TI-17-011 Individual Grant Awards

Wyckoff Heights Medical Center (Wyckoff) proposes Positive Health IMPACT (Improving Access to Comprehensive Treatment), a community-based collaborative venture to expand and enhance Substance Use Disorder (SUD) and Co-occurring Substance Use and Mental Disorder (COD) services for racial and ethnic minority individuals at risk for or living with HIV and/or Hepatitis C in Brooklyn, New York. Population to be served: Based on local disparities in access, retention, and clinical outcomes, Wyckoff has selected Black and Hispanic Men who have Sex with Men (MSM), and Black and Hispanic Women, as its populations of focus. Positive Health IMPACT will reach 600 members of these populations per year. Strategies and interventions: Wyckoff will expand and enhance its existing integrated model of Behavioral Health care in Primary Care settings to better meet the needs of the proposed populations of focus. Strategies will include Motivational Interviewing and Trauma Informed Care. Interventions will include Screening, Brief Intervention, and Referral for Treatment (SBIRT); the Collaborative Care intervention for the treatment of depression and anxiety in primary care; the “Seeking Safety” intervention for survivors of trauma; Buprenorphine Treatment; Tailored HIV Prevention and Treatment services and interventions; and priority addiction treatment and addiction support services provided by five key community partners. Purpose, Goals and objectives: The purpose of Positive Health IMPACT (PHI) is to expand, enhance, and improve the system of care for racial and ethnic minority persons at risk for or living with HIV, Hepatitis C (HCV), and/or Behavioral Health conditions in Wyckoff’s service area. The PHI program aims to achieve five major long term goals for the populations of focus: 1) to reduce the incidence of HIV and Hepatitis C among those at risk; 2) to contribute to local achievement of the 90-90-90 goals for HIV linkage and treatment; 3) to improve behavioral health and trauma related outcomes; 4) to improve the system and quality of care for persons who are at risk for or living with HIV, HCV, SUD and COD; and 4) to reduce health system and local community stigma around HIV, HCV, LGBT populations, and behavioral health conditions.

ABSTRACT South Texas Substance Abuse Recovery Services (STSARS) is the largest state-funded provider in the Coastal Bend area of integrated Substance Use Disorder (SUD) Treatment, Medication Assisted Treatment (Methadone or MAT), Co-occurring Disorders (COD) Treatment and HIV/VH Prevention. These treatments are for youth, young adults and adults and include gender-specific programming. STSARS is currently administering a SAMHSA-funded HIV TCE which provides comprehensive services to predominately Latino adults with IVDU and other SUD/ COD and who are HIV+ or at high risk. SAMHSA funding for this project will end in September 2017. This project is entitled MEJOR. STSARS has collaborated with local grass-roots organizations and individuals to design this strategic proposal entitled HUMANITY Project based on lessons learned and local data trends. The proposed project supports the SAMHSA purpose in the related FOA with aims to contribute to the nation’s achievement of the 90-90-90 goals regarding HIV status and treatment. The purpose of this project is to increase 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 HIV positive. The proposed project aims to contribute to the nation’s achievement of the 90-90-90 goals regarding HIV status and treatment as evidenced in established goals and objectives. Project HUMANITY proposes to provide: linkage to care for racial and ethnic minority MSM/YMSM with SUD and/or COD treatment needs who are HIV positive or at high risk for HIV, including directly providing SUD and/or COD treatment and recovery support services; HIV/AIDS testing and case management services, including linkage and provision of HIV care and treatment; Hepatitis testing, vaccination, and referral/linkage for treatment and case management; housing support services; outreach; and enhancement and expansion of infrastructure and capacity to retain clients in SUD/COD and HIV/AIDS care. The expected outcomes for the project include increasing the number of population of focus with SUD/COD who are HIV positive that are on antiretroviral therapy (ART) and linked to HIV care, reducing the impact of behavioral health problems, reducing HIV risk and incidence through intervention and through Pre-Exposure Prophylaxis (PrEP), reducing trauma related conditions, and increasing access to and retention in treatment for MSM/YMSM with co-existing behavioral health, HIV, and hepatitis conditions. Project HUMANITY will ensure that individuals who have been diagnosed with a SUD and/or COD and who are HIV positive or most at risk for HIV/AIDS have access to and receive appropriate related services.

