the Homeless Population

Conducting a review of the literature available on this topic of medication adherence in the population of adults who are homeless was difficult due to the sheer lack of research done. While the negative effects of homelessness and medication noncompliance on both physical and mental health of adults in this population is well documented and studied, the same cannot be said about possible interventions to increase medication compliance to improve said negative effects. The research base currently focuses primarily on providing housing support, some with added social supports as well, to increase medication compliance, with a small number of articles that use other means of support. The population of homeless adults studied tended to be populations that were dealing with a type of illness that needed prolonged medication treatment, such as HIV/AIDs, tuberculosis, or schizophrenia. Noncompliance with medication in persons with these illnesses is more detrimental than others, as the successful treatment of the illness depends on being able to consistently medicate the patient. 

            Of the literature that addressed the effect of providing housing support on medication compliance, the articles differed in the type of housing support they offered to the research participants, but all concluded that providing housing support to adults experiencing homelessness increases medication compliance. One research article focused on determining the effects of two different types of housing support configurations, scattered site and congregate, versus treatment as usual (using existing supports) on medication compliance in the population of homeless adults with Schizophrenia living in Vancouver, Canada (Rezansoff et al., 2017). The article defined scattered-site as single market rentals with multidisciplinary supports available 24/7 and congregate as separate units in a single housing building with onsite multidisciplinary supports (Rezansoff et al., 2017). The results of this randomized controlled trial study found that the scattered site configuration of housing support produced a more significant increase in medication compliance than the congregate configuration or the treatment as usual control group (Rezansoff et al., 2017). This article focused on the different types of housing supports but also had a social support component that was not discussed in detail in the article. 

In a different research article, the effect of rapid rehousing and housing case management versus treatment as usual on adherence to antiretroviral therapy and subsequent viral load suppression was studied in the population of adults who are homeless with HIV/AIDs (Towe et al., 2019). This article focused on determining the effect that the of length of time it took to provide housing had on adherence and found that the participants who were provided with the rapid rehousing and case management were twice as likely to achieve or maintain suppression through medication adherence (Towe et al., 2019). Similar to the article by Rezansoff et al., the social support portion of the support studied was integral to producing the results of increased medication compliance. The social support given was in the form of case management and participants were assigned a case manager who accompanied them to all housing appointments, assisted with entitlements advocacy to secure eligible housing subsidies, conducted housing quality standard reviews, and other activities related to securing housing placements (Towe et al., 2019). This is another article that uses both housing support and social support in the form of case management to improve medication compliance in the population of homeless participants studied. 

            The literature that addressed other means of support included providing incentives such as food and cell phones as ways to fulfill basic needs to increase medication compliance in homeless population. In one article, food packages were given to homeless patients with tuberculosis receiving tuberculosis medication treatment at a dispensary to increase their compliance and decrease interruption of treatment (Garden et al., 2013). The nutritional support provided proved to result in more patients continuing their treatment without interruption as compared to the control group (Garden et al., 2013). Another interesting form of support was studied in a different research article, which investigated providing cell phones with unlimited use to homeless adults and using automatic survey calls daily to collect data on medication adherence (Burda et al., 2011). The participants responded with 100% medication adherence during the daily survey calls and in exit interviews collected in the study, stated that the survey calls served as reminders to take their medication (Burda et al., 2011). While these two articles have very different supports being offered to increase medication compliance, they both showed that the supports did increase medication compliance in the populations studied. Unfortunately, the research surrounding this type of support or any support other than providing housing was very limited. This is certainly a type of support for this population that could use further research, but for now cannot be used to determine recommendations for practice changes. 

In most of the literature that was found on this topic, the sample sizes of the articles were relatively small, and most were based in the USA or Canada. While our population of interest to provide recommendations on this topic for is also based in the USA, the small sample sizes and lack of population diversity in the literature does mean that the results and data cannot be generalized with good confidence to our population of interest. There were a good mix of study designs for the articles found, from randomized controlled trials to single qualitative or quantitative studies, which solidifies the quality of evidence found. While all studies focused on the topic of medication compliance in the population of adults experiencing homelessness, the studies differed in how the outcome of medication compliance was measured or quantified. Overall, no matter how medication compliance was measured, all articles discussing housing supports, either combined with social supports or not, found that the type of support increased medication compliance in this population of homeless persons.