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Assessing the Impact of Seasonal Factors on HIV Care in the Homeless Population of Pittsburgh

Fogelman, Lauren (2020) Assessing the Impact of Seasonal Factors on HIV Care in the Homeless Population of Pittsburgh. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Homelessness is a serious public health problem across the United States that is linked to negative health outcomes. Those who are homeless face variable seasonal weather conditions which result in weather-related health concerns, diminished ability to access health care, and fluctuating homeless shelter usage. It is established that those without housing stability are at higher risk for Human Immunodeficiency Virus (HIV), however current literature does not examine how season-specific challenges may affect how HIV care can be managed. This study explores the effect of seasonality on HIV care management among different housing statuses.

Methods: Anonymous aggregate data was obtained from 1,133 patients who visited Allegheny Health Network’s (AHN) Positive Health clinic between 01/01/2017 and 12/31/2019. Patients were grouped by their housing status (stable, temporary or unstable) for each year. Patient data was selected only from qualifying summer or winter months. Statistical analyses were performed by the AHN biostatistician.

Results: Excluding winter 2017, those with temporary and unstable housing appeared to have consistently lower rates of viral suppression than the stable housing subgroup. Summer 2017 and summer 2019 both showed weak statistically significant associations between housing status and viral load suppression. Black individuals were also shown to be more likely unstably or temporarily housed across all three years (2017-2019), and males were more likely to be unstably or temporarily housed in 2017.

Conclusions: The results show those with unstable and temporary housing have consistently lower rates of viral suppression than those stably housed. Additionally, there are clear associations between race and housing status. However, the direct effect of seasonality on HIV viral load management among people with varying housing statuses is unclear and should be further investigated.

Public Health Significance: Current literature concerning HIV, homelessness, and seasonality is limited; however, there are known associations between People Living with HIV and those with unstable housing. Since adverse weather events more severely impact those with unstable housing, seasonality can potentially cause an interruption in the HIV care continuum. To our knowledge, this is the first study in Southwestern Pennsylvania to investigate how seasonal factors affect HIV among different housing subgroups.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairKrier,
Committee MemberFriedman,
Committee MemberHawk,
Date: 9 September 2020
Date Type: Publication
Defense Date: 10 August 2020
Approval Date: 9 September 2020
Submission Date: 8 June 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 38
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: homelessness, unstable housing, housing status, HIV, AIDS, human immunodeficiency virus, seasonality, weather, temperature, Pittsburgh
Date Deposited: 09 Sep 2020 18:39
Last Modified: 01 Sep 2022 05:15


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