Housing and Other Factors Associated with HIV Viral Suppression Among Ryan White Non-Medical Case Management Clients in South Florida

This study examined longitudinal administrative records from Ryan White Part A non-medical case management clients served by a nonprofit HIV service provider in Broward County, Florida, United States, from 2017 through 2025. The sample included 3,287 client-year observations from 1,228 clients. Logistic regression models estimated the odds of detectable viral load (≥40 copies/mL) and unsuppressed viral load (≥200 copies/mL). In unadjusted analyses, nonpermanently housed clients had higher rates of both outcomes than permanently housed clients (26.7% vs. 18.9% for detectable viral load; 14.6% vs. 9.9% for unsuppressed viral load; both p < .001). After adjustment, housing status was not significantly associated with either outcome. However, Black clients had higher adjusted odds of both outcomes (detectable: OR = 1.62, 95% CI [1.20, 2.18]; unsuppressed: OR = 2.00, 95% CI [1.33, 2.99]), whereas female clients had lower odds of both. Younger age was also associated with poorer viral load outcomes. Findings suggest that housing instability is intertwined with broader demographic and structural inequities rather than functioning as an isolated predictor. Ryan White programs should address housing needs alongside persistent disparities in HIV care. Future research should use more nuanced measures of housing instability to better target limited resources.