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The Oakland, California-based California Prostitutes Education Project (CAL-PEP) - in close collaboration with Tri-City Health Center, East Bay Community Recovery Project, Asian & Pacific Islander Wellness Center, East Bay AIDS Center, and Dr. Barbara Green-Ajufo of the UCSF Center for AIDS Prevention Studies - proposes to implement Bay Area Safe Space (BASS), a program of integrated substance use and mental health treatment, social support and life skills training, and HIV and hepatitis C testing, treatment, and prevention services that is directed toward some of the highest risk and most highly underserved populations in California. BASS will be a multi-dimensional, high-impact, non-traditional, peer-centered program that is specifically directed toward high-risk MSM and transgender women of color living in Alameda and Contra Costa Counties, with a special emphasis on African Americans and commercial sex workers. The program will bring about significant reductions in the number of new HIV infections while reducing substance use and improving the health and well-being among a group of extremely disadvantaged, underserved, and low-income individuals. The program will also build upon our existing safe space for MSM of color to create the first safe space for transgender women in the hard-hit city of Oakland, California. The program will generate new models of community outreach, engagement in care and services, and social support that can be replicated in other regions and settings. BASS will provide integrated, peer-based outreach that reaches at least 4,570 high-risk individuals, at least 420 of whom will be enrolled in a program of integrated, SAMHSA-funded substance use treatment, mental health services, and HIV prevention services - including access to PrEP medications - that incorporate comprehensive case management, peer-based support, and complementary life skills, employment, housing, and other services. Two-thirds of the enrolled project population will be high-risk MSM of color and one-third will be high-risk transgender women of color. Approximately half of the MSM population will be young people ages 18 - 29 while half will be older MSM of color. Overall, 76% of the project population will be African American (310); 18% will be Latino (81); 5% will be Asian / Pacific Islander (30); and 1% will be Native American (4). Approximately 15% of the project population will be persons living with HIV (PLWH), including an estimated 23 new PLWH identified through the project’s aggressive street and venue-based HIV testing program. Key project outcome objectives include: a) successfully linking at least 60 high-risk, HIV-negative MSM of color and transgender persons of color to comprehensive PrEP treatment services at one of BASS’ medical partner agencies; b) documenting significant decreases in alcohol use among at least 35% of clients who complete at least 12 weeks of treatment and at least 60% of clients who complete at least 24 weeks of treatment; c) securing voluntary commitments to modify at least one key HIV risk behavior among at least 40% of clients who complete at least 12 weeks of treatment and among at least 75% of clients who complete at least 24 weeks of treatment; d) attaining significant improvements in self-reported levels of self-esteem, wellness, and future directedness among at least 40% of clients who complete at least 12 weeks of treatment and among at least 75% of clients who complete at least 24 weeks of treatment, including increases in self-reported health, personal empowerment, and reduced depression.~

The San Francisco, California-based Women's HIV Program (WHP), a highly regarded, multi-service women's primary care clinic based within the University of California, San Francisco (UCSF) - proposes to utilize SAMHSA TCE HIV funding to implement the Health, Empowerment, and Recovery Services (HERS) Program, a comprehensive clinic-based behavioral health program that will be fully integrated into the clinics existing medical and support services. HERS will create a model program of merged behavioral health, medical, and support services for women living with or at high risk for HIV in which integrated, trauma-informed care forms the underlying foundation for all medical, behavioral health, and support services provided to program clients. Through this approach, WHP will build upon its pioneering, nationally recognized trauma-informed clinic to produce the most intensive trauma-informed HIV and behavioral health model to date. HERS will serve a population 368 unduplicated low-income women of color who are either living with or are at high risk for HIV, 59 percent of whom are women living with HIV and 41 percent of whom are high-risk HIV-negative women. The HERS matrix of integrated, trauma-centered, clinic-based substance use and behavioral health services will use a four-phase treatment model that integrates the stages of trauma treatment with the Stages of Change Transtheoretical Model. Key interventions at the precontemplation, contemplation, and preparation stages of change (Pre-Phase 1: Engagement Phase) include bi-annual behavioral health and trauma screening; ongoing motivational interviewing; harm reduction counseling; open drop-in support and mindfulness groups, and ongoing Wellness Action Recovery Plan (WRAP) groups. In Phase I of the treatment process, which corresponds to the Action phase of the Transtheoretical Model, clients with severe substance issues will receive onsite motivational enhancement therapy and trauma-informed psychopharmacology services and medication-assisted treatment overseen by the HERS Psychiatric Nurse Practitioner. Additional services at this stage include Seeking Safety group therapy and warm linkages to intensive residential detox. Clients who achieve stabilization and a greater degree of drug and alcohol control may proceed to a more intensive Action Stage (Phase II) that more deeply address trauma issues, including existing individual trauma-focused individual therapy, the Skills Training in Affective and Interpersonal Regulation (STAIR) group therapy program, and expressive therapy and leadership opportunities. In the recovery stage (Phase III), activities include drop in one-on-one therapy; drop-in support groups; case management and screening; and opportunities to serve in peer leadership roles. Key outcome objectives include: a) successfully retaining at least 90 percent of HIV-positive clients in care; b) successfully retaining at least 75 percent of high-risk HIV-negative clients on PrEP treatment; c) documenting significant decreases in alcohol use among at least 40 percent of project participants; d) documenting significant decreases in depression symptoms among at least 50 percent of participants; e) documenting significant decreases in PTSD symptoms among at least 45 percent of participants; f) documenting significant increases in self-reported quality of life among at least 50 percent of participants; and g) achieving viral load suppression among 40 percent of clients who begin their involvement in HERS with an unsuppressed viral load.

In the collaboration of three key agencies: the Public Health Institute (PHI), Instituto Familiar de la Raza (IFR), and Asian Health Services (AHS), the Mariposa Targeted Capacity Expansion (TCE) aims to reduce substance use and HIV risk behaviors and increase access to HIV/VH testing and treatment and trauma informed treatment services for transwomen of color in Alameda and San Francisco counties. Mariposa TCE will implement Motivational Enhancement Intervention (MEI) for transwomen of color, defined as racial/ethnic minority persons who were born as male, but identify their gender as transgender/transsexual women or gender non-conforming. In collaboration with stakeholders, local CBOs, and the Public Health Department, Mariposa TCE will conduct community and on-line outreach for the targeted transwomen of color (18 years and older) who are at risk for substance abuse and HIV/VH infection and provide HIV/VH testing and treatment and MEI to reduce substance use and HIV risk behaviors and increase overall quality of life. Also, clients in Mariposa TCE will be able to enroll in the Stable Housing and Employment (SHE) in which clients will gain skills and knowledge about job application and finding affordable housing in a safe neighborhood. Mariposa TCE will also provide support groups at a safe project space (Butterfly Nest) to promote healthy behaviors and increase positive support. Mariposa TCE aims to attain the following objectives during the five-year project period: 1) 6,750 contacts through community and online outreach activities (1,125 in year 01, 1,500 each in year 02, 03, and 04, and 1,125 in year 05); 2) Screen and provide referrals for HIV/VH testing and other services (4,050; 675 in year 01, 900 each in year 02, 03, and 04, and 675 in year 04); 3) Enrollment in Mariposa TCE (MEI) and the intake assessment (540; 90 in year 01, 120 each in year 02, 03, and 04, and 90 in year 05); 4) HIV/VH testing and referrals for treatment (540; 90 in year 01, 120 each in year 02, 03, and 04, and 90 in year 05); 5) Screening for trauma (540; 90 in year 01, 120 each in year 02, 03, and 04, and 90 in year 05); 6) Enrollment in HIV primary care (28; 5 in year 01, 6 each in year 02, 03, and 04, and 5 in year 05); 6) Enrollment in substance abuse and/or mental health treatment programs (108; 18 in year 01, 24 each in year 02, 03, and 04, and 18 in year 05); 7) Enrollment in SHE (270; 45 in year 01, 60 each in year 02, 03, and 04, and 45 in year 05); 8) Completion of MEI and the exit assessment (486; 81 in year 01, 108 each in year 02, 03, and 04, and 81 in year 05); 9) Completion of 6-month follow-up assessment (432; 72 in year 01, 96 each in year 02, 03, and 04 and 72 in year 05); and 10) Support group at project offices (1,900; 300 in year 01, 400 each in year 02, 03, 04, and 05). Results of the process and outcome evaluation will be reported to SAMHSA and the targeted communities through community forums and newsletters. Mariposa TCE will have a significant impact on health promotion for transwomen of color who are most vulnerable and struggling against racial and gender discrimination, but health promotion interventions are limited.