Project Summary – Hudson River HealthCare, Inc. (HRHCare), a NY State licensed, federally qualified health center, is seeking SAMHSA support to expand services in Suffolk County, NY to address the epidemic of opioid and other substance use disorders in the County. HRHCare will expand its medication assisted treatment program (MAT/buprenorphine), and increase the number of HIV positive and at risk persons with SUD/COD linked to HIV treatment & ART. Project Name: HRHCare TCE-HIV: High Risk Populations Populations to Be Served: [demographics and clinical characteristics] HRHCare’s initiative will focus on the high-risk populations in and around three (3) of HRHCare’s Genesis HIV treatment program service sites, located in the towns of Wyandanch, Brentwood and Patchogue in Suffolk County, Long Island, New York. HRHCare will target high risk populations, including the large numbers of African Americans and Hispanics/Latinos in these communities; gay, lesbian, bisexual and transgender (GLBT) youth (ages 13-26), as well as patients with substance use disorder (SUD) and/or co-occurring substance use and mental disorder (COD) who are at risk of HIV or who are HIV positive; patients diagnosed with STIs, Hep C and/or HIV; and patients and/or community members with opioid addiction. Strategies/Interventions – The strategies and interventions that HRHCare will implement to achieve its project goals will include: fully staffed, highly qualified Care Teams, expanded SUD/ MAT services, HIV & Hepatitis C screening, care & treatment, integrated BH/primary care, and robust case management at the identified Suffolk sites, supported by the following EBPs: o SBIRT – Systems-Level Implementation of Screening/Brief Intervention/Referral to Treatment o Motivational Interviewing o Medication Assisted Treatment (MAT)/Suboxone program for treatment of opioid addiction o Stanford Chronic Disease Self-Management Program (CDSMP) with HIV-specific Positive Self-Management Program (PSMP) o IMPACT model for depression care Project Goals / Measurable Objectives: To increase the number of racial and ethnic minority individuals with substance use disorder (SUD) or co-occurring substance use/ mental disorders (COD) who are HIV positive or at high risk for HIV who are linked to HIV care and treatment. HRHCare will achieve this by linking them to, and then retaining them in, comprehensive, integrated, culturally competent, linguistically appropriate care and treatment, including HIV/HCV/STD screening & testing at the 3 Health Centers, as well as onsite at partnering BH agencies; HIV primary care; Hepatitis C care and treatment; SUD/COD screening and assessment; linkage to SUD/OUD treatment services through HRHCare’s MAT program; and SUD/COD referral to partnering substance abuse & mental health providers, where appropriate. HRHCare anticipates serving 4,050 patients annually, with a 5-year project total of 20,250.

The proposed project seeks to improve the health outcomes of men who have sex with men (MSM) and young men who have sex with men (YMSM) and transgender individuals of color through comprehensive HIV prevention and intervention with integrated behavioral health services to deliver a seamless and culturally relevant system of care. The overarching goal of the project is to link the target population with Substance Use Disorder (SUD) and/or Co-Occurring Disorders (COD) treatment and recovery support services; HIV/AIDS testing and case management services (linkage and provision of HIV care and treatment); Hepatitis testing, vaccination, and referral/linkage for treatment and case management; housing support services; and outreach. Project participants will represent the 22,000 residents of New York City who already visit The Center annually and utilize its services, those who visit but remain disengaged from direct services, and individuals currently disconnected from any HIV-related programming. The project has the following major objectives: Reduce the negative impact of substance use and other behavioral health issues; Increase access and retention in behavioral health treatment and care; Reduce risk of HIV and Hepatitis C; Increase HIV and Hepatitis C testing and knowledge of HIV and Hepatitis C status; Reduce the number of barriers to engagement in primary care and HIV care including ART; Improve retention in primary and HIV care Improve access to supportive services including insurance enrollment, educational/vocational support, and housing assistance; and Make improvements in major life domains including: housing, employment, substance use, social consequences of addiction, criminal justice system involvement, and financial.

