title: Housing Stability and Medication Adherence among HIV-Positive Individuals in Antiretroviral Therapy: A Meta-Analysis of Observational Studies in the United States.
abstract: 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 the overall effect size and 95% confidence interval (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 to 0.29). The association was slightly larger in the quality effects analysis (standardized mean difference = 0.20, 95% CI: 0.01 to 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 antiretroviral therapy initiation until the patient's housing circumstances are improved.
authors: *Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; and †Albert Einstein College of Medicine, Bronx, NY.
authors: Rebecca Arden
authors: RA
authors: Harris
authors: Xiaonan
authors: X
authors: Xue
authors: Peter A
authors: PA
authors: Selwyn
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006798:Housing; D006801:Humans; D055118:Medication Adherence; D014481:United States
chemical_list: D044966:Anti-Retroviral Agents