Watts Healthcare Corporation (WHCC) proposes to engage in outreach and a range of treatment and case management services for black young men who have sex with men (Y/MSM) (ages 18-29), and other high-risk groups such as Latino Y/MSM and men who have sex with men (MSM) (ages 30 year and older), and gay, bisexual, and transgender individuals who have a substance use disorder or a cooccurring substance use and mental health disorder, and who are HIV positive or are at high risk for HIV/AIDS. The program is called Watts Behavioral Health Project (WBHP). With more than 1.03 million residents, the service area is densely populated. A majority of residents are Hispanic/Latino (66.3%) or Black/African American (28.2%). African American and Latino Y/MSMs face increased risks to health and well-being when compared with other non-white residents and whites. The communities of South Los Angeles are poor communities. As a Federally Qualified Health Center, WHCC serves residents who are uninsured, or who live on household incomes below 200% of the Federal Poverty Guideline. Rates of poverty are far higher than for Los Angeles County, or California. WHCC intends to enhance its capacity to reduce the number of at-risk residents, their friends and family members who become infected with HIV due to impaired conditions from substance abuse and/or poor mental health status by providing culturally competent and responsive treatment that includes education and outreach, diagnosis of HIV infection, linkage to care, retention in care, receipt of antiretroviral therapy, and achievement of viral suppression (reaching and maintaining a low level of endemic HIV). With the goal of increasing the number of persons within the population of focus that are engaged and treated, objectives that flow from this approach include: (a) To offer free HIV rapid antibody testing for racial/ethnic minorities, including African American MSM (18-29), Latino YMSM, gay, bisexual, and transgenders, who have a substance use disorder (SUD) or co-occurring mental health disorder (COD), who are at-risk for contracting the HIV virus, logging more than 900 tests each year; (b) To enroll a minimum of 70 persons in pre-treat educational groups each year; (c) To provide facilitated enrollment in treatment services for a minimum of 143 persons each year with substance abuse and/or mental health disorders who are also at risk for HIV, including HIV/AIDS testing and counseling services, residential and outpatient substance use services, and mental health services; (d) To provide a minimum of 1,430 case management and supportive services encounters for participants each year; (e) To enroll/refer a minimum of 40 participants in substance use treatment services each year; and (f) To enroll/refer a minimum of 35 participants in mental health treatment services each year, and 10 participants in COD services. WHCC has developed a multi-tiered intervention plan that progressively provides more intensive services based on several factors, including clients’ willingness to engage, their ability to engage, specific bio-psychosocial needs, and resources available to them. Every effort will be made to facilitate timely access to treatment.

Abstract Coastal Horizons Center, a major provider of community-based mental health and substance use prevention, treatment, and recovery services in North Carolina since 1970, proposes to implement a project that will expand and enhance services, and increase the engagement in care of individuals in racial and ethnic groups who have substance use disorders (SUD) and co-occurring substance use and mental disorders (COD) who are at risk for HIV or who are HIV positive. It will focus on high-risk populations that identifies young black men ages 18-29 who have sex with men (YMSM) and other high risk populations such as Latino young men having sex with men, older men 30 and older who have sex with men (MSM), and gay, bisexual, and transgender individuals who have SUD or COD who are HIV positive or who are at risk for HIV/AIDS as priority populations in alignment with the Congressional Minority AIDS Initiative. People who inject drugs (PWID) constitute another priority population in alignment with the goals of the National Viral Hepatitis Action Plan. The goals of the proposed project are as follows: Goal 1. To screen the population of focus for Substance Use Disorders (SUD), Human Immunodeficiency Virus (HIV), and Hepatitis B and C. Goal 2. To engage those who test positive for HIV and Hepatitis B and C and those who are diagnosed with SUD in care. Goal 3. To link participants in need of stable and permanent housing with housing and other services. Goal 4. To establish a continuous quality improvement system for the proposed project. Goal 5. To sustain the project beyond the grant funding period. The goals of the proposed project are aligned with those that the National HIV/AIDS Strategy (NHAS) has set for 2020: 100 percent will be screened for SUD and HIV; 100 percent of those who screen positive will receive a warm hand-off to treatment providers; 90 percent of those screened are engaged in care; 90 percent of those engaged in care reduce their use of substances and increase viral suppression; and 90 percent are linked with housing services. This applicant organization will collaborate with New Hanover Regional Medical Center, Cape Fear Clinic, New Hope Clinic, Brunswick County Health Department and other partners in the implementation of the proposed project. The proposed project will serve 200 annually with a total of 1,000 served over the five-year grant funding period.  

Project Name: Support Training on Prevention (STOP)  Population to Be Served: The geographic area to be served is the East St. Louis area. East St. Louis is a city located in St. Clair County, Illinois, directly across the Mississippi River from St. Louis, Missouri in the Metro-East region of Southern Illinois. We will focus on BMSM 18 and up, Black Trans women of all ages, non-identified BMSM, bi-sexual Black men, and BMSM/Transgender women who have a substance uses disorders (SUDs) or co-occurring disorders (COD) who are HIV positive or at risk for HIV/AIDS.  Service Expansion and Service Enhancement: This project will increase availability of services by serving an additional 150 participants per year. Service enhancement components will include the use of Recovery-Oriented Systems of Care and the development of a wider selection of recovery support services and interventions for 150 participants per year.  Strategies and Interventions: Project staff will receive training on the use of Recovery-Oriented Systems of Care, trauma informed care, developing interventions, and cultural competency. Recruitment through social network strategies (SNS) will be conducted to ensure that the targeted population is reached in sufficient numbers throughout the funding period. The project evaluator will collect and analyze data, including the GPRA and the Consumer Outcome Study, and provide periodic feedback to help monitor and improve outcomes.  Project goals: The goals of the project are to increase access and availability of services to 150 additional participants per year. WPT hopes to improve the quality and the intensity of services we provide to uninsured individuals who are screened/assessed as substance involved or having a mental health conditions.  Measurable objectives: 90% of the 150 participant’s admitted annually to the program will successfully complete the program by September 30, 2022. WPT has provided life enhancing services to BMSM and Trans women for over 14 years. Additionally, WPT has been one of the state’s leading capacity building assistance leaders serving local providers who have deficits in providing culturally affirming services. In this project’s design, we have planned to implement programming that will provide: prevention and treatment services; ongoing community discovery and assessment processes; linkage to care functions that will improve access to treatment and medical care for HIV, SUDs, and CODs; case-management services to support BMSM/Trans women through the navigation of various treatment landscapes; mental health/substance misuse group level and individual level interventions; and capacity building services through our cultural competency curriculum that will enhance retention in programs, ensure improved access, and determine and fill the gaps in services to our target population. Fortunately, this program will increase access and availability of treatment and recovery support services to an additional 150 uninsured individuals, per year, on the waiting lists for treatment services at Comprehensive Behavioral Health Center, New Vision Services, and New Day Recovery Club in East St. Louis, Illinois. The program will improve the quality and the intensity of treatment and recovery support services by adding evidence based treatment and recovery support services and mental health services that will provide participant’s access to Recovery-Oriented Systems of Care. The program will enhance management information systems, consumer intake and assessment record systems, and provide cultural competency and intervention training to help the clinical staff provide effective services to undeserved, diverse participant’s and their families.

