Table 2 Summary of Evidence Table: Interventions for Homeless People (Continued) Fitzpatrick-Lewis et al. BMC Public Health 2011, 11:638 http://www.biomedcentral.com/1471-2458/11/638 Rotheram-Borus et al., 2009 [97] Study design: Prospective observational cohort Sample size: 280 Study population: HIV+ homeless and marginally housed individuals. Homeless was defined as ≥ one night on street or in shelter in last quarter, whereas marginally housed was defined as ≥ 90% of nights in single-room occupancy dwelling in past quarter with no nights spent on street or in shelter. Approach: This study examined the effect of case management on acute health services use and health outcomes in homeless or marginally housed persons with HIV. Study design: RCT, sub-group analysis Sample size: 270 Study population: HIV+ marginally housed individuals including reports of currently being homeless, living in a shelter or welfare hotel, or having lived in either condition within the 12 months prior to each assessment. Approach: The subgroup analysis (N = 270) of participants in a larger RCT (N = 936) examined the efficacy of the Healthy Living Program in reducing sexual behaviour and substance use among adults with HIV who were marginally housed. The intervention might have worked by inducing abstinence from targeted behaviours or by reducing frequency of acts. Schwarcz et al., 2009 [98] Study design: Retrospective observational study Sample size: 6,558 Study population: HIV+ individuals. Cases were defined as homeless if medical records documented individuals were homeless or if addresses listed in chart were for shelters, health care clinics, or a general delivery address not connected to an address. Approach: This study examined the effect of homeless on the mortality of persons with AIDS and the effect of supportive housing on AIDS survival. Slesnick et al., 2007; Slesnick & Kang, 2008 [33,34] Page 5 of 14 Health services utilization: Moderate CM was associated with increased adherence to antiretroviral therapy compared to no or rare CM. CM was not associated with increased use of primary care or hospital-based services. Health/biological: Both consistent and moderate CM were associated with ≥ 50% improvements in CD4+ cell count. Risk behaviours: no statistically significant differences in intervention effects (P values ranged from .072 days using alcohol or marijuana to .275 for number of partners who were HIV-negative or of unknown serostatus). Most significant effects were the numbers of partners who were HIV-negative or of unknown serostatus and the number of days of alcohol or marijuana use. The intervention also reduced the number of risky sexual acts and the number of days of hard drug use compared to the control. After adjusting for confounders, homelessness was significantly associated with increased mortality (RH 1.20; 95% CL 1.03, 1.41). Receiving housing post diagnosis improved survival rates (adjusted RH 0.20; 95% CL 0.05, 0.81). Study design: RCT Youth who received the Community Reinforcement Approach therapy + Sample size: 172 HIV education reported better improvement on the frequency of Study population: Homeless youth, with homelessness defined as condom use than the control treatment as usual group. Youth in the having no place of shelter and is in need of services and shelter intervention group showed a greater decrease in substance free days where supervision and care are provided. than in the control group. Approach: This RCT (N = 180) evaluated change in HIV risk behaviours among a sample of homeless youth. Woliski et al., 2009; Kidder et al., 2007 [55,56] Study design: RCT At 18 months, 51% of the comparison group had housing. Intent-to-treat Sample size: 644 analysis indicated significant improvements in self-reported physical and Study population: HIV+ individuals living in the following housing mental health. Significant improvements between stably housed versus contexts: having one’s own place to live, being unstably housed homeless participants were found in as-treated analysis for health care (staying temporarily with others/living in a transitional setting and utilization, perceived stress and detectable viral load. had not been homeless), or being homeless ≥ one night (e.g., sleeping in shelters or locations not suitable for human habitation) in the last 90 days. Approach: This study evaluated the effectiveness of providing rental assistance to homeless people living with HIV/AIDS on physical health, access to medical care, treatment adherence, HIV risk behaviours, and mental health status.