Program and implementation context of a housing support initiative to address homelessness and improve HIV service uptake among youth in the United States

PROJECT SUMMARY/ABSTRACT Rates of homelessness among youth and young adults living in the United States have more than doubled in the last decade, and transition-age youth face elevated levels of housing insecurity and an increased risk of homelessness. Developmental and systemic challenges during this critical life stage—such as aging out of foster care, limited access to stable employment, and gaps in social support—contribute to the heightened vulnerability to homelessness in this group. Housing instability among transition-age youth can exacerbate existing risk factors for poor health outcomes and create new environments that pose additional risks, including survival sex, physical and/or sexual abuse, and injection drug use. To add to this, unstable housing may challenge already suboptimal access to and engagement with healthcare services, including HIV prevention and treatment. Existing guidelines and strategic plans in the United States emphasize the importance of safe and affordable housing to HIV service utilization and outcomes, but innovative strategies that operate within the existing program environment and effectively cater to the distinctive needs of young people are largely unavailable and understudied. While housing support programs and rental assistance are not novel among the array of existing social safety net interventions, their effective implementation has faced obstacles such as administrative complexities, conditions linked to work or behavior change, and a lack of adaptability to evolving needs. To address these complexities, we will first document the existing program environment that influences housing and HIV, and second partner with Point Source Youth (PSY), an advocacy leader in the youth homelessness space, to refine and measure the implementation of a housing support program intervention for youth at or about to enter the homelessness system in Baltimore City. 60 young people will be provided with rental support over two years to sustainably exit homelessness, find housing in alignment with apartment share arrangements, and more easily access HIV services. To guide this research, we will use two implementation science frameworks in conjunction: the Consolidated Framework for Implementation Research (CFIR) 2.0 and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM). The proposed strategy is grounded in insights from community-identified needs and barriers, consideration of implementation challenges at the individual and organizational levels, and an understanding of the ongoing evolution of the program context. The specific aims of this study are: Specific Aim 1 – Map existing municipal and state programs that impact housing and HIV among young people and generate a program index to quantify their breadth and depth, 2020-2025 Specific Aim 2 – Inform and tailor the implementation of a housing support program intervention for youth based on stakeholder perspectives in Baltimore City Specific Aim 3 - Measure the implementation of a housing support program intervention to address homelessness and improve HIV service engagement among youth in Baltimore City