Powering Up Male Prevention (PUMP) is a new program at the Ruth M Rothstein CORE Center created to provide support for and improve the lives of African American/Black and Hispanic/Latino HIV positive MSM age 30 and over who have also been impacted by substance use (SUD) and/ or co-occurring disorders (COD). This program will aim to address the syndemic of trauma, substance use disorders, mental health problems and other medical co-morbidities among HIV positive MSM. The goals of PUMP are to improve the lives of HIV positive MSM with SUD/COD by targeting structural and social barriers to care; reduce the impact of trauma on SUD/COD among HIV positive MSM and address the local MSM HIV positive epidemic by increasing engagement and retention in medical and behavioral care for this unique population. PUMP will offer a comprehensive program that addresses the structural, stigmatic, and trauma- related barriers to engaging in SUD, COD and HIV care by offering direct services thru a comprehensive behavioral and culturally sensitive intervention for trauma and HIV. The PUMP program revolves around a 12-session psycho-educational group intervention designed to increase awareness of HIV as a source of trauma that impacts SUD and COD based on the Trauma Recovery Empowerment Model (TREM). Structural barriers to care will be actively addressed thru SUD/COD focused case management which is available on a walk in basis. Peer patient navigators will work with group interventionists to create a community that is accepting and engaging for Minority MSM, to lend structural support to linkages and increase retention to SUD, COD and HIV care. PUMP will offer drop in brief counseling and linkage and retention services to higher level SUD and COD providers and medical providers, helping to overcome trauma related issues with engaging in health care.

Bridging Access to Care (BAC), formerly Brooklyn AIDS Task Force (BATF), is responding to FOA# TI – 17-011, Targeted Capacity Expansion – HIV Program. BAC is proposing to deliver a program to achieve the goals of the National HIV/AIDS Strategy 90-90-90 plan regarding HIV. We are proposing to build the capacity of our current YMSM/MSM programming to address client’s substance misuse and co-occurring substance misuse and mental disorders. BAC proposes a program that will increase engagement in care and decrease HIV/HCV transmission rates among high risk populations (YMSM/MSM). The target population (TP) of focus to be reached through the proposed interventions and services will be young men who have sex with men (YMSM) and men who have sex with men (MSM). The proposed program will target the high needs areas of central Brooklyn, specifically Bedford Stuyvesant, Crown Heights, Brownsville and Flatbush to address the needs of substance using youth. BAC proposes to serve 600 unduplicated individuals (over the entire project period), 120 unduplicated (annually). BAC will implement evidence based interventions proven to achieve desired outcomes. The proposed program goals are as follows: Goal 1: Increase engagement in care for proposed population, especially those who are HIV+. Objective 1-1: Provide case management to 100 racial and ethnic minority individuals with SUD and/or COD treatment needs who are HIV positive or at high risk for HIV, Objectives 1-2: link 80 racial and ethnic minority individuals with SUD and/or COD treatment needs who are HIV positive or at high risk for HIV, to SUD and/or COD treatment and recovery support services, housing and other support services; Goal 2: Reduce the number of new HIV/HCV infections. Objective 2-1: Conduct 120 HIV/AIDS testing to those who screen at risk and provide case management services, including linkage and provision of HIV care and treatment to 100% of those who test positive. Objectives 2-2: Conduct 120 targeted Hepatitis testing and provide referral/linkage for treatment and vaccinations as appropriate; Goal 3: Improve the health outcomes. Objective 3-1: Provide case management to 100 racial and ethnic minority individuals with SUD and/or COD treatment needs who are HIV positive or at high risk for HIV, Objectives 3-2: provide 50 individuals of the target population with unmet SUD and/or COD treatment needs, with EBP individual and group SUD and or COD sessions; Goal 4: Reduce HIV/HCV related disparities. Objective 4-1: Screen 200 unduplicated members of the target population for SUD and/or COD treatment needs annually, Objective 4-2: Screen 200 unduplicated members of the target population for HIV risk and incidence needs annually, Objectives 4-3 : Provide 80 behavioral health assessments annually.

Borinquen Medical Centers of Miami-Dade, Inc. (BMC), a federally qualified health center in Miami-Dade County, Florida, proposes to enhance the capacity of its award-winning TCE-HIV program (known as STOPP-E) to provide outreach substance use disorder (SUD) and co-occurring disorder (COD) treatment and services to high-risk minority (African American and Hispanic) YMSM, MSM, homeless, and/or LGTBQ individuals. Through this project, high-risk substance users who are HIV positive and/or Hepatitis B or C positive will be immediately linked to care at BMC and will be offered integrated health services. All clients enrolled in this project, going forward referred to as STOPP-Y, will receive culturally competent, integrated behavioral health and medical healthcare and services via BMC’s indigenous staff. Those services include: outreach, outpatient SUD and/or COD treatment services; referral and linkage to residential SUD treatment facilities; access and linkage to BMC psychiatric services, specialty medical services, Ryan White or PAC Waiver case management, and additional community support services, such as housing and employment assistance, with collaboration from our community partners. The goals and objectives of the project over the five-year period are to: 1) increase the number of high-risk YMSM, MSM, homeless, and/or LGBTQ individuals in Miami-Dade County who know their HIV/Hepatitis status; 2) increase the number of people living with HIV and/or Hepatitis B or C from the target population who are not in care and who receive specialty medical care and other supportive services; 3) increase the number of high-risk, minority YMSM, MSM, homeless and/or LGBTQ individuals with a SUD and/or COD who receive substance use treatment and mental health services; and 4) reduce behaviors that put high-risk minority YMSM, MSM, homeless and/or LGBTQ individuals at risk for HIV and/or Hepatitis B or C infection. BMC proposes to achieve these goals by enhancing its current SUD and COD services by adding additional evidenced-based practices (EBPs) to its existing program, ones shown to be successful when working with the YMSM and MSM populations, such as the Matrix Model, and ones that focus on reducing trauma, such as Trauma-Incident Reduction and Rapid Resolution Therapy, BMC’s also proposes to achieve these goals by increasing the level of integration between BMC’s behavioral health, medical specialty care, and Ryan White services; and by enhancing its collaborations and current partnerships while also seeking out new partnerships that will provide additional support services to our target population.