ABSTRACT BIENESTAR Human Services, Inc. (Bienestar) will expand its Nuevo Amanecer program—a culturally responsive substance use and co-occurring mental health disorder treatment program. The new program will target Latino men who have sex with men (MSM) of all ages who are at high risk for acquiring or transmitting HIV living in Los Angeles County Service Planning Areas 4 (Metro) and 6 (South). The program will serve a minimum of 520 participants. SPAs 4 and 6 are home to approximately 2.1 million residents, 21% of Los Angeles County’s total population. Using 2015 data from the California Health Interview Survey (CHIS), Bienestar estimates there are 66,000 Latino MSM (all ages) living in SPAs 4 and 6, of whom 7,000 (10.6%) are YMSM and 89.4% are older MSM. SPAs 4 and 6 have a higher than average proportion (35.9%) of the general population who live below 100% of the federal poverty level (FPL), compared to 23.6% in Los Angeles County. The 2015 CHIS estimates that 71.4% of Latino YMSM in SPAs 4 and 6 live below 100% FPL and 30.5% of Latino MSM. According to the CHIS, although 100% of Latino YMSM speak both English and Spanish very well, 10.2% of Latino MSM speak only Spanish, and 31.6% report that they do not speak English very well. The Los Angeles County Substance Abuse Prevention and Control (SAPC) served 938 MSM in all of Los Angeles County in 2014. The 2015 CHIS estimates that there are 8,000 Latino MSM in SPAs 4 and 6 alone that have a need for mental health/substance use treatment, and none (0%) were able to find help. SAPC reports that methamphetamines are the primary drug among lesbian, gay, bisexual, and questioning (LGBQ) admissions compared to 19.6% of all SAPC admissions. There are 9,670 people living with HIV, including AIDS (PLWH), who are Latino in SPAs 4 and 6, 47.2% of all Latino PLWH in the county. Men who have sex with men (MSM) represent the primary exposure to HIV in the County and among Latinos. About 94% of Latinos living with HIV identified MSM or MSM/injection drug use (IDU) as their exposure risk. Latinos represented 46.6% of newly diagnosed HIV positive individuals from 2009-2013. The most severe problem in SPAs 4 and 6 for Latino MSM is the overall lack substance use and co-occurring disorder treatment programs to meet current need. Nuevo Amanecer will increase the availability of Latino culturally responsive, gay-specific substance use and co-occurring mental health disorder treatment. Bienestar will deliver Getting Off, an 8-week condensed and gay-specific version of the Matrix Model evidence-based practice for substance use and co-occurring disorder treatment. Getting Off yields comparable outcomes as the Matrix Model in reducing substance use, as well as symptoms of mental health disorders. Additionally, it reduces HIV-related sexual risk behaviors of MSM. The program will serve a minimum of 520 participants, of whom approximately 20% (N=104) will be YMSM and 80% (N=416) MSM.

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.

The proposed project (TCE-HIV Program: Substance Use Disorder Treatment for Young Gay and Bisexual Men of Color ages 18-24 at High-Risk for HIV/AIDS) is designed to expand and enhance integrated substance use treatment, behavioral health and HIV services for 1,264 young gay and bisexual men of color (YGBMC) ages 18-24 in Los Angeles, CA over 5 years. The project will address disparities in access to youth-specific substance use treatment for YGBMC at risk for or living with HIV by providing a group-level intervention, Seeking Safety; individual level treatment services; access to psychiatric treatment; as well as opportunities for engagement and leadership from YGBMC. The expected outcomes are as follows: 1) increase the number of YGBMC living with HIV that are on ART and linked to HIV care; 2) reduce the negative impact of behavioral health problems; 3) reduce the risk and incidence of HIV; 3) reduce trauma-related conditions; 4)increase access to and retention in treatment for individuals with co-existing behavioral health, HIV, and Hepatitis conditions; 5) youth development - >85% of participants will have gained knowledge, skills and tools that will help them in their transition to adulthood); 6) community connections - >85% of participants will have positive support people in the community that they can rely on and go to for help and support); and 7) resilience - >85% of participants will have developed resilience factors such as an understanding of their own strengths, hopes for the future, and connections to community resources for meeting their needs. The objectives for this project are as follows: Objective 1.1: CHLA will increase enrollment of YGBMC into treatment for substance use and/or co-occurring disorders (individual and/or group) by a minimum of 150 additional clients in Year 1 and 200 additional clients in Years 2-5; Objective 1.2: A minimum of 80% of youth enrolled in adapted evidenced based-intervention (i.e. Seeking Safety) will complete five sessions (or more); Objective 1.3: 70% of youth completing at least five sessions will report decrease in self-reported substance use, increase in coping strategies, and/or decreased mental health symptoms; Objective 1.4: 100% of youth ineligible for health insurance (e.g. due to residency status) will be provided with treatment services; and Objective 1.5: 70% of youth enrolled in treatment services that complete at least 5 sessions (individual or group) will report decrease in self-reported substance use, increase in coping strategies, and/or decreased mental health symptoms; Objective 2.1: A minimum of 266 YGBMC will be screened for SUD/COD; Objective 2.2: A minimum of 266 YGBMC will be screened HIV/STIs; Objective 2.3: 100% of all youth identified as HIV positive or positive for Viral Hepatitis will be linked to treatment services (including case management); Objective 2.4: 75% of youth enrolled in services will be linked to a minimum of one additional essential support service (e.g. biomedical HIV prevention, housing support); and Objective 2.5: 100% of insurance-eligible YGBMC enrolled in project will report having health insurance within 6 months of enrollment and will be able to identify their medical home and a primary care physician; Objective 2.6: 100% of treatment notes will be entered in a certified electronic health record.

