Giordano Thomas P, Gallagher Kerrin, Davich Jo Ann Whitlock, Rathore Mobeen, Borne Deborah, Davies Erika, Altice Frederick L, Cabral Howard
Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health.
Am J Public Health. 2018 Dec;108(S7):S531-S538. doi: 10.2105/AJPH.2018.304731.
To determine the impact of improvements in housing and HIV clinical parameters on health-related quality of life (HRQOL) in persons with HIV infection experiencing homelessness. This prospective cohort study took place in 9 US sites. Local efforts sought to improve HIV and housing status. Longitudinal data analyses determined the impact of changes in housing status, HIV suppression, and CD4 cell counts on HRQOL at 12 months, measured as mental and physical component summary scores. Among 909 participants enrolled from 2013 to 2016, 75.1% were homeless, 51.6% did not have HIV suppression, and 23.6% had a CD4 count less than 200 cells per cubic millimeter. Median mental and physical component summary scores were 35.4 and 38.9, respectively. These 5 parameters all improved by 6 months. In multivariate modeling, maintaining or achieving stable housing predicted higher PCS at 12 months, but CD4 count and HIV suppression improvements did not. Improvements in housing, CD4 count, and HIV suppression did not predict mental component score at 12 months. Housing and HIV treatment are necessary but not sufficient to improve HRQOL in this challenging population. The high prevalence of socioeconomic and mental health needs we found support the call for patient-centered comprehensive care.
确定住房条件改善和艾滋病毒临床参数变化对无家可归的艾滋病毒感染者健康相关生活质量（HRQOL）的影响。这项前瞻性队列研究在美国的9个地点进行。当地致力于改善艾滋病毒感染状况和住房状况。纵向数据分析确定了住房状况、艾滋病毒抑制和CD4细胞计数变化对12个月时HRQOL的影响，以心理和身体综合得分衡量。在2013年至2016年招募的909名参与者中，75.1%无家可归，51.6%的艾滋病毒未得到抑制，23.6%的CD4细胞计数低于每立方毫米200个细胞。心理和身体综合得分的中位数分别为35.4和38.9。这5个参数在6个月时均有所改善。在多变量模型中，维持或实现稳定住房可预测12个月时更高的身体综合得分，但CD4细胞计数和艾滋病毒抑制的改善则不然。住房、CD4细胞计数和艾滋病毒抑制的改善并不能预测12个月时的心理综合得分。住房和艾滋病毒治疗对于改善这一具有挑战性人群的HRQOL是必要的，但并不充分。我们发现社会经济和心理健康需求的高患病率支持了对以患者为中心的全面护理的呼吁。