Special Health Resources for Texas (SHRT) proposes to implement Project STROW (Supporting Treatment & Recovery from Opioid Withdrawals) with a primary target population of minority young men who have sex with men (YMSM), who have been diagnosed with a substance use/abuse disorder (SUD) or co-occurring substance use and mental health disorder (COD). Project STROW’s secondary target population includes MSMs 30 years or older, other LGBTQ individuals, and heterosexual individuals at-risk of infection, who have been diagnosed SUD/COD and are at-risk for homelessness. Project STROW will expanding existing treatment capacity by increasing the number of individuals receiving treatment by 65 yr. one, 100 yrs. 2-4, and 65 yr 5 for a total of 430 individuals served in addition to the current census of 60 per year. The project will also enhance services by adding SOAR-based case management, centering all services around a trauma-informed model, and coordinating of SUD/COD/MAT treatment and medical treatment. SHRT will further enhance services by extending its license to include its mobile health clinic. SHRT’s experience with the YMSM population spans for over 20 years ago. To fulfill the purpose of the grant SHRT will assign/hire experienced and competent staff that includes a Project Director, Project Coordinator, two Licensed Chemical Dependency Counselors, one Licensed Professional Counselor, two SOAR case managers, and an external evaluator. The measurable goals and objectives in line with the FOA and the National HIV/AIDS Strategy are 1) to expand current substance abuse treatment services by increasing census capacity, prioritizing minority YMSM and MSM, other LGBT, and heterosexual individuals who are HIV+ or at-risk for infection and have a SUD or COD diagnosis; 2) to enhance current intensive outpatient substance abuse treatment by integrating SOAR case management/care coordination, adopt a trauma-informed model, and offering detox, residential treatment, and MAT services to a total number of clients of 430 by the end of the 5-year funding-period; and 3) to evaluate and measure project accountability and impact. Direct service implementation will begin on the fourth month of funding. Services will include recruitment, screening for COD, HIV testing, Hepatitis testing and vaccinations, and intense case management. Project STROW will utilize community partners Homeward Bound for detox and residential services and The Methadone Clinic of East Texas providing Methadone MAT services. Project STROW plans to enroll 430 clients for the life of the program (65 year one, 100 years two through four, and 65 year five). Direct substance abuse treatment target goals are: 10 detox services, 35 residential, and approximately 25 MAT, contingent of funds utilized. The selected EBP, recommended by SAMHSA or CDC are: Seeking Safety, Cognitive Behavioral Therapy, Foundations of HIV Counseling and Testing, and Personalized Cognitive Counseling. A comprehensive Evaluation Plan will be adopted by Project STROW which includes clear performance and outcome measures and data management procedures to ensure expeditious and reliable collection, processing, analyses, and reporting of program data.

The UT HIV Education, Awareness, Referral and Treatment for Substance Use Disorders (UT-HEARTS) Program will provide integrated substance use disorders (SUD) treatment and HIV/AIDS prevention services for ethnic minority individuals who are at risk for or affected by HIV/AIDS. The project is a collaborative effort among the Center for Neurobehavioral Research on Addiction at the University of Texas Health Science Center at Houston (UTHealth), Change Happens, the Association for the Advancement of Mexican Americans (AAMA), Legacy Community Health and the Harris County Psychiatric Center (HCPC). Specifically, UT-HEARTS will provide culturally consistent, inclusive and trauma-informed HIV/STD and substance abuse prevention and treatment. The overarching goal of the program will be to reduce substance abuse and the transmission of HIV/AIDS and other sexually transmitted diseases among ethnic minority individuals in the Houston area. Activities in the program will be aligned with SAMHSA's overall purpose of increasing engagement in care for racial and ethnic minority individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for HIV or are HIV positive. The goals of the program are to: Goal 1: Increase the availability of SUD treatment for ethnic minority substance using individuals or individuals with COD who are at high risk for HIV Goal 2: Decrease the incidence and level of substance use among ethnic minority individuals at risk for HIV/AIDS Goal 3: Decrease the risk of new HIV/HCV infections among substance using ethnic minority individuals Goal 4: Increase the number of ethnic minority individuals who are aware of their HIV/HCV status Goal 5: Increase knowledge about the cause, transmission, progression and prevention of HIV/HCV and other STDs among clients Goal 6: Link HIV and HCV positive individuals to care and prevention services.

The MATCH (Minority Addiction Treatment Co-Location with HIV Services) initiative represents and innovative model of integrated and comprehensive care that will deploy evidence-based practices and adapt them to enhance existing services, primarily for high risk ethnic/racial minorities with or at risk for or living with HIV (PARLWH). Project MATCH will enhance and expand HIV prevention and treatment services for the target population of high risk people of color from the young MSM and PWID communities. We will expand our activities by integrating services provided from a mobile medical clinic (MMC) operated by the Yale AIDS Program (YAP) with AIDS Project New Haven (APNH), Connecticut's oldest and AIDS Service Organization (ASO), with long standing roots in the community to deliver 4 evidence-based interventions: 1) SBIRT for co-occurring disorders (COD); 2) PrEP for high risk people of color; 3) medication-assisted therapies to treat alcohol and opioid use disorders; and 4) MPowerment risk-behavior reduction for young MSM of color. This strategy overcomes traditional ""brick and mortar"" challenges to integration and co-location of services through provision using a MMC with documented effective treatment and prevention for HIV, HCV, addiction and mental illness. Moreover, MATCH will co-located and integrate these services for an especially vulnerable population - young MSM and PWID. For PWID we will provide needle and syringe exchange services and community outreach through the MMC. Young MSM will be recruited and followed through an ASO using social media, community outreach and the mPowerment intervention. The MATCH program will overcome health disparities associated with criminal justice-involved (i.e., transitions from jail or prison, probation, parole) PARLWH with alcohol and opioid use disorders, mental illness (e.g., depression), and high risk behaviors. Thus, PARLWH will be fully engaged and retained in quality medical care, mental health and addiction treatment using integrated HIV prevention and treatment interventions. Evidence-based practices will include modified Screening, Brief Intervention and Referral to Treatment (SBIRT) for 100 high risk minorities annually (400 clients over 4 years) from the YMSM (N=200) and PWID (N=200). Additional evidence-based practices to be used include provision of medication-assisted therapies (MAT), like buprenorphine, methadone or extended-release naltrexone, for treatment of opioid or alcohol use disorders that is linked to mental health services provided on a MMC; antidepressant treatment for mental illness; and PrEP for HIV people at-risk for HIV. All HIV and HCV clients will be treated onsite through colocation of services and needle/syringe program (NSP) services will be provided by the MMC. The mPowerment EBP will be implemented by APNH to engage young MSM of color in use of a social media to reduce high-risk behaviors and link them to screening and treatment for CODs and PrEP. MATCH synergizes the strengths and enhances systems-building and service delivery by the collective experiences learned previously by the YAP and APNH in creating comprehensive and novel targeted interventions for PARLWH, especially young high risk people of color.