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.  

Casa Esperanza, Inc.’s Tu Bienestar: Culture, Health, and Empowerment will increase engagement in care of Latinxs with substance use and co-occurring mental disorders (CODs) who are at risk for or living with HIV and other infections (including viral hepatitis (VH)), especially individuals facing the highest risk and greatest stigma and marginalization, including people who inject drugs (PWID), men who have sex with men (MSM) (especially young MSM), women, and transgender individuals. Tu Bienestar will work to reduce substance use and other risk behaviors, reduce HIV/VH infection and transmission rates, increase retention in HIV/VH care and achievement of viral suppression, and support long-term recovery and wellness—contributing to the nation’s achievement of the 90-90-90 goals regarding HIV status and treatment. Our population of focus is predominantly Latinx (98%); 40% are monolingual Spanish speakers; 97% have a co-occurring mental illness in addition to their substance use disorder; nearly three quarters have an incarceration history, and almost all have extensive trauma histories. Complex social and cultural stigma around substance use, mental illness, HIV, gender roles, and sexual orientation, combined with cultural and linguistic marginalization, and disparities in access to care require a culturally focused, trauma-informed, integrated, empowerment-based approach. Tu Bienestar will (1) Assertively identify and engage hard-to-reach individuals in culturally-competent HIV/VH/STI prevention, education, screening, testing, and connection to care through: conducting street outreach to at least 380 individuals; conducting 6 stakeholder interviews/focus groups as part of Community PROMISE community identification process to deliver targeted risk reduction stories in subsequent years; providing HIV/VH counseling and testing to 280 individuals; and providing screening and referral to COD treatment for 280 individuals; (2) Increase access to and deliver culturally-focused integrated, trauma-informed care through: Comprehensive Assessments for 280 clients; Person-Centered Care Plans for 280 clients; IDDT-based integrated care for 280 clients; specialty HIV/VH medical case management, for 190 clients; connection to safe, stable housing for 280 clients; and comprehensive recovery support services for 280 clients; and (3) Address the impact of stigma and marginalization on Latinxs’ increased risk for substance use and HIV by building peer support and empowerment through: gender-specific Seeking Safety trauma groups for 280 clients; peer support groups for 280 clients; Health and Recovery Program (HARP) groups for 280 clients; and access to community building activities for 280 clients. Tu Bienestar will provide integrated services to 280 individuals across five years, empowering them to make informed decisions about their health, including trauma-related HIV risk-behaviors.

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.

Behavioral Health Services (BHS) is a component of Lakeview Center Inc. (LCI) in Escambia County (Pensacola) FL. LCI is an organization with more than 60 years of demonstrated experience serving local minority communities and proposes to expand SUD treatment services in conjunction with HIV/AIDS services. These services will be provided to local minority communities in Escambia County (focusing on zip codes 32501, 32503, 32505, 32507 and 32526) which combined account for ¬¬70% of local African American residents with HIV infection. Services will also be provided to minority areas in the rural northern end of the county, Century (zip code 32535), as well as to rural sections of the three adjacent counties in the region (Region/Area I Florida): Santa Rosa (Milton, 32570), Okaloosa (Crestview, 32536) and Walton (DeFuniak Springs, 32433) Counties. Over the 5-year period the proposed project, PHASE IIII (Personalized HIV & Addiction Services Enhancement IIII) with supporting services from community partners, will provide screening for 2,280 persons, assessment for 1,710 of persons screened, SUD treatment for 855 of those assessed and Case Management for 640 SUD clients. The population of focus (POF) for the project is African Americans males and females, all genders, concentrating on IDU & MSM. Over the 5 year period, 855 persons will receive evidence-based motivational enhancement therapy offered through a number of modalities. Treatment modalities include: drug-free or medication assisted outpatient treatment, residential treatment, and/or intensive outpatient treatment; and 75% (640 persons) of those enrolled in any treatment modality will also receive strengths-based intensive case management. PHASE will also provide confidential rapid HIV & HCV testing, risk-reduction counseling, linkage and follow-up services. A minimum of 80% of the POF who enter any treatment modality (690) will be tested over the 5-year period, though this number is expected to be higher, as testing will also be offered to clients’ partners. Though Blacks comprise only 22.9% of the adult population in Escambia County Florida, they also represent 60% of AIDS cases and 51% of HIV infections reported in 2016. Corresponding trends for HIV infections locally are also demonstrated among the MSM population. 2016 data shows that the most common risk factor locally for HIV and AIDS (61% and 61% respectively) is MSM. Further, DOH Area I Florida (which includes 4 counties, of which Escambia is the most densely populated) is experiencing a significant surge in opiate deaths and overdoses. The project will: increase access/availability and effectiveness of SUD treatment in conjunction with HIV/HCV testing services; exercise linkages with grassroots/ community-based health, education and human services agencies; embed and sustain the project services locally; and evaluate the effectiveness of this culturally appropriate service array. The evaluator for this project will be Dr. Susan Walch (University of West FL), who has 20+ years of experience in programmatic assessment and evaluation. Dr. Walch is a professor of abnormal psychology, health psychology and behavior modification. She is a clinical psychologist specializing in psycho-oncology, cognitive-behavioral therapies and women’s health (among others). She has (co)written numerous peer-reviewed journal articles on the social factors of homophobia, attitudes toward transgendered persons and managing diversity in the workplace. Supporters of her research on HIV/AIDS prevention and interventions have included: the FL Department of Health, Southern REACH and the EJAF (et.al.).

