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Background Unstable housing has tremendous harms on health and well-being and people who use drug experience significant barriers to housing. The objectives of this study were to estimate the prevalence of housing assistance among people who use drugs experiencing unstable housing in Oregon and explore factors associated with obtaining housing assistance. Methods We used cross-sectional survey data collected between March and November 2023 from people who were unstably housed and used drugs across eight counties in Oregon ( N  = 425). Unstable housing was defined as experiencing unsheltered or sheltered homelessness in the past year. Participants reported whether they obtained housing assistance in the past year. We explored associations between sociodemographic characteristics and housing assistance using multivariable log-binomial models. Results There were 133 participants (31.3%) who reported obtaining housing assistance in the past year. There was a lower prevalence of housing assistance for cisgender men (versus cisgender women and gender expansive participants) (PR = 0.73, 95% CI: 0.55–0.98) and those interviewed in non-urban counties (versus urban counties) (PR = 0.72, 95% CI: 0.53–0.98). Using opioids 21 or more days (versus 0–20 days) was associated with a lower prevalence of obtaining housing assistance (PR = 0.67, 95% CI: 0.48–0.94) Community supervision was associated with a higher prevalence of housing assistance (PR = 1.70, 95% CI: 1.27–2.27). Conclusion We found a large gap in housing assistance for people who use drugs in Oregon and identified several factors associated with obtaining housing assistance. Our findings can inform future interventions to connect people who use drugs with stable housing.

Purpose of Review This review summarizes key implementation strategies to advance oral and long-acting PrEP delivery for unstably housed people in the United States. Recent Findings People experiencing homelessness and housing instability face barriers to PrEP uptake and adherence including lack of safe medication storage, competing basic needs, insurances issues, and/or mental health or substance use disorders. Recent advancements in HIV treatment and prevention provide evidence on high-touch, low-barrier implementation approaches to address these challenges. We compiled these approaches into a multi-component implementation strategy, “SHELTER”, which includes: low-barrier primary care, case management, incentives, outreach, care coordination, multidisciplinary provider collaboration, data tracking, and robust provider-patient relationships. Summary The US has fallen short of our Ending the Epidemic targets, in part due to challenges in PrEP delivery for people experiencing housing instability. SHELTER provides a comprehensive approach for considering critical components of HIV prevention for this population that can be used in future oral and long-acting PrEP programs.

According to Eviction Lab there were 6877 evictions in Chicago in 2016. The rate was “1.1%” and came out to 18.79 evictions per day in Chicago in 2016. The presence of children in a household (HH) poses a greater risk for eviction than race or gender. Census tract-level data from the Chicago Department of Public Health, the Eviction Lab and American Community Survey was used to assess the relationship between eviction and pediatric health outcomes for 653 census tracts in Chicago. Correlation matrices and linear regression models were used to evaluate the relationship between eviction and health outcomes. Regression models were adjusted for the following: (1) female-led family HH with less than a high school degree and below poverty and (2) race/ethnicity. Compared to White Non-Hispanic HH, predominantly Black and Hispanic HH had higher rates of very low birth weight (VLBW), infant mortality (IM), eviction filings, and evictions. All covariates were found to be significantly correlated (p < 0.01). Eviction filing rates and eviction rates were significant predictors for both VLBW and IM in both unadjusted and adjusted models (p < 0.05). Though we cannot conclude causality, these results suggest that census tracts which experience high rates of eviction also experience high rates of VLBW and IM and this relationship should be further investigated.

We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 ( N  = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse (adjusted odds ratios (AOR) = 1.37, 95 % CI 1.01–1.87) and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months (AOR = 1.65; 95 % CI 1.18–2.29). Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months (AOR = 3.97; 95 % CI 1.58–9.94), while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months (AOR = 1.71; 95 %CI 1.02 = 2.86). There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.

