck, AIRS/Empire Homes of Maryland Slides

In 2010 the Federal Strategic Plan to Prevent and End Homelessness (HEARTH Act) proposed that "graduation" programs – programs that would assist people who have achieved stability and desire to leave PSH to transition to independent living— be one of the strategies that cities use to free up units to house those who need housing most. This session explores how we researched a number of non-profit organizations and city governments that are pioneering assessment tools for "graduation programs" under the rubric of "Moving In, Moving Up, and Moving Forward." We'll discuss commonalities and differences in those assessment tools, how practical they are to employ, pitfalls and promises they hold, and what kinds of resources and barriers might present in their deployment. We test some factors with Baltimore's HMIS data and see some expected and unexpected success markers. We compiled the existing tools to develop a more universal assessment for program staff to use to identity those best suited to participating in a graduation program. We explore why participants choose to participate, what factors motivated them, and who, ultimately, appeared to be successful and "Moved On." We will share our tool with attendees with the hope others will pilot it and begin collaborating on a universalized version and discuss the need to incorporate "graduation" into our rubric of care.

eLearning Toolkit: Caring for individuals with complex health and social needs

Barbara Ross, Provincial Harm Reduction Supervisor, Alberta Health Services and Floyd Visser, Executive Director, SHARP Foundation Slides

The goal of the eLearning Toolkit is to provide frontline workers with the information they need to better understand, empathize with, and care for individuals/patients with complex health and social needs. The Toolkit covers topics including stigma, harm reduction, health issues (physical, mental, social, and emotional), assessment and additional resources. Toolkit project development was guided by a community planning committee with support from subject-matter experts (i.e. health professionals, behavioural specialists, community members, clients, etc.). Focus groups with a variety of community and public service providers were held to gain feedback on the ease of using the eLearning Toolkit and the relevance of the content to their work. Community consultations are now resulting in ideas for additional modules and resources to be included in the Toolkit. This session will discuss the pros and cons of using this type of learning model for diverse service groups and its applicability to services that extend beyond housing and supports.

 

Plenary: Financing Integrated Models of Care and Support

Peggy Bailey, Senior Policy Advisor, CSH and NAHC Board Member Slides

Miranda Compton, Manager, HIV/AIDS Services, Vancouver Coastal Health Slides

Doug Wirth, President and CEO, Amida Care

Meghan Gleason, Director, Government Health Care Transformation, KPMG Slides

 

Plenary: END OF AIDS? Challenges and Opportunities

Johanne Morne, Director, Office of Planning and Community Affairs, New York State Department of Health AIDS Institute Slides

Gina McGowan, Director, Population and Public Health Division, British Columbia Ministry of Health Slides

Michael Kharfen, Senior Deputy Director, HIV/AIDS, Hepatitis, STD & TB Administration, D.C. Department of Health Slides

Oliver Bacon, Associate Professor and Infectious Slides