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.

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 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.

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)

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.

Center for Health Justice (CHJ), with significant input from its Community Advisory Board (CAB), proposes to use SAMHSA funds over a 5-year period to expand access and enhance the capacity of its Outpatient Substance Use Disorders (SUD) and Co-Occurring SUD and Mental Health Disorders (COD) Treatment programming with the Self-Discovery in Motion Program (SDIM) for 18-29 year-old Black and Latinx members of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Two Spirit (LGBTQIA2-S) communities who are transitioning from Los Angeles County (LAC) Jails back into their South and Metro LAC neighborhoods. Through SDIM, CHJ will: 1) utilize adaptations of Motivational Interviewing and Seeking Safety Model evidence-based practices to provide trauma-informed outpatient SUD and COD counseling and case management (including navigation to permanent housing); 2) integrate electronic health records to improve efficiency and make data-informed treatment decisions; and 3) improve HIV and HCV-related outcomes by providing onsite HIV, HCV, and STI rapid testing (and treatment referrals) for all participants. SDIM will feature ongoing input by a CAB of formerly incarcerated 18-29 year-old LGBTQIA2-S identifying youth, including those in recovery themselves, to guide the development of SDIM’s programming. SDIM’s comprehensive evaluation will include data collection, monitoring, analysis, reporting, local performance assessment, and quality assurance; which will also guide ongoing modifications to more effectively meet SDIM’s Objectives while assuring participants receive consistently high levels of service. During the 5-year funding period: a) a minimum of 1,251 formerly incarcerated LGBTQIA2-S youth will be screened for SDIM eligibility and receive rapid HIV, HCV, and STI testing (and referrals for treatment); b) 350 will be enrolled in SDIM SUD/COD Outpatient Treatment; and c) 280 will remain in SUD/COD Treatment for 3 months and self-report statistically significant improvements in knowledge, intentions, and behaviors related to non-prescribed substance use, social connectedness, safe coping skills, safety in relationships, emotional literacy, and HIV/HCV health outcomes. It is anticipated that SDIM will cost $8,641 per participant to complete 3 months of SUD/COD Treatment that includes HIV, STI, and HCV rapid testing, 9 hours of case management, 36 hours of individual level counseling, and 240 hours of group level sessions.

AIDS Arms, Inc. d/b/a Prism Health North Texas will create the Supporting Treatment, Empowerment and Progress (STEP) program whose purpose is to address access and engagement in care for racial/ethnic minority youth with a substance use disorder (SUD) who are at risk for HIV or viral hepatitis (VH). Given the interconnectivity of these conditions in North Texas, STEP will serve a very important role for this community. STEP will serve racial/ethnic minority YMSM (ages 18-29), MSM (> 30), and gay, bisexual and transgender individuals with SUD/COD who are at risk for HIV or HIV positive, through an integrated model of behavioral health and medical care. The program will serve 90 unduplicated clients annually and 450 unduplicated clients in total through an integrated model of care utilizing evidenced-based practices that infuse SUD and/or COD treatment with HIV medical care and supportive services. Evidence Based Practices will include Counseling, Testing and Referral; Screening, Brief Intervention and Referral to Treatment; Integrated Treatment for Co-occurring Disorders; Motivational Interviewing; and Cognitive Behavioral Therapy. The STEP program goals and measurable objectives include:  Expand SUD/COD treatment and recovery support services by increasing access and availability to the populations of focus. o Increase utilization of integrated behavioral health services o Increase engagement and retention in behavioral health care o Increase patient stability (including self-efficacy) o Decrease the symptoms of SUD/COD o Provide services with high-fidelity to evidence- based practices  Increase linkage to and engagement in, HIV and VH testing, risk reduction education, case management services, and treatment for populations of focus and their drug-using and/or sexual partners. o Increase in number of individuals tested for HIV and VH among focus population o 90% of HIV positive program participants engaged in HIV medical care o 80% of individuals tested positive for HIV will be linked to integrated care services o 80% of individuals tested positive for VH linked to case management services o 95% of individuals tested for HIV/VH completed risk reduction education o 100% of individuals tested for HIV/VH provided materials to refer drug-using and/or sexual partners to HIV/VH testing A program advisory board with membership comprised of program participants and their family members will provide input to inform assessment, planning and implementation of the STEP program. Additionally, the STEP program will host a semi-annual Celebrating STEPS Forward event to acknowledge participant achievements, obtain input, and additional education.