Reproductive health care access is essential in preventing poor health outcomes for women who are unstably housed. Resources need to be adapted to meet the needs of these women, who have higher rates of experiencing health care judgment and medical distrust. This quality improvement project involved the development and implementation of an evidenced-based Reproductive Health Protocol and Reproductive Health Resources Guide to increase access to health care for women who are unstably housed in Philadelphia. The results indicated a clinically significant association of women with unstable housing between receiving a pregnancy test and referral to pregnancy care services (Fisher exact test, P = .054). The use of an evidence-based reproductive health protocol can improve outcomes for women who are unstably housed. •Women who were unstably housed were able to receive reproductive health care access.•Homeless Outreach Workers are uniquely situated in crucial roles to bridge the gaps in health care for women who are unstably housed.•Greater education and increased knowledge about reproductive health care can allow women who are unstably housed to have greater reproductive autonomy.

Background Mental health is reported to be a significant issue among slum dwellers and unhoused (homeless) individuals worldwide, particularly those facing housing instability. Ho Chi Minh City, the largest city and industrial hub of Vietnam, has a substantial population experiencing housing instability, although its exact scale has rarely been accurately measured. This study aimed to estimate the prevalence of serious psychological distress among slum dwellers and unhoused individuals in Ho Chi Minh City and to identify factors associated with serious psychological distress. Methods A cross-sectional survey involving 415 individuals experiencing housing instability, including 383 slum dwellers and 32 unhoused individuals, was conducted between November 2023 and April 2024. Data were collected using a structured questionnaire incorporating the 6-item version of the Kessler Psychological Distress Scale (K6). Results The overall prevalence of serious psychological distress was 19.8%, with 18.5% among slum dwellers and 34.4% among unhoused people. Multiple logistic regression analysis revealed significant associations between serious psychological distress and female gender (adjusted odds ratio = 3.086, p  < 0.001), labour exploitation (adjusted odds ratio = 1.914, p  = 0.046), and debt (adjusted odds ratio = 3.109, p  < 0.001). Notably, 68.7% of the participants reported experiencing some form of labour exploitation, which commonly included contract rejections, forced overwork, wage theft, and physical or verbal abuse. Furthermore, 43.7% of the participants were in debt, with 38.6% borrowing from moneylenders. Conclusions The prevalence of serious psychological distress among individuals with unstable housing in Ho Chi Minh City was significantly higher than that of the general population, highlighting the urgent need for mental health interventions targeted at this population. Those with serious psychological distress frequently faced both labour and economic exploitation, without sufficient social protection. In terms of labour exploitation, policy interventions, particularly from an occupational health perspective, are necessary. To address economic exploitation through debt, given the prevalence of loan sharks, efforts to crack down on predatory lending and promote financial inclusion are essential.

Background Opioid use disorder, mental health conditions, and housing instability are frequently intertwined and have a profound impact on health outcomes. While past research has focused on the opioid use and mental health of people experiencing homelessness, less is known about those experiencing housing instability. We examined the cross-sectional associations between housing status (currently unhoused, unstably housed, and stably housed) and mental health and substance use severity among primary care patients with co-occurring disorders. Methods Data are from a randomized controlled trial, Collaboration Leading to Addiction Treatment and Recovery from other Stresses, which tests the Collaborative Care Model for primary care patients with opioid use disorder and co-occurring depression and/or post-traumatic stress disorder (PTSD). We defined being unhoused as not living in stable housing in the past 3 months and being unstably housed as living in stable housing but being worried or concerned about loss of housing in the next 3 months. We assessed differences in baseline characteristics across the housing groups using ANOVA for continuous variables and chi-squared tests for categorical and binary measures. Adjusted linear regression models were used to assess associations between housing status and mental health and substance use symptom severity scores. Results Among the 797 patients randomized, 13% of the sample was currently unhoused, 24% was unstably housed, and 63% was stably housed. Individuals who were unhoused were on average younger, received less education, never married, and had not used prescribed medications for opioid use disorder (MOUD) in the past 30 days. The adjusted regression results showed that both being unhoused and being unstably housed were significantly associated with higher PTSD symptom severity, depression symptom severity, opioid use severity, and opioid overdose risk behaviors compared to being stably housed. Conclusion Primary care patients with co-occurring disorders who were either unhoused or unstably housed have worse mental health and substance use symptom severity when compared with stably housed individuals. This suggests primary care providers should screen patients with co-occurring disorders not only for being unhoused but also for unstable housing. Addressing housing instability in primary care settings could lead to improved health outcomes and reduced healthcare costs. Trial registration Clinicaltrials.gov NCT04559893, registered on January 8, 2021.

