AIDS Foundation of Chicago: Chicago Housing for Health Partnership
Founded in 1985 by community activists and physicians, AIDS Foundation of Chicago (AFC) is a local and national leader in the fight against HIV/AIDS. AFC collaborates with community organizations to develop and improve HIV/AIDS services, and fund and coordinate prevention, care, and advocacy projects. AFC has a long history of building coalitions with service providers and other health organizations, and public officials to avoid duplication of services, maximize scarce resources, and ensure quality services for those living with and at risk for HIV/AIDS, as well as for vulnerable homeless populations.
AFC maintains a central management information database to track client demographics, service utilization, and outcomes across partner agencies.
AFC also has an established infrastructure for leading multi-agency, multi-system collaborations—encompassing hospitals/healthcare providers, providers of specialty mental health/substance abuse treatment and outreach, and a broad spectrum of community-based housing and homeless service agencies—for efficient, quality service delivery within and beyond Chicago. During 2010, AFC subcontracted $13 million in federal funds to more than 65 partner housing and case management agencies. AFC maintains a central management information database to track client demographics, service utilization, and outcomes across partner agencies. See http://aidschicago.org
Proactive Grant Overview & Goals:
The Chicago Housing for Health Partnership (CCHP) was a four-year research and demonstration project (2003-2007) led by the AIDS Foundation of Chicago. It involved a citywide collaboration with 15 healthcare, housing, and social service agencies. The project objectively examined the effectiveness of a case management and housing program in reducing the use and costs associated with emergency and longer-term medical services among homeless adults with chronic medical illnesses.
During an 18-month research phase, CHHP researchers – the Collaborative Research Unit of Stroger Hospital, Cook County Bureau of Health Services – used a randomized control trial design to study the number of hospital, emergency room, and nursing home visits incurred by two groups: 201 individuals who received CHHP supportive housing and case management compared to the 204 individuals who received “usual care,” a piecemeal system of emergency shelters, family and recovery programs. Composition of the groups included high rates of long-term substance abuse (86 percent), mental illness (46 percent), and medical issues such as HIV/AIDS (34 percent) and hypertension (33 percent), as well as a number of other chronic medical illnesses, such as diabetes and cancer.
The independent research used electronic surveillance, medical records and interviews to track health outcomes and assess whether and how much in medical expenses could be saved through case management and stable housing. A CHHP Substudy of over 100 HIV positive participants assessed the effectiveness of this service model in assisting this sub-group by examining immune system function through participants’ viral loads.
In 2007, due to its documented success, CHHP evolved from a research and demonstration project to an established citywide collaboration. CHHP presently provides permanent, scattered-site housing and supportive services to 180 homeless individuals dually or triply diagnosed with HIV or another chronic medical illness, substance addiction, and/or mental illness. http://aidschicago.org/housing-home/hospital-to-housing
Combined MRHT Grants:
$885,000 from 2002-2008
Impact of CHHP:
- The CHHP research study is the first in the nation to establish and empirically evaluate whether providing stable housing and case management services to chronically medically ill homeless individuals improves their health and health service utilization, and saves net costs. The results of the study have been published in Journal of the American Medical Association [JAMA] and American Journal of Public Health [AJPH]. Summary sheets for both studies: http://www.aidschicago.org/pdf/2011/chhp_study_summary.pdf
[Citations to the studies are noted below]
- According to the conclusion of the May 6, 2009 article on CHHP in JAMA, “offering housing and case management to a population of homeless adults with chronic medical illness resulted in fewer hospital days and emergency department visits, compared with usual care.”
- The intervention group had a relative reduction of 29% in hospitalizations and a 24% reduction in emergency room visits compared the similar group that received usual care.
- The intervention is estimated to have reduced nursing home costs alone by over $500,000.
- 55% of HIV-positive individuals in the intervention group had a relatively healthy immune system, compared with 34% in the usual care group.
- 40% of HIV-positive individuals in the intervention group had undetectable levels of virus in their blood, compared to 21% in the usual care group.
- The median HIV viral load was 87% lower in the intervention group. A low viral load is evidence of effective treatment and reducing levels of HIV in the bloodstream.
- CHHP produced extremely valuable published data on the cost and health benefits of supportive housing and case management that continues to be used to advocate for more housing and case management resources for homeless individuals locally and nationally.
- According to AFC, CHHP data was used by the Obama Administration to shape its FY 2011 HUD Budget request to Congress that included 4,000 new subsidies for homeless persons living with a chronic medical illness.
- CHHP data and its collaborative process have resulted in a number of other similar supportive housing projects in Chicago that continue to provide housing for hundreds of the most vulnerable homeless individuals, such as the Samaritan Housing Program, the Chicago 100,000 Homes Campaign, the AFC Medicaid Supportive Housing Program and others.
Citations of Peer Reviewed Journal Articles related to the CHHP program grants:
Buchanan, D. (2009). The health impact of supportive housing for HIV-positive homeless patients: A randomized controlled trial. American Journal of Public Health, 99(Suppl 3), S675-S680.
Sadowski, L., Kee, R., VanderWeele, T., & Buchanan, D. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. JAMA - Journal of the American Medical Association, 301(17), 1771-1778.
Arturo V. Bendixen
Vice President, Housing Partnership - AIDS Foundation of Chicago
Executive Director – Center for Housing and Health
200 West Jackson Blvd.
Chicago, IL 60606