Housing instability results in increased acute care utilization in an urban HIV clinic cohort

Angelo Clemenzi-Allen, John Neuhaus, Elvin Geng, Darpun Sachdev, Susan Buchbinder, Diane Havlir, Monica Gandhi, Katerina Christopoulos

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background. People living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention. Methods. We collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits—urgent care (UC) visits, emergency department (ED) visits, and hospitalizations—and whether suboptimal primary care visit adherence (<75%) interacted with housing status on acute care visits. Results. Among 1198 patients, 25% experienced HUH. In adjusted models, unstable housing resulted in a statistically significant increase in the incidence rate ratio for UC visits (incidence rate ratio [IRR], 1.35; 95% confidence interval [CI], 1.10 to 1.66; P < .001), ED visits (IRR, 2.12; 95% CI, 1.44 to 3.13; P < .001), and hospitalizations (IRR, 1.75; 95% CI, 1.10 to 2.77; P = 0.018). Homelessness led to even greater increases in UC visits (IRR, 1.75; 95% CI, 1.29 to 2.39; P < .001), ED visits (IRR, 4.18; 95% CI, 2.77 to 6.30; P < .001), and hospitalizations (IRR, 3.18; 95% CI, 2.03 to 4.97; P < .001). Suboptimal visit adherence differentially impacted UC and ED visits by housing status, suggesting interaction. Conclusions. Increased acute care visit frequency among HUH-PLWH suggests that interventions at these visits may create opportunities to improve care.

Original languageEnglish
JournalOpen Forum Infectious Diseases
Issue number5
StatePublished - May 1 2019


  • Emergency room visits
  • HIV
  • Homelessness and unstable housing
  • Hospitalizations
  • Urgent care
  • Visit adherence


Dive into the research topics of 'Housing instability results in increased acute care utilization in an urban HIV clinic cohort'. Together they form a unique fingerprint.

Cite this