Practice Adaptations

Case Report

Comorbid TB and HIV in a Chronically Homeless Male: Social Isolation Compounds Stress of Medical Confinement (2006) | Homelessness, long recognized as a risk factor for tuberculosis, can also complicate treatment, as the following case report demonstrates. HIV coinfection increases the risk of progression from latent TB infection to active tuberculosis. Clinicians experienced in the care of homeless persons stress the importance of maintaining communication with these patients, even during medical confinement, and recommend close collaboration among public health, hospital, and primary care providers throughout the course of treatment.

Council Publications

  • Homeless Care Providers and Rapid HIV Testing (2015) | HIV testing and counseling are the cornerstones of HIV prevention response, allowing individuals to know their HIV status and access appropriate services. The Centers for Disease Control and Prevention (CDC) recommends routine, voluntary HIV screening for all patients aged 13 to 65 years in all health care settings as a normal part of medical practice, similar to screening for other treatable conditions. In the spring of 2013, staff of the National HCH Council in collaboration with Dr. Cathie Fogg, Associate Nursing Professor at St. Anslem College in Manchester, NH developed a survey based on Pender’s Health Promotion Model. The survey was administered to homeless care providers  to assess their Rapid HIV testing practices. The report contains the results of the survey.
  • In Focus: December 2012: HIV/AIDS among Persons Experiencing Homelessness (2012)
  • Healing HandsHomeless People at Higher Risk for CA-MRSA, HIV & TB (2006)
  • Healing HandsNetwork to Study HIV and Homelessness (1998)

Clinical Tools

  • HIV Testing in Health-Care Settings: Program Assistance Letter 2010-13 | Health Resources and Services Administration – The purpose of this Program Assistance Letter (PAL) is to provide grantees information regarding the Centers for Disease Control and Prevention’s (CDC) “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings.” The Health Resources and Services Administration (HRSA) and Bureau of Primary Health Care continue to support reducing the number of people who become infected with HIV, increasing access to care and optimizing health outcomes for people living with HIV, and reducing HIV-related health disparities. This PAL also identifies resources for training and technical assistance to help Health Centers follow the Revised Recommendations.

  • HIV/AIDS Care & Treatment in Health Centers: Program Assistance Letter 2011-06 | Health Resources and Services Administration – This Health Center Program Assistance Letter (PAL) provides information and resources regarding the treatment and care of people living with HIV/AIDS (PLWHA). In alignment with the National HIV/AIDS Strategy (NHAS) (, the Health Resources and Services Administration (HRSA) and the Bureau of Primary Health Care (BPHC) will continue to support efforts to prevent new HIV infections, provide access to high quality care for PLWHA, and reduce HIV-related health disparities.

  • Informed Consent and Agreement to HIV Testing

  • Learn to Recognize Acute HIV Infection Tool  (2007) | Developed by the HIV Medicine Association, the tool Learn to Recognize Acute HIV Infection helps clinicians who work in emergency room and primary care settings identify the symptoms most specific to acute HIV infection, to conduct risk screenings, and, if appropriate, laboratory tests. Appropriate selection of patients for diagnostic testing to identify acute HIV infection is important. Current diagnostic testing for acute HIV infection has limitations in specificity and can produce false positive results. This tool will help guide clinicians through the evaluation process of identifying key symptoms, conducting a risk assessment for HIV transmission and using appropriate laboratory diagnostic tests. The tool also includes tips on counseling patients and helpful resources.

Additional Online Resources

  • Cultural Competence: Strengthening the Clinician’s Role in Delivering Quality HIV Care within Homeless Communities | An archived recording from the AIDS Education and Training Center-National Multicultural Center at Howard University, College of Medicine, this webinar will identify the factors that contribute to homelessness among people living with HIV/AIDS, will help you to understand barriers that homeless people living with HIV/AIDS face when attempting to access quality medical care, and will present strategies for providing culturally competent, quality, HIV/AIDS care to persons who are homeless or at risk of becoming homeless.
  • Housing is HIV Prevention and Health Care | Findings from the National Housing and HIV/AIDS Research Summit Series convened by the National AIDS Housing Coalition in collaboration with the Johns Hopkins Bloomberg School of Public Health
  • Kaleidoscope of Care | A cross-disciplinary training curriculum to increase knowledge and awareness of the relationship between HIV infection and substance use. The training curriculum is designed for HIV medical and substance abuse treatment providers as a Training of Trainers (TOT), with the goal of enhancing their ability to provide interdisciplinary care to their common clients, HIV-infected substance users. The full curriculum is available in both English and Spanish.
  • Treating Adolescents with HIV: Tools for Building Skills in Cultural Competence, Clinical Care & Support | Free online training series for MDs, NPs, PAs, RNs, psychologists, social workers, case managers and other health professionals; continuing education credits available.