The Tennessee HIV/AIDS, Related Substance Use Disorders, and Mental Disorders Services Program, a joint venture between The University of Tennessee College of Social Work and the Helen Ross McNabb Center, a Regional Behavioral Health System, expands and enhances culturally competent services in minority (predominately African-American) and Hispanics/Latinos communities for persons with great risk for HIV/AIDS and having mental health needs, and to others linked to the clients’ Individual Treatment Plan (ITP), e.g., parents, partners, and dependents. The program addresses the epidemic of minority persons who: a) are HIV positive and have a DSM diagnosis, or b) are HIV positive and have mental health problems that do not reach the criteria for DSM diagnosis; and parents, partners, dependents, and others linked to the client’s Individual Treatment Plan (ITP). The program is intended to alleviate significant unmet needs of this population based on the data to indicate the small percentage of clients with HIV/AIDS currently receiving mental health services (12.5%), and of those 12.5%, the very few (1.47%) who receive additional substance abuse services. These clients will receive direct services that consist of outreach, decision to pursue treatment, case management, mental health and substance abuse screening and HIV/VH assessment, mental health and substance abuse treatment, and aftercare. This proposed project seeks to expand and enhance the intensive outpatient services of the Regional Behavioral Health System in East Tennessee to provide a specialized continuum of care to the target population, i.e. outreach, pre-treatment, and mental health treatment services and in-patient and outpatient substance abuse treatment (ASAM Levels I and II.1). We further seek to improve the infrastructure to support service delivery expansion through:  Building partnerships to ensure the success of the project and entering into service delivery and other agreements.  Developing or changing the infrastructure to expand treatment or prevention services.  Training to assist treatment or prevention providers and community support systems to identify and address mental health or substance abuse issues, HIV and Hepatitis care, and screenings for viral hepatitis.  Increase services for black young men who have sex with men (YMSM) (ages 18-29), and other high-risk populations such as Latino YMSM and men who have sex with men (MSM) (ages 30 years and older), and gay, bisexual, and transgender individuals who have a SUD and/or COD who are HIV positive or at risk for HIV/AIDS. One-hundred individuals will be served each year for outreach, 80 for case management and 60 for treatment services (in conjunction with their parents, partners, dependents). Staff from the College of Social Work Behavioral Health Services Research Center will conduct the project evaluation. The College of Social Work will be responsible for collecting the GPRA data and for disseminating evaluation findings. The affiliated agencies of the Helen Ross McNabb Center (HRMC) Regional Mental Health System, Incorporated, will serve as the sites for the provision of services.

The goal of the United Community Center (UCC) Paso Doble (PD) project is to increase engagement in care, in Milwaukee, Wisconsin, for 400 (80 annually) racial and ethnic minority individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for or living with HIV. UCC will prioritize services for 1) Hispanics; 2) men who have sex with men (MSM) 3) and people who inject drugs (PWID). PD will address a major service gap in Milwaukee by building a SUD treatment capacity for Hispanic MSM. UCC will provide SUD/COD treatment, HIV rapid testing, and HIV prevention while project partner Sixteenth Street Community Health Centers (SSCHC), a Federally Qualified Health Center (FQHC), Ryan White Title 2 & 3 HIV provider, and State of Wisconsin Designated HIV Counseling, Testing and Referral Site, will offer HIV confirmatory testing, Viral Hepatitis (VH) risk screening, linkage to HIV and VH care, antiretroviral therapy (ART), and referral for VH (B & C) treatment. Services will be delivered within the context of UCC’s “one-stop-shopping” multi-program community center serving Milwaukee’s Hispanic community. PD will employ the following evidence-based practices: 1 To address the needs of the PD PoF, UCC will deliver services within a framework of culturally competent, gender-responsive, SUD/COD treatment for racial ethnic minority (prioritizing Hispanic) men and women at high risk for or living with HIV. Within that framework, UCC will utilize two central EBPs: 1) the Matrix Model, a framework that integrates aspects of several treatment approaches, and 2) Seeking Safety, a model that considers the context of historical trauma within which a large proportion of both men and women who develop SUD/COD. These two practices, which represent the service enhancement to be facilitated by the TCE-HIV grant, will be supported by a menu of current UCC services that include an array of other EBPs such as Motivational Interviewing Dialectical Behavioral Therapy, the Trauma Recovery and Empowerment Model (TREM); Helping Men/Women Recover; and the Nurturing Program for Families in SUD Treatment. Clients will be provided with 16 different types of services (by UCC and community partners; by grant and other funding sources): outreach, case management, SUD/COD treatment, HIV risk-reduction, HIV case management and treatment, primary health care, peer support, job readiness/ training, education, health education, child care, children’s services, fatherhood education, family preservation/reunification, parenting assistance/education, fitness, domestic violence services, and transportation. Project goals and measurable objectives are consistent with the expected SAMHSA outcomes outlined in the FOA. The goals are 1) Increase engagement in care for racial and ethnic minority individuals who have SUD and/or COD who are at risk for HIV or are HIV positive and need or are receiving HIV services/treatment.; 2) Develop capacity to provide culturally competent Hispanic-specific SUD/COD for MSM; 3) Participants will be retained in SUD/COD treatment; 4) Decrease participants’ use and/or abuse of alcohol and illicit drugs; 5) Improve participants' mental health; 6) Participants in SUD/COD will receive HIV prevention services.; 7) Provide HIV testing to individuals with SUD/COD; 8) Link participants to HIV medical care; 9) Retain participants in HIV medical care; 10) Participants diagnosed with HIV will receive and adhere to antiretroviral therapy; 11) Participants diagnosed with HIV will be linked to housing, and 12) Screen, test, and refer participants to care for hepatitis in accord with CDC/USPSTF guidelines.

Friendship House Association of American Indians, Inc. (Friendship House) TCE-HIV: High Risk Populations Grant will enhance existing residential substance abuse treatment program for American Indian and Alaska Native (AI/AN) adults with substance abuse disorders, with risk for HIV, Hepatitis B/C, and mental health disorders. The overarching goal of the project is to meaningfully impact the lives of AI/AN people in substance abuse recovery by decreasing substance use disorder, improving co-occurring mental health outcomes, decreasing HIV & Hepatitis B/C risk through education of safer sex and the impacts of violence and trauma, strong case management support and linkages to appropriate screening, vaccination, and health care related to individualized needs. Services will be provided to 250 people per year and 1250 unduplicated clients over the 5-year grant project. Selection of the target population is based on: 1) the trends of the HIV and Hepatitis B/C epidemic in the AI/AN population; 2) the unmet need for supplemental mental health services; and 3) alignment with the service population and mission of the Friendship House. Clients will receive proven culturally-based, substance abuse treatment services with integrated management of co-occurring mental health, as well as HIV and Hepatitis care needs. Friendship House employs the Friendship House Traditional Treatment and Healing Model, a culturally-focused approach that has demonstrated effectiveness with the population of focus. Traditional American Indian healing methods such as drumming, sweat lodge ceremonies, talking circles, traditional healer ceremonies and singing are integral to the Friendship House model. Enhanced services from TCE funding will support inclusion of HIV/Hepatitis Rapid Testing for all clients. Client-facing staff will receive training on HIV, Hepatitis, violence and trauma-informed care. In addition, clients will benefit from improved sexual health and safer sex health education services that address the impact of Hepatitis B and C, and sexually transmitted infections (STIs). Measurable objectives will track success for project goals including increases in the number of clients tested, diagnosed, and linked to HIV and Hepatitis care within 30 days, and receiving quality HIV and Hepatitis care. All clients will create an individually tailored relapse prevention plan, and receive career counseling, job interview skills, and job and housing placement support. Expected program outcomes include reduced substance use and relapse, decreases in new HIV infections, decreases in Hepatitis and STI risk, decreases in unprotected sex, decreases in trauma risk and intimate partner violence, and increases in HIV/Hepatitis care outcomes, employment and life skills. Funding will also support the strengthening of linkages between Friendship House and local service providers and agencies to improve case management and outcomes for clients and leave a lasting impact on the agency and AI/AN population it serves.