Miami Men at-Risk Project Abstract: Substance misused HIV/AIDS and Viral Hepatitis among African Americans and Blacks is unquestionably a significantly public health dilemma. These priority health-risk behaviors, which are behaviors that contribute to some of the leading cause’s morbidity and mortality among youth adults, are often established during adolescent, extend into adulthood, are interrelated, and are preventable. In its effort to provide a service continuum to address the various stages of SUD, HIV/AIDS and adverse health consequences, needed primary and secondary prevention, intervention and treatment in a special population. Bethel Family Enrichment Center of Miami Gardens, Florida – proposes a TCE/HIV intervention “Miami Men at-Risk Project (MMRP) expanded comprehensive and vital service for to underrepresented racial and ethnic minority groups; targeting young adult African Americans and other Black MSMs, ages 18-29, that experience high, unmet demands for early HIV/AIDS, HIV and SUD screening, intervention and treatment. The purpose of the proposed project is to increase access, engagement, intervention and medical care for young black MSMs with SUD, who are at high for HIV or HIV positive and to facilitate treatment entry and supportive services. The project also aims to reduce limitations and gaps in services and contribute to SAMHSA 90-90-90 goals regarding HIV status and treatment. This is a twelve-to-eighteen month’s service project, admitting 300 unduplicated MSMs, over five years; with an emphasis on young black MSM and bisexual, men who sex with men and women (MSMW). The main theoretical framework guiding these intervention activities will be a combination and replication of three CDC evidence-based interventions: MANY MEN, MANY VOICES (3MV), Stages of Change (SCM), PROMISE, and other NIDA/SAMHSA effective intervention strategies, including motivational interviewing techniques and life skills training (social, cognitive and emotional management, health literacy and treatment entry). On-going assessment and data collection on MSM’s intake, response, and progress will involve administration of the GPRA, ASI, Risk Reduction Activities (RRA), General Health Questionnaire (GHQ), and Drug, HIV and VH Testing. The project activities will generate both quantitative and qualitative data sources; project evaluation will include both summative and formative components. To address keys questions; whether the project has been implemented as planned, how implemented project has affected the lives of the participants, particularly in terms of their reduce risk factors HIV and substance use; improved access and utilization and measurable improvement on clients functioning and health. A variety of instruments and techniques will used to collect performance data to complete descriptive and comparative analysis, including categorical, content, theme and cross-case analysis of project data. The Social Development and Functional model, as operationalized by Catalano and Hawkins (1996), provides an integrating conceptual framework for the project needs assessment. This model integrates social control and social learning theories with ecological models of youth growth and development to describe the antecedents of SUD – HIV risk behaviors and related problems, and the resiliency factors that prevent such behaviors in multiple ethno-cultural domains.

Fundación Latinoamericana de Accion Social (FLAS)/Latin American Foundation for Social Action based in Harris County, Houston, Texas, proposes to implement Project PRIDE, the purpose of which is to increase engagement in care for Latino Young Men Who Have Sex With Men (LMSM) (18-29), MSM individuals (30+) and Transgender women with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for HIV/Hepatitis or HIV positive that receive HIV services/treatment. The project will serve 475 unduplicated individuals over the 5 year grant period. The project will focus on individuals who live in the Gulfton (zip code 77081) and Sharpstown (zip code 77036) areas of southwest (SW) Houston, Texas. Project goals include: Goal 1. Recruit Latino YMSM, MSM, and Transgender individuals whose primary diagnosis is SUD or COD. Goal 2. 100 percent of enrolled Latino YMSM, MSM, and Transgender participants will be screened for SUD, COD, HIV, and Viral Hepatitis; testing and counseling, and treatment care coordination. Goal 3. 90 percent of enrolled Latino YMSM, MSM and Transgender participants will show a decrease in substance use and dependence. Goal 4. 90 percent of enrolled Latino YMSM, MSM and Transgender participants will show a reduction in HIV risk behaviors and seroconversion rates. Goal 5. 90 percent of those who are HIV positive and homeless (or living in unstable housing) will be linked to housing services; The chosen Evidence Based Practices (EBP’s) for Project PRIDE are Motivational Interviewing, Motivational Enhancement Therapy, Cognitive Behavioral Therapy (CBT), and Many Men, Many Voices (3MV). Services will include General Outreach; LMSM Outreach; HIV Testing; Hepatitis testing; HIV and Hepatitis Care Management; Case Management, Co-occurring Disorder (COD) treatment; Substance Use Disorder (SUD) treatment; HIV Risk Reduction Services; and Linkages to Social Services and Health/Behavioral Healthcare.

