A patient navigation trial for housing and health (PATHH): a randomized controlled trial - nearly one in three women have experienced physical or sexual violence

The National Institute of Nursing Research awarded Friends Research Institute, Inc. $1.542 million on September 26, 2025, under the Nursing Research program (CFDA 93.361) to develop and evaluate PATHH (Patient Navigation Trial for Housing and Health), a randomized controlled trial testing patient navigation services designed to improve housing stability and healthcare engagement for women survivors of violence.

The project adapts evidence-based patient navigation intervention components to address the dual challenge of housing instability and fragmented healthcare access among women survivors of violence, who experience elevated rates of substance use disorders, depression, HIV, and related health complications. PATHH will conduct a parallel two-arm randomized controlled trial enrolling 300 women survivors of violence, assigning 150 to the patient navigation intervention and 150 to treatment-as-usual. Work includes adaptation of navigation services across individual, organizational, and community levels with guidance from a community advisory board, pilot evaluation as an augmentation to existing services in partnership with community organizations, and assessment of primary outcomes including housing stability. Place of performance is Baltimore, Maryland, with period of performance extending through July 31, 2030.

Women who have survived violence (WSV) demonstrate high rates of housing instability and health problems, including increased morbidity and mortality related to substance use, depression, and HIV. Housing influences long-term well-being and contributes to differences in health outcomes that can persist over time. Healthcare engagement for WSV is often limited by factors such as fragmented services, complex eligibility requirements, and inconsistent follow-up systems. Despite the established link between housing and health, there is a lack of evidence-based interventions designed to directly improve housing instability while simultaneously supporting improved connection to healthcare services. There is an urgent need for approaches that promote housing stability and improve engagement in care for WSV to reduce preventable negative health outcomes. Patient navigation (PN) is an evidence-based intervention shown to support engagement in social and healthcare services among populations facing complex needs. Building on our prior research and adapting the core components of the navigation services to avoid RE-hospitalization (NAVSTAR) intervention, we propose to develop and test PATHH (patient navigation trial for housing and health), a PN model focused on improving housing stability and health self-efficacy for WSV. Guided by a community advisory board, we will adapt PN to support PATHH's implementation across individual, organizational, and community levels (aim 1). PATHH will then be evaluated as an augmentation to existing services in partnership with community organizations (aims 2 and 3). To assess effectiveness, we will conduct a parallel, two-arm randomized controlled trial (N=300), randomly assigning WSV 1:1 to PATHH (N=150) or treatment-as-usual (N=150). Primary outcomes will include housing stability and health self-efficacy; secondary outcomes include substance use, mental health, and physical health. We will also evaluate implementation outcomes at the trial's conclusion. This study is significant in testing a scalable PN approach designed to improve housing stability and health for WSV, and innovative in extending PN beyond traditional healthcare settings into community-based partnerships, while also generating evidence to guide future implementation of PN models.