Project Title: Healthy, Safe and Sober (HSS) In a targeted effort to improve health-related outcomes for racial and ethnic minorities, Gateway Community Services, Inc. is joining together with Florida Department of Health, APEL Health Services, and JASMYN, to develop a system of care for young (18-29) minority MSM and transgender women. According to combined data from 2010, NSDUH, 25% of PLWHA engaged in binge drinking in the past month, and nearly 33% used illegal drugs in the past month. IV drug use and needle sharing are responsible for about 10% of HIV cases annually, and one in six people with HIV/AIDS have used an illegal drug intravenously in their lifetime. HIV cases documented among men in the Jacksonville TGA, in 2010, regardless of AIDS status, indicated that MSMs accounted for 65.6% of the epidemic. Where African Americans represent 22% of the TGA, they represent 62% of the PLWA and 67.92% of those who are HIV positive. BMSM represent 51% of the PLWHA in the TGA. This project plans to develop a well-coordinated system of care for substance abuse treatment and HIV prevention for Young Men of Color who have Sex with Men (YMCSM) and transgender women who are high risk for, or living with HIV; expand culturally competent practices for YMCSM throughout all services; provide targeted, data-driven outreach programs; expand capacity of substance use disorder (SUD) and mental health (MH) disorder treatment; increase testing for HIV in the YMCSM and transgender women populations; and increase early identification and referral for viral hepatitis. Evidence-based services will be employed and the project will utilize effective linkages for care with other community service providers. It is expected that through these services that an average of 80 YMCSM will be served annually (400 over five years) with the following impact: Reduced HIV transmission; Increased number of people receiving treatment for substance use and/or co-occurring substance use and mental disorders; Increased number of people who, post-treatment, receive recovery support services; Increased number of people who know their HIV status; Increased number of HIV positive people who are case-managed and referred to primary HIV care for antiretroviral therapy (ART) and other services necessary for optimizing health outcomes; Increased number of people screened for viral hepatitis; Increased number of people who know their hepatitis status and ; Increased number of people positive for viral hepatitis who are referred to primary care.

Trauma Informed Assertive Case Management and Motivational Interviewing for MSM and Transgender Persons of Color with SUD and COD: A Program Expansion will increase engagement in care for 360 men who have sex with men (MSM) and transgender persons of color, aged 18 and older, who have a primary substance use disorder (SUD) and a co-occurring mental disorder (COD) and who are HIV positive or at risk for HIV/AIDS. The population of focus is disproportionately impacted by HIV/AIDS and experiences disparities in service, access, use and outcomes. This project will reduce current disparities by using active outreach to engage members of the population of focus and providing a combination of evidence-based interventions targeted to each client's needs. Three evidence-based practices, known to be effective with the population of focus, will be used: Assertive Case Management, Motivational Interviewing, and Seeking Safety. Project goals are to (1) Reduce the impact of SUD and COD, including trauma related conditions, (2) Increase access and engagement in appropriate healthcare services to reduce risk and incidence of HIV and viral hepatitis, and (3) maintain high levels of client satisfaction with services. Multiple performance indicators will be measured via participant report, project staff report, and clinical and administrative records to evaluate progress towards project goals. The project will serve 360 participants over the five-year funding period (60 in Year 01, 80 in Year 02, 80 in Year 03, 80 in Year 04, and 60 in Year 05). The majority of clients are expected to be male and Latino or African American. The UCSF Alliance Health Project (AHP) has over 30 years of experience serving the population of focus and providing comprehensive case management services to complex, underserved populations. AHP has a highly qualified, diverse staff that shares the cultural identities and values of the population of focus. AHP will collaborate with ten partner agencies that are also committed to serving the population of focus to recruit eligible participants and to insure that participants have the full range of needed SUD, COD, HIV, and hepatitis services.

The purpose of this project is to increase engagement in care for racial and ethnic minorities with substance use disorders (SUD) and/or co-occurring substance abuse and mental health disorders (COD) who are at risk for HIV or who are HIV positive and on ART and linked to HIV care. CCA will accomplish this by providing culturally competent, comprehensive community-based services and supports, including a seamless integration of HIV prevention, education and testing; mental health services; and recovery services.

The purpose of Spectrum is to provide HIV prevention and education services (including HIV and Hepatitis testing and counseling) and to expand and enhance substance use and co-occurring disorder screening, referral to treatment, and outreach and pretreatment services for 400 LGBTQ+ identified youth and young adults (primarily ages 13-24) from elevated-risk multi-ethnic communities, primarily, Latino, African American and Native American. through an existing collaborative effort among the University of Arizona Southwest Institute for Research on Women (SIROW), the Southern Arizona AIDS Foundation (SAAF), and Devereux Advanced Behavioral Health (Devereux). The primary target population includes youth who might not be identified as having substance abuse and related behavioral health problems or receive needed interventions in culturally responsive ways. SAMHSA funds will enhance and expand the continuum of services for participants. All 400 participants will receive the either the SIROW Health Education for Youth (SIROW HEY) curriculum or the SIROW Sexual Health Education-Queer (SIROW SHE-Q), facilitated by staff from the SAAF, Devereux and UA SIROW. All youth will receive a GPRA and a GAIN-Short Screener assessment and those identified as having treatment needs will be referred to treatment and supported using Motivational Interviewing (MI) techniques. Over the life of the grant, 96 of the 400 participants will engage in assessment, substance abuse and co-occurring treatment, and continuing care services at Devereux. All 400 participants will be offered HIV testing and 320 (80%) will have HIV testing and counseling from SAAF staff. 175 high-risk, HIV-negative participants will be enrolled in HIV Prevention Navigation Services. Devereux’s intensive outpatient substance abuse and mental health co-occurring treatment is culturally-responsive, LGBTQ+ affirming and utilizes Trauma Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavioral Therapy (DBT) for participants and their families. Aftercare consists of 8-12 weeks of Continuing Care Groups, ongoing individual and family therapy, and one-year of case management services. The three primary components of the evidenced-based SIROW-HEY and SIROW SHE-Q include: 1) age appropriate, interactive, culturally-responsive, LGBTQ+ affirming HIV prevention education curriculum that focuses on reproductive sexual anatomy, HIV transmission and prevention, and healthy relationship/ communicating skills, 2) HIV Rapid HIV counseling and testing provision, and 3) assertive referrals to Ryan White care services for HIV positive youth and passive referrals to other needed community services (STI testing; pregnancy testing; educational/vocational services). The curriculum will be delivered in a group format at ADA-compliant facilities including the Spectrum project space, SAAF youth spaces, Devereux treatment sites and schools.