The Positively Empowered Program targets minority (particularly Black {African-American, Caribbean Black and other Black, hereafter referred to as Black} and Latino YMSM) persons suffering from Substance Use Disorder and/or Co-Occurring Disorders who are at risk of, or infected with, the HIV spectrum disease and/or Hepatitis who reside in the Central Florida community (Orlando MSA). Based on the current at-risk and HIV+ population served throughout Aspire Health Partner’s (Aspire) existing continuum of care, the Black and Latino population of focus has been determined as a necessary area of expansion. In the most recent needs assessment, it was identified that a focus of service expansion for substance abusing and co-occurring Black and Latino males, particularly those who are YMSM, as well as other minority males was warranted. Not only is this population faced with limited services in residential substance abuse treatment, but access to mental health care is also severely lacking. The target area of this proposal is also located in an area designated as one with a professional health shortage in both medical and behavioral health services. The Program is designed to increase the access and availability of residential substance abuse/co-occurring, treatment services, increase access to testing for HIV, Hepatitis and other sexually transmitted infections (STI), and increase access to supportive services needed to insure success and medical stability for those individuals who are HIV and/or Hepatitis positive or at high risk of becoming HIV or Hepatitis positive, particularly YMSM Black and Latino minorities in the greater Orlando area. Positively Empowered Program will serve a minimum of 60 individuals per year through residential treatment services, care coordination and peer support; for an estimated 300 individuals over the course of the five year grant program receiving treatment, care coordination and/or peer support. Through outreach efforts, it is anticipated that a minimum of 250 individuals eligible for services will be identified, offered testing, COD and SUD services as appropriate, and will be placed within the Aspire system of care. Over the 5 year project, a minimum of 1,250 will receive services through the outreach component funded by the FOA.

The TCE-HIV program proposed by CrescentCare will expand its current capacity to provide substance abuse counseling and treatment services, including a partnership with local substance abuse provider, the Council on Alcohol and Drug Abuse of Greater New Orleans (CADA). It will focus on African Americans in New Orleans who have SUD and/or COD and who are HIV positive or at risk for HIV. It will provide treatment to 250 individuals over the 5-year period. CrescentCare will expand its existing substance abuse counseling program through the following: 1) expanding its individual and group substance abuse counseling and behavioral health counseling programs; 2) providing for a patient navigator to assist in ensuring clients can access appropriate programs and stay engaged in care; 3) expanding its partnership with CADA to provide for additional referrals to the CADA programs and joint case management of clients for referrals to other treatment programs; and 4) expanding psychiatric services and other treatment services through development of new partnerships for those individuals needing services beyond what CrescentCare and CADA can provide in-house. Evidence-based practices provided by CrescentCare will include Brief Strength-Based Case Management (SBCM). CADA will use SBCM as well as: Living in the Face of Trauma (LIFT);Seeking Safety; Motivational Enhancement Therapy; Matrix Model, and Living in Balance. CrescentCare will coordinate with CADA for referrals to CADA’s in-house programs which will also be expanded through a sub-contract and MOU. CADA will also provide linkage and referrals to other outpatient and inpatient treatment programs for patients needing more intensive services. CrescentCare’s case managers will screen all patients to assess their counseling and treatment needs. CrescentCare will also identify existing African American patients with low rates of engagement in care and viral suppression and outreach to those individuals to engage them in care and review their SUD or COD status. CrescentCare will also offer SUD and COD screening to individuals accessing CrescentCare’s syringe exchange program and its homeless housing program and engage those individuals in care. Other project components include testing for HIV and viral hepatitis, and payment of SUD medication for patients that do not qualify for any health care coverage. Outreach and testing will be provided to 100 individuals per year. The goal of the proposed project is to increase engagement in care and improve continuum of care outcomes for African American individuals with SUD or COD and who are HIV positive or at risk for HIV. The expected outcomes for program participants include: 1) improved engagement in care; 2) improved continuum of care outcomes; 3) decreased HIV substance use risk behaviors; 4) improved mental health outcomes; and 5) decreased substance use. A total of $500,000 per year is requested for the five year grant period.