Setting As of June 10, 2020, 37 people experiencing homelessness or unstable housing in Calgary, Alberta, had developed lab-confirmed COVID-19. Spread occurred despite standard outbreak controls at affected shelter and supportive housing sites. Among these 37 cases, drink sharing was frequently identified as a modifiable mode of possible transmission. We collaborated with emergency shelters, a supportive housing site, and street and encampment outreach groups, using mixed service delivery by health staff, non-profits, and peers with lived experience with homelessness. Intervention To empower individuals to decrease COVID-19 transmission using a harm reduction approach, we provided disposable paper cups to service providers for distribution to clients. Service providers tracked the number of cups distributed. To assess effectiveness, we interviewed staff and peers who distributed the cups. Outcomes Cup distribution was highest among populations with higher rates of alcohol use, and the intervention was well received by people who drink alcohol regularly, providing unique opportunities to promote COVID-19 awareness and safer drinking practices. Providers to these populations reported enthusiastic client engagement and repeat requests for cups for safer drinking. Intervention usefulness was limited in contexts with low alcohol consumption and in the absence of paired COVID-19 education. Provider reports suggest appropriate disposal of these cups after use. Implications Disposable cups are a novel, rapidly implementable, low-cost harm reduction tool to empower people experiencing homelessness to reduce the risk of COVID-19 transmission due to drink sharing, ideally as part of a larger harm reduction and community education strategy.

Background The social determinants of health that influence steps in the entire Hepatitis C Virus (HCV) treatment cascade must be identified to achieve HCV elimination goals. This project aimed to evaluate the association of these factors with HCV treatment completion and return for sustained virologic response (SVR) testing. Methods We used retrospective cohort data from our primary care-based HCV treatment program that provides comprehensive harm reduction care to those who use or formerly used drugs. Among persons who began direct-acting antiviral HCV treatment between December 2014 and March 2018, we identified two outcomes: HCV treatment completion and return for SVR assessment 12 weeks after treatment end. Several predictors were ascertained including sociodemographic information, substance use, psychiatric symptoms and history, housing instability, and HCV treatment regimen. We then evaluated associations between predictors and outcomes using univariate and multivariable statistical methods. Results From a cohort of 329 patients treated in an urban primary care center, multivariable analysis identified housing instability as a single significant predictor for HCV treatment completion (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.1–0.9). Among patients completing treatment, 226 (75%) returned for SVR assessment; the sole predictor of this outcome was Medicaid as primary insurance (compared to other insurances; OR 0.3; 0.1–0.7). Conclusions Innovative strategies to help unstably housed persons complete HCV treatment are urgently needed in order to reach HCV elimination targets. Educational and motivational strategies should be developed to promote individuals with Medicaid in particular to return for SVR viral load testing, a critical post-treatment component of the HCV treatment cascade. Trial registration Not applicable.

PurposeGlobally, hepatitis C treatment uptake is lower among people who are homeless or unstably housed compared to those who are housed. Understanding and addressing this is essential to ensure no one is left behind in hepatitis C elimination efforts. This study aims to explore peoples’ experiences of unstable housing and health care, and how these experiences influenced engagement in hepatitis C treatment.Design/methodology/approachPurposive sampling was used to recruit people with lived experience of injection drug use, hepatitis C and unstable housing in Melbourne, Australia. In-depth semistructured interviews were conducted and a case study approach with interpretative phenomenological analysis was used to identify personal experiential themes and group experiential themes.FindingsFour people were interviewed. The precarious nature of housing for women who inject drugs was a group experiential theme, however, this did not appear to be a direct barrier to hepatitis C treatment. Rather, competing priorities, including caregiving, were personal experiential themes and these created barriers to treatment. Another group experiential theme was “right place, right time, right people” with these three elements required to facilitate hepatitis C treatment.Originality/valueThere is limited research providing in-depth insight into how personal experiences with unstable housing and health care shape engagement with hepatitis C treatment. The analyses indicate there is a need to move beyond a “one size fits-all” approach to hepatitis C care. Instead, care should be tailored to the needs of individuals and their personal circumstances and regularly facilitated. This includes giving greater attention to gender in intervention design and evaluation, and research more broadly.