Housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy: A meta-analysis of observational studies in the U.S.

BACKGROUND: Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE: We conducted a meta-analysis of the housing-adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000 – January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS: A random effects model was used to estimate overall effect size and 95% CI. Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS: The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15; 95% CI = 0.02 – 0.29). The association was slightly larger in the quality effects analysis (SMD = 0.20, 95% CI = 0.01 – 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSIONS: Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence, and questions the potential benefit of deferring ART initiation until the patient’s housing circumstances are improved.

• Determinants of Health
  • Housing
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment