Jan. 18, 2022 – 
When Ellen Eaton, M.D., reflects on how important the 340B drug pricing program is to her patients living with HIV, one of the first people she thinks about is a woman she calls “Linda.” For many years, Linda struggled with substance use disorders. She lost custody of her children, was estranged from her family, had no income, and she was living without stable housing.
A turning point in her life came when she started receiving treatment at UAB Medicine’s 1917 Clinic, a Ryan White HIV/AIDS clinic that recently had launched an initiative to help its patients obtain housing. Linda describes her HIV diagnosis more than two years ago as “not a death sentence but the first time she was really living,” Eaton says. Linda’s life has completely changed for the better with the help of the 1917 Clinic and the 340B funding that the clinic uses to help patients like her.
A partnership between 340B-funded social workers from the clinic and a local nonprofit housing organization assisted Linda with temporary housing. With that support, she gained a sense of security and independence and got a job. Since then, she has moved into housing that she pays for, gone back to graduate school, and reconnected with her children.
Linda’s health also has significantly improved. Her HIV viral load is suppressed, and her chronic medical conditions are under control. Eaton, an infectious disease specialist who treats Linda at the 1917 clinic, expects her patient will have a normal life expectancy.
Eaton shares Linda’s story in the first podcast episode of 2022 for 340B Insight.
Linda “will tell you that her life has just begun and she’s doing great things,” Eaton said. “And it’s one of the stories that we say in our clinic, ‘This is our why, this is why we come in,’ because she has hit all those goals.”
Creating a Robust Safety Net
Linda is one of many patients living with HIV who needs support from the health care safety net. The federal government reports 1.2 million Americans are living with HIV and estimates that half of newly diagnosed cases each year are in the South. This means UAB Medicine and the 1917 Clinic already had been providing critical health services for the prevention and treatment of HIV prior to establishing their 340B-funded temporary housing initiative.
Eaton describes how 340B savings funded other wraparound services, such as pharmacists providing counseling to patients to improve medication adherence and wound care for patients who also are diabetic. The care UAB Medicine and its 1917 Clinic provides is emblematic of the nation’s 340B hospitals. 340B disproportionate share (DSH) hospitals are nearly twice as likely as non-340B hospitals to provide HIV/AIDS services. This includes the 71% of 340B hospitals that are using their program savings to provide HIV pre‐exposure prophylaxis (PrEP) free of charge to patients at risk.
But the team at 1917 Clinic wanted to provide even more comprehensive care. They determined that a subset of the clinic’s patients struggled to improve their health despite receiving the medications they needed to suppress the virus. Eaton said the most common factor among these patients was unstable housing. Patients who lack stable housing often do not have a place to store their medications correctly and therefore do not take them as scheduled. The result is a “cascade of transmission” as their viral load increases. They are more likely to transmit the disease to sexual partners, their children, and any other members of the community with whom they are using substances and sharing needles. “So really, housing is health care,” Eaton said.
The 1917 Clinic aimed to create a program that would use 340B savings to offset the cost of providing housing resources. Rather than starting from scratch and organizing the housing themselves, the clinic approached two local community nonprofit organizations that already had access to housing and were experts in the area. The result has been a variety of services for patients referred to the program, including short-term rental assistance for those who are in between jobs and facing evictions, and longer-term, affordable housing that includes group homes specializing in substance use recovery.
Patients must continue to receive needed care at the 1917 Clinic while receiving their temporary housing. With both their medical needs and housing needs addressed, patients have achieved measurably improved health outcomes. Eaton says more than 75% of participating patients have virally suppressed HIV. That not only means better health for them but dramatically reduces the possibility of sharing HIV with a sex partner.
“We’ve just provided an additional warm hug, warm handshake, warm touchpoint for these patients to connect to both our social work staff, our medical providers, and now our housing partners in the community, really this robust safety net,” Eaton said. “I think our entire group would tell you without 340B funding, we would not be able to provide these services for our patients.”
Ending the HIV/AIDS Epidemic
In recent years there has been an increased focus on ending the HIV/AIDS epidemic over the next decade. Eaton believes continuing to address the social determinants of health, including housing, is critical to meeting this goal. She stresses the importance of using 340B resources to address social determinant interventions based on the needs and environments of individual communities.
The success of UAB’s efforts in HIV also can be applied to other areas and populations. “There’s so many parallels between the opioid epidemic and even the hepatitis C epidemic,” Eaton said. “These same barriers, these social determinants of health are critical to ending all these endemics. You know, what’s working for my patients in my opioid treatment clinic is also helping their HIV.”
Listen to Eaton’s entire interview about UAB Medicine’s 1917 Clinic and its temporary housing partnership on our 340B Insight podcast.