Abstract Background HIV viral suppression remains suboptimal among people with HIV (PWH) facing barriers such as homelessness, substance use, and mental health disorders. In 2019, Ward 86 launched the POP-UP program, a low-barrier HIV care model serving PWH with unstable housing and difficulty engaging in care. In 2021, we introduced long-acting antiretroviral therapy (LA-ART) including for PWH unable to attain viral suppression on oral ART. This study evaluates temporal trends in viral suppression and mortality within POP-UP. Methods We conducted a retrospective cohort study of PWH enrolled in POP-UP between August 2019 and December 2024. Eligibility included viremia (HIV viral load ≥200 copies/mL) or being off ART, homelessness/unstable housing, and difficulty engaging in care. Criteria later expanded to include PWH with severe mental health or substance use disorders. Primary outcomes were viral suppression (200 copies/mL) and mortality. Results Among 241 PWH ever enrolled in POP-UP, 86% attained viral suppression at least once during follow-up. Cross-sectional viral suppression was 47% in August 2019 (eight months after program inception) and increased to 64% in December 2024. By December 2024, 46% of suppressed patients were on LA-ART. Mortality declined from 8.8/100 person-years in 2020 to 2.6/100 person-years in 2024, with reductions in both AIDS-related and overdose deaths. Conclusions The POP-UP program improved viral suppression and may have reduced mortality among PWH with substantial barriers to care. Improvements were likely driven by integration of LA-ART and continued quality improvement. Persistent viremia within the program highlights the need for additional strategies to address structural and psychosocial barriers.
Imbert et al. (2026) studied this question.