WestCare California, Inc. (WC-CA) is proposing the (Behavioral, Educational And Treatment) BEAT HIV/AIDS program. BEAT HIV/AIDS will place an emphasis on minority young men who have sex with men (YMSM), and transgender individuals who have a Substance Use Disorder (SUD) or a Co-Occurring Disorder (COD) and are HIV positive or at risk for HIV/AIDS and viral hepatitis. The program also will serve other high-risk adults such as men who have sex with men (MSM), lesbian, gay, and bisexual individuals. The program will be intensive residential treatment for substance abuse and identification and treatment of co-occurring mental health disorders followed by quality outpatient aftercare. WC-CA’s substance abuse programming will serve 60 clients annually or 300 in five years and enhance services by including a sober living environment during the outpatient services. GOAL 1: Expand access to services and increase engagement into care to reduce substance misuse/mental health symptoms. Objective 1.1 Provide evidenced based substance use treatment services to 60 YMSM, MSM, LGBT community and transgender individuals. (300/5 yrs). Objective 1.2: At least 80% of clients who complete treatment will remain alcohol and drug free and 70% of those will remain alcohol and drug free at 6-months post admission. Objective 1.3: At least 80% of those clients who complete treatment will exhibit decreased mental health symptoms at discharge and 70% of those will maintain the improvements or show additional decreases at 6-months post admission. Objective 1.4: Provide Seeking Safety to at least 90% of all program clients experiencing trauma. Objective 1.5: At least 70% of clients who complete the Seeking Safety intervention will report a reduction of trauma symptoms at discharge. Objective 1.6: 80% of clients who complete the program without stable living arrangements at admission will have stable housing at discharge. GOAL 2: Contribute to the overall achievement of the 90-90-90 goals and reduce the spread of substance related HIV infections. Objective 2.1: Provide HIV Counseling and Testing to at least 60 YMSM and transgender individuals annually and refer 100% of individuals with a reactive HIV test for confirmatory testing. Objective 2.2: 100% of those screened positive for HIV will receive a linkage for care Objective 2.3: 90% of those screened positive for HIV and engaged in care will achieve reduced substance use. Objective 2.4: 90% of those screened positive for HIV and engaged in care will achieve HIV viral suppression. Objective 2.5: Enroll at least 80% of clients identified as living with HIV or at high risk for HIV into CLEAR. Objective 2.6: At least 80% of high-risk persons who complete CLEAR will exhibit no change in their HIV status between time of initial HIV test and at 6-months post admission. 3: Contribute to the achievement of the National Hepatitis Action Plan by improving the lives of those living with VH and reducing VH disparities. Objective 3.1: Provide VH testing to at least 60 YMSM and transgender individuals annually.

The Bronx-Lebanon Hospital Center TCE-HIV project will serve Hispanic and African American adults diagnosed with a substance use disorder/co-occurring disorder (focusing on LGBT clients) at risk of contracting HIV/who are HIV positive. Staff will screen, test, counsel, link to services, provide case management, and will implement five evidence-based practices. An estimated 2,000 patients (500, year 1 and 375, years 2-5) will be served over the five-year period. The project staff will provide: Outreach; substance use disorder (SUD)/co-occurring disorder (COD) screening; HIV screening, testing, and counseling; Linkage to HIV treatment; HIV case management; Viral hepatitis testing; and Linkage to hepatitis treatment. Both an HIV and hepatitis C specialist will provide consultation and consolidate treatment of hepatitis and HIV with outpatient SUD treatment. Five evidence-based practices (Seeking Safety, Wellness Self-Management Plus, SBIRT, Motivational Interviewing, and Motivational Interview-Based Risk Reduction) will be implemented to address disparities in service access, use, and outcomes. Rachel Schoolcraft, MD, Medical Director, Life Recovery Center, Associate Director, Division of Addiction Psychiatry, will serve as the Project Director. An Evaluation Consultant will direct the performance measurement and assessment, evaluation, and will support reporting. The project will accomplish the following: Goal 1: Increase the clinicians’ skill level and competency in serving clients with a SUD/COD that are at risk for or have contracted another comorbid condition, including hepatitis and HIV/AIDS. (Objectives: Prescribe medications to treat 60% of patients with HIV/AIDS; Treat 60% of patients with hepatitis C; Train at least 80% of staff in 2 or more evidence-based practices). Goal 2: Improve the health of and reduce the prevalence of behaviors among clients with SUD that increase their risk of contracting or spreading HIV/AIDS. (Objectives: 100% of clients will be screened for SUD and HIV; 100% of those screened HIV+ will receive a warm handoff to HIV treatment; 90% of those screened HIV+ will be linked to care; 90% of those linked to care will achieve reduced substance use and HIV viral suppression; 90% of HIV+ clients will be linked to housing services; 90% of clients who screen negative (HIV/hepatitis) will be engaged in SUD treatment and linked to HIV and hepatitis risk-reduction education; Increase by 50% HIV+ clients that practice safe sex; Increase by 50% HIV+ clients receiving antiretroviral therapy; Increase by 50% clients diagnosed with hepatitis C completing treatment; Increase by 50% clients remaining abstinent from alcohol and drugs, or that have decreased their consumption). Goal 3: Meet all grant requirements for data collection, evaluation, and reporting by SAMHSA deadlines. (Objectives: 100% of clients will receive an intake GPRA interview; At least 80% will receive a 6-month post-intake GPRA interview; Conduct required reporting and the annual performance assessment).

The Village HART (Healthy Alternatives Require Transitions) program will improve disparities in access, service use, and outcomes by incorporating a social systems model for addressing structural barriers associated with YMSM and healthcare utilization. The HART Program will use the CRA/ACC models for substance use disorder and co-occurring disorder treatment. Services will be provided to 60 clients in-home (300 in 5 years) and will include CLEAR, an evidence-based HIV prevention intervention. GOAL 1: Expand access to services and increase engagement into care to reduce substance misuse/mental health symptoms among racial and ethnic minority YMSM living in Miami-Dade County who have a substance use or co-occurring disorder and are living with or at risk of HIV/AIDS or VH. Objective 1.1 Provide evidenced based substance use treatment services, using CRA/ACC, to 60 YMSM (18-29 years) annually (300 YMSM across the life of the grant). Objective 1.2: At least 80% of clients who complete treatment will remain alcohol and drug free during the 30 days prior to discharge and 70% of those will remain alcohol and drug free at 6-months post admission. Objective 1.3: At least 80% of those clients who complete treatment will exhibit decreased mental health symptoms at discharge and 70% of those will maintain the improvements. Objective 1.4: Provide Seeking Safety to at least 90% of all program clients. GOAL 2: Contribute to the overall achievement of the 90-90-90 goals and reduce the spread of substance related HIV infections among racial and ethnic minority YMSM (18-29 years) living in Miami-Dade County. Objective 2.1: Provide HIV Counseling and Testing to at least 60 YMSM annually and refer 100% of individuals with a reactive HIV test for confirmatory testing. Objective 2.2: 100% of those screened positive for HIV will receive a linkage for care and HIV treatment, and 90% of those will be engaged in care Objective 2.3: 90% of those screened positive for HIV and engaged in care will achieve reduced substance use. Objective 2.4: 90% of those screened positive for HIV and engaged in care will achieve HIV viral suppression. Objective 2.5: Enroll at least 80% of clients identified as living with HIV or at high risk for HIV into CLEAR. Objective 2.6: At least 80% of high-risk persons who complete CLEAR will exhibit no change in their HIV status between time of initial HIV test and at 6-months post admission. Objective 2.7: At least 60% of persons completing CLEAR will report a reduction in unprotected sex and decreased number of sexual partners. GOAL 3: Contribute to the achievement of the National Hepatitis Action Plan by improving the lives of those living with VH and reducing VH disparities among racial and ethnic minority YMSM (18-29 years) living in Miami-Dade County who have a substance use or co-occurring disorder and are living with or at risk for VH. Objective 3.1: Provide VH testing to at least 60 YMSM annually and report 100% of positive VH results to the Health Department. Objective 3.2: 100% of those screened positive for VH will receive a linkage for care and VH treatment.

