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. This cohort study examines the association of a hotel-based protective housing intervention and the incidence of SARS-CoV-2 infection among persons experiencing homelessness in Chicago, Illinois. 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 A 1c , 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 A 1c 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.
【초록키워드】 COVID-19, Treatment, SARS-CoV-2, HIV/AIDS, severe COVID-19, mental health, SARS-COV-2 infection, COVID-19 pandemic, Infection, diagnostic, risk, Intervention, Substance use disorder, Symptom, drug, outcome, hypertension, cohort study, improvement, Cohort, Health, SARS-CoV-2 testing, male, pathway, Health care worker, hemoglobin, incidence, Chicago, disease, First wave, Care, glycemic control, Protective, Emergency use, association, food, blood pressure, exposure, Support, retrospective cohort study, black, Systolic blood pressure, higher risk, 95% CI, increased risk, complex, study period, specimen, measure, white, participant, finding, chronic health conditions, positive, health condition, objective, setting, secondary, polymerase chain, upper respiratory, IMPROVE, Result, defined, analyzed, physically, provided, reduced, adjusted, less, reduce, reduction in, conditions, Importance, baseline, Person, Point, Relevance, 【제목키워드】 SARS-CoV-2, homelessness, Program, assessment, chronic, illness, Person,