UP-CARE Lab (Unhoused Persons Care Access, Retention, and Engagement)
Dr. Asgary's Research Lab
UP-CARE (Unhoused Persons Care Access, Retention, and Engagement)
300 million+
people worldwide are estimated to experience homelessness.
3.5 million
Americans experience homelessness each year.
550,000+
Americans experience homelessness on any given night in the U.S.
UP-CARE Lab focuses on improving chronic disease and cancer prevention for people experiencing homelessness by identifying gaps in access to healthcare at the individual, provider, and system level. Through studies conducted in shelters and shelter‑clinics, we have documented consistently low rates of breast, cervical, and colorectal cancer screening, high rates of uncontrolled hypertension and diabetes, and misinformation around HPV and cancer risks. We test practical solutions, including in‑person patient navigation and SMS text-based digital health interventions that improve disease screening, prevention, chronic disease control, and management. We also develop training programs that strengthen providers' skills to care for homeless persons.
Resources and Publications provide detailed methods and results of our research.
Unmet Needs in Chronic Disease and Cancer
- Cardiovascular disease and cancer are the leading causes of death among homeless adults over 45.
- Cancer incidence is 4 times higher, and cancer mortality is twice as high as in the general population.
- Diabetes and hypertension are twice as likely to become uncontrolled among homeless adults.
- Many homeless adults live with multiple chronic health conditions.
Gaps in Prevention and Screening
- Lower rates of breast, cervical, and colorectal cancer screening are recorded among homeless adults.
- Population-level strategies such as patient navigators for cancer screening or chronic disease management have not yet been systematically tested in homeless populations.
Shelters as Gateways to Care
- The majority of homeless persons reside in shelters or transitional housing.
- Case managers, navigators, and social workers can help improve care coordination for access to preventive care, disease screening, and follow-up care.
Digital Health Interventions
- 80% of homeless persons have access to cell phones, enabling behavioral support, care coordination, and health promotion.
- mHealth strategies, including SMS texting, have improved care in low-income populations, but have not been systematically tested for cancer screening or preventive care among homeless populations.
- Digital health interventions could be leveraged to improve access to care among highly mobile homeless populations.