The Long Island Association for AIDS Care, Inc. (LIAAC), with 30+ years of experience in the HIV/AIDS and substance abuse prevention/treatment field, is requesting funding through SAMHSA/CSAT Targeted Capacity Expansion-HIV Program: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (FOA TI-17-011). Our proposed program-Project Safety Net-is an innovative field-based model that combines outreach, HIV/HCV/STI testing and Evidence Based interventions (Think Twice, Motivational Interviewing) with recovery support services (i.e. case management, linkage to care) and social marketing campaigns. Seafield Center is the leading provider of substance use treatment across Long Island—and proposed partner on this project—with 30+ years of reaching and serving low-income and minority individuals. This new initiative intends to increase engagement in care for: male and female racial/ethnic minorities’ individuals living with or at risk for HIV/AIDS, ages 18 and older. LIAAC has designed this proposed program to address the behavioral health needs of YMSM (18-29), MSM (30 and older), Transgender individuals and returning veterans and their families. Project Safety Net supports the 2020 National HIV/AIDS Strategy and will be focusing on reducing new HIV infections, improving health outcomes, and reducing related health care disparities. Our population of focus will live or congregate in the Metropolitan Statistical Area of Long Island, New York, and live/congregate in primarily Black and Hispanic high-risk communities that are disproportionately burdened with the co-occurring epidemics of poverty, substance abuse, mental health disorders, HIV/AIDS and Hepatitis (HBV and HCV). Individuals who are eligible for this program will identify as members of the above population of focus, reside in our targeted communities and have SUD as their primary diagnosis. Project Safety Net’s Objectives are as follows: • Outreach to 1,500/year individuals (1,125 in year one, 7,125 project); • 400/year unduplicated clients will receive program services (300 year one, 1,900 project); • 200/year rapid HIV tests (150 year one, 950 project); • 150/year individuals will receive rapid HCV tests (113 year one, 713 project); • 150/year individuals will receive STI screenings (Syphilis, Gonorrhea, and Chlamydia) (113 year one, 713 project); • 100/year individuals/year will complete a GPRA survey (75 year one, 475 project); • 100/year clients will receive SAMISS screenings (75 year one, 475 project); • 100/year clients will be enrolled into Linkage to Care program (75 year one, 475 project); • 60/year clients will be enrolled into Case Management (45 in year one, 285 project); • 10/year clients will be enrolled into Think Twice EBI (7 year one, 47 project); • 100/year clients will be linked to HBV testing (75 year one, 475 project); • 100/year clients will be linked to HAV/HBV vaccination (75 year one, 475 project)

Substance use is associated with negative health outcomes including greater HIV risk behavior and poorer health outcomes among individuals living with and at high risk for HIV. Community Resources for Empowerment and Wellness (CREW) will provide a continuum of substance use screening, education and treatment services and wellness promotion for individuals living with HIV and minority MSM and transgender women regardless of HIV status. These services include community outreach, individual and group education and mental health/substance abuse screening and treatment, care management and HIV/HCV testing. The program will be situated in Charlotte NC, a southern metropolitan area that is highly affected by HIV. The primary aim of the proposed project is to enhance and expand the comprehensive substance use services provided for HIV-positive individuals in the SAMHSA funded CADRE program (TI-024350). Specifically, services will be enhanced by adding the use of technology, including making available group and individual education and counseling by video conferencing, text and phone interfaces, and developing a supplementary social media treatment companion site, in addition to in-person services to improve treatment engagement. The program will be expanded to increase capacity to identify minority MSM and transgender individuals in need of services and to provide culturally competent services in a structure that best suits their needs. The capacity for expanded focus on the minority MSM and transgender populations was developed through infrastructure building in the current CADRE grant, which piloted programs specifically for minority MSM and transgender women. Services to these populations will include outreach services, offering HIV/HCV testing and education in social clubs, more formalized partnerships with organizations working with transgender women and minority MSM, transgender and MSM specific groups offering the evidence based treatment “Seeking Safety” provided in convenient settings, and case management services to assist with linkage to medical care and other needed services. We expect to provide services for 40 transgender women (over 5 times the number included in the pilot) and increase the percentage of clients who are minority MSM by 40%. Our secondary aims are to: 1) increase the infrastructure of the targeted communities to provide a seamless continuum of substance use and HIV/hepatitis and other medical care for individuals living with HIV and minority MSM and transgender women through education and formal community collaboration 2) increase the ability of the program and community infrastructure to provide services for Latino MSM and transgender women 3) determine the effect of the program services on outcomes for the HIV-positive participants including substance use, mental health, HIV treatment adherence, and use of HIV services and 4) determine the effect of the comprehensive outreach and services on outcomes for transgender women and MSM, regardless of HIV status, including substance use, mental health, knowledge of HIV/hepatitis status and services use. The target population for this project is minority individuals, primarily African Americans, with or at high-risk for HIV with a particular focus on minority MSM and transgender individuals. We will serve 210 individuals (30 in Yr 1) and provide 215 HIV/HCV tests. We will provide 6 months of comprehensive services including: 1) individual and group substance use screening, education, and treatment using evidence-based models including Motivational Interviewing, Seeking Safety, and Cognitive Behavior Therapy 2) Case management and peer navigation 3) linkage to services such as HIV case management, psychiatric care, HIV/hepatitis medical care and 4) HIV/HCV testing. The program is expected to address the negative effects of substance use on health outcomes and HIV risk behavior.

Provision of Treatment for Substance Use Disorders and Mental Health Disorders in Mississippi to Reduce Transmission and Improve Clinical Outcomes in People Living with HIV. The Helping to Advance in New Directions (Helping HAND) program will provide screening for and treatment of substance use disorders (SUD) and co-occurring mental health disorders (COD) in people living with HIV (PLWH) in Mississippi. We aim to serve 228 PLWH with SUD/COD treatment and case management in Jackson, and at clinics in the Delta and Southeastern MS through telemedicine. This state has the highest case fatality rate among PLWH in the country, and the Metropolitan Statistical Area (MSA) around Jackson has the highest incidence of new AIDS diagnoses. The Helping HAND program would take place within the Adult Special Care Clinic (ASCC), which provides care for about 2000 PLWH. There is a great need for SUD and COD treatment, which is estimated to affect more than 20% of the clinic population. Young black men who have sex with men (YBMSMs) have the highest rate of new HIV/AIDS diagnoses, and this project would target that group first, then other minority MSMs, and other minority PLWH. The clinic population is 36% female, 86% African American, and 40% uninsured. ASCC would begin routine use of substance abuse Screening, Brief Intervention, and Referral for Treatment (SBIRT), which has been used in training through another SAMHSA project since 2015, and patients identified as at high risk or dependent levels would receive evidence-based SUD treatment as well as screening and treatment for COD, while those at lower risk levels would receive a brief intervention to reduce risk. Helping HAND would provide the treatment in various settings, as well as case management for participants with focus on housing and social connectedness. Goal 1: 100% of ASCC patients will be screened for SUD, especially targeting those who are young black men who have sex with men (YBMSMs) and transgender individuals. Goal 2: 100% of those who screen positive for SUD will receive a brief motivational intervention at ASCC Goal 3: 50% of those screened high risk or dependent for SUD are expected to enroll in our Helping HAND program, estimated at 48 persons per year. Helping HAND will screen for COD, provide treatment for SUD/COD, and case management for housing and access to other services, especially for minority MSMs and transgender individuals. Goal 4: 80% of those who enroll in the Helping HAND program will be retained through six months post-intake. Discharge from the program will occur when clinical outcomes have been met according to self-report and lab values, and will be evaluated every six months. Goal 5: Linkage to HIV care, as shown by a medical visit within 3 months of diagnosis, and early engagement in care as seen by at least 1 visit in each 4-month block of the following 12 months after linkage, will increase to 90% in minority MSMs and transgender individuals from the current rate of 54%. In addition, retention in care, as seen by a visit in each 6-month block in the last 24 months, will increase from 66% to 90%. Goal 6: 90% of Helping HAND participants will have fully suppressed virus, as seen by viral loads under 200 at the last viral load test after at least 6 months’ enrollment in Helping HAND.