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Assessment of a Hotel-Based Protective Housing Program for Incidence of SARS-CoV-2 Infection and Management of Chronic Illness Among Persons Experiencing Homelessness

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Was a hotel-based protective housing intervention associated with reduced incidence of SARS-CoV-2 infection among persons experiencing homelessness (PEH) in Chicago, Illinois?

Findings  In this cohort study of 259 PEH, a significant reduction in SARS-CoV-2 incidence was observed during the study period among PEH provided with protective housing compared with PEH in shelters citywide. Improvements in hypertension and glycemic control were also observed; 51% were successfully housed at departure.

Meaning  These findings suggest that protective housing interventions may reduce SARS-CoV-2 incidence among PEH at increased risk for severe COVID-19.

Abstract

Importance  Persons experiencing homelessness (PEH) are at higher risk for SARS-CoV-2 infection and severe illness due to COVID-19 because of a limited ability to physically distance and a higher burden of underlying health conditions.

Objective  To describe and assess a hotel-based protective housing intervention to reduce incidence of SARS-CoV-2 infection among PEH in Chicago, Illinois, with increased risk of severe illness due to COVID-19.

Design, Setting, and Participants  This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID-19 pandemic from April 2 through September 3, 2020. Participants were PEH at increased risk for severe COVID-19, defined as (1) aged at least 60 years regardless of health conditions, (2) aged at least 55 years with any underlying health condition posing increased risk, or (3) aged less than 55 years with any underlying health condition posing substantially increased risk (eg, HIV/AIDS).

Exposures  Participants were housed in individual hotel rooms to reduce the risk of SARS-CoV-2 infection; on-site health care workers provided daily symptom monitoring, regular SARS-CoV-2 testing, and care for chronic health conditions. Additional on-site services included treatment of mental health and substance use disorders and social services.

Main Outcomes and Measures  The main outcome measured was SARS-CoV-2 incidence, with SARS-Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration. Secondary outcomes were blood pressure control, glycemic control as measured by hemoglobin A1c, and housing placements at departure.

Results  Of 259 participants from 16 homeless shelters in Chicago, 104 (40.2%) were aged at least 65 years, 190 (73.4%) were male, 185 (71.4%) were non-Hispanic Black, and 49 (18.9%) were non-Hispanic White. There was an observed reduction in SARS-CoV-2 incidence during the study period among the protective housing cohort (54.7 per 1000 people [95% CI, 22.4-87.1 per 1000 people]) compared with citywide rates for PEH residing in shelters (137.1 per 1000 people [95% CI, 125.1-149.1 per 1000 people]; P = .001). There was also an adjusted change in systolic blood pressure at a rate of −5.7 mm Hg (95% CI, −9.3 to −2.1 mm Hg) and hemoglobin A1c at a rate of −1.4% (95% CI, −2.4% to −0.4%) compared with baseline. More than half of participants (51% [n = 132]) departed from the intervention to housing of some kind (eg, supportive housing).

Conclusions and Relevance  This cohort study found that protective housing was associated with a reduction in SARS-CoV-2 infection among high-risk PEH during the first wave of the COVID-19 pandemic in Chicago. These findings suggest that with appropriate wraparound supports (ie, multisector services to address complex needs), such housing interventions may reduce the risk of SARS-CoV-2 infection, improve noncommunicable disease control, and provide a pathway to permanent housing.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: October 18, 2021.

Published: December 13, 2021. doi:10.1001/jamanetworkopen.2021.38464

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Huggett TD et al. JAMA Network Open.

Corresponding Authors: Thomas D. Huggett, MD, MPH, Lawndale Christian Health Center, 3860 W Ogden Ave, Chicago, IL 60623 (thomashuggett@lawndale.org); Elizabeth L. Tung, MD, MS, Section of General Internal Medicine and Center for Health and the Social Sciences, University of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL 60637 (eliztung@uchicago.edu).

Author Contributions: Drs Huggett and Tung had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Huggett and Tung contributed equally.

Concept and design: Huggett, Tung, Cunningham, Ghinai, McCauley, Detmer.

Acquisition, analysis, or interpretation of data: Huggett, Tung, Ghinai, Duncan, Detmer.

Drafting of the manuscript: Huggett, Tung, Cunningham, Ghinai, Duncan.

Critical revision of the manuscript for important intellectual content: Huggett, Tung, Ghinai, McCauley, Detmer.

Statistical analysis: Tung, Ghinai, Detmer.

Administrative, technical, or material support: Huggett, Ghinai, Detmer.

Supervision: Huggett, Ghinai, Detmer.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Tung was supported by a National Heart, Lung, and Blood Institute career development grant (1K23HL145090-01) in patient-oriented research.

Role of the Funder/Sponsor: The funding organizations/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors would like to acknowledge the Lawndale Christian Health Center clinicians and staff who provided care at the hotel-based housing intervention; especially site manager Robert Werner who also provided the initial design for eFigure 1 in the Supplement; clinical leaders Susan J. Erlenborn, MD, and Alex Porte, MD; interns Simon Lee, Caitlin Somerville, Linda Phung, and Joshua Wang for data entry; City of Chicago staff and members of CHHRGE who supported this project; and the SARS-CoV-2 PCR testing teams from Rush University, University of Illinois at Chicago and Lurie Children’s Hospital. None of these contributors were compensated.

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