The Ursuline Sisters HIV/AIDS Ministry, in Youngstown, Ohio, will replicate a successful program developed in Pittsburgh that improves adherence to HIV treatment by providing stable housing.
A University of Pittsburgh Graduate School of Public Health evaluation recently documented the success of the Pittsburgh program, operated by The Open Door, Inc., a nonprofit organization founded in 2006 with the goal of providing affordable housing for people with HIV/AIDS who would otherwise be at high risk of homelessness. The evaluation found that the organization helps clients make significant improvements in adherence to HIV medications, general health and quality of life.
The evaluation was funded by a grant from AIDS United and MAC AIDS Fund. In addition to the evaluation, the grant also provided money for Pitt Public Health to develop a toolkit for other institutions to use in replicating the program and charged The Open Door with distributing some of the grant money to other organizations interested in starting similar programs. The Ursuline Sisters HIV/AIDS Ministry is the first such program selected.
“AIDS United and MAC AIDS Fund were very forward-thinking when they funded our research to expand and evaluate The Open Door,” said Mary Hawk, Dr.P.H., L.S.W., assistant professor and senior associate director of the Institute for Evaluation Science in Community Health at Pitt Public Health’s Department of Behavioral and Community Health Sciences and co-founder of The Open Door. “We found that, by providing a stable address, the program has been remarkably successful in helping clients increase their clinical adherence to HIV regimens. Now the success of The Open Door can be spread to other cities nationwide.”
In addition to a $20,000 grant to help The Ursuline Sisters HIV/AIDS Ministry replicate the program in Youngstown, The Open Door will provide training, problem solving, implementation assistance and ongoing support. Coaching will be provided by the peer staff of The Open Door; by Dr. Dana Davis, also one of the program’s co-founders; and by the program’s executive director, Christina Farmartino, who is a graduate of Pitt Public Health.
Funding is still available to extend the replication assistance in one more location, and The Open Door is accepting applications. The initial evaluation grant also enabled Dr. Hawk and The Open Door to create a free toolkit that other organizations can use as a guide for creating their own housing program to support people living with HIV/AIDS. The toolkit can be found on the organization’s website, www.opendoorhousing.org.
“The Open Door concentrates first on providing stable, safe housing and uses a harm reduction approach. We have found that this type of support provides the foothold that many people with HIV/AIDS need in order to improve their health,” said Dr. Hawk. “The Open Door gives participants the tools and support to make the best possible individual health decisions, but does not place any requirements or expectations on them.”
Dr. Hawk and Dr. Davis reported in a 2011 journal article published in AIDS Care that 69 percent of The Open Door clients achieved undetectable HIV viral load counts within three months after moving into the program. Viral load is a measure of medication adherence, and having an undetectable viral load count not only predicts an improved clinical prognosis but also reduces the likelihood of transmitting the virus to others. This finding reflects a significant improvement compared with the findings of previous studies of housing programs for marginalized populations, which reported undetectable viral loads in only 13 to 32 percent of the people they serve.
Grant support from AIDS United and the MAC AIDS Fund also made it possible for The Open Door to expand its representative payee program, in which staff assists people with HIV who are homeless or at risk of homelessness in managing their income so they can pay their rent and other bills. This support reduces stress and allows participants to prioritize their medical care and treatment. Dr. Hawk and colleagues from The Open Door have recently completed a pilot study evaluating the impact of the services. Early findings suggest that, for people with HIV who are unstably housed but not living at The Open Door, representative payee services can significantly improve the likelihood of achieving HIV viral suppression.