Metro Wellness and Community Centers, a substance use treatment, mental health and HIV medical provider with 24 years of experience and a proven track record of serving the population of focus, proposes to implement its TCE-HIV project to expand and enhance trauma-informed and culturally and linguistically appropriate SUD and/or COD outpatient treatment, care coordination and recovery support services for racial and ethnic minority and transgender individuals who are at risk for HIV or HIV positive ensuring increased access, engagement and retention in integrated care for those with co-existing behavioral health, HIV, and hepatitis conditions in Hillsborough and Pinellas counties. Project Name: TCE-HIV Population(s) to be served: Black and Latino young men who have sex with men (ages 18-29), Black and Latino men who have sex with men (ages 30+), and transgender individuals who have SUD and/or COD treatment needs who at risk for HIV or HIV positive. Strategies/Interventions: Expanded integrated biobehavioral health systems infrastructure: (1) Behavioral Health Disparities Impact Statement/Targeted Outreach Plan/Strategic Plan within first 60 days; (2) Train/Certify Recovery Support Specialists as Peer Navigators ensuring peer participation on local planning bodies; and (3) Workforce training on all EBP/EBIs. Provide SUD and/or COD treatment and recovery services; HIV/AIDS testing, case management, linkage, care and treatment; hepatitis testing/vaccination; housing supports; outreach; and capacity enhancements (telehealth/social media) to retain participants in care. Evidence based practices: Trauma-informed SUD/MH standardized screening/assessment (TSI, GAIN SS, GAIN-Q3); Motivational Interviewing; Screening Brief Intervention Referral to Treatment; Strength-based Case Management; Seeking Safety; Motivational Enhancement Therapy/Cognitive Behavioral Therapy; Wellness Recovery Action Planning; Recovery Coaching; Many Men, Many Voices; and HIV Navigation Services. Project Goals: Aligned with the 2020 National HIV/AIDS Strategy/90-90-90 goals: (1) 100% screened and assessed for COD, trauma and HIV; (2) 100% screened HIV+ will receive a warm handoff to the service home for HIV treatment; (3) 90% screened will be engaged in care; and (4) 90% engaged in care will achieve reduced trauma, substance use and HIV viral suppression. Measurable Objectives: 100% with improved access to integrated behavioral health and HIV services; 90% reduced trauma related conditions; 95% substance use abstinence; 100% stabilized in housing; 90% sustained employment; 85% reduced criminal justice involvement 95% retained in treatment; 95% increased recovery supports and social connectedness; and 85% reduced frequency of risky behaviors to reduce HIV/AIDS and Hepatitis. Number to be served: 150 each year (115 Black YMSM/MSM; 35 Latino YMSM/MSM), totaling 750 in five years.

The Matrix Institute will expand and enhance effective, culturally competent Outpatient Treatment (OPT) for substance use disorder (SUD) among injection heroin users who are African American and Latino/Hispanic in South Los Angeles, reducing their drug use and risk and incidence of HIV and viral hepatitis. The TCE-HIV Program will increase access to behavioral and primary medical care for 540 individuals over the five years of the project. Evidence-based practices, including Matrix Model groups, Seeking Safety treatment for women, and Motivational Interviewing are embedded in an outpatient methadone treatment setting specifically to address drug use, resistance to HIV and hepatitis testing, to increase recognition of HIV risk behaviors, and to promote on-site Rapid HIV testing, and hepatitis B and C testing, both with counseling and referral to medical treatment as indicated. Expanded services will consist of current, high quality, methadone maintenance treatment (MMT), for individuals who are without public or private insurance and have the inability to pay for treatment. Enhanced services will consist of Matrix Model groups, Seeking Safety, and HIV and hepatitis C education groups. Specialized women's and men's groups will be provided with education and counseling interventions designed to address the HIV and hepatitis risks associated with substance use and high-risk sexual behavior. Participants will be afforded medical care, including comprehensive hepatitis treatment, through a formalized agreement with St. John’s Well Child and Family Center, a nearby licensed FQHC. Licensed therapists will screen for mental health disorders using a standardized instrument, and will provide linkages to specialty care. Transportation assistance and case management will help ensure follow- through care with community providers. The TCE-HIV Program anticipated target population is 75% African-American and Hispanic, 41% female, and having heroin use histories of nearly 20 years on the average. Expanded services will provide ongoing treatment to a continuing census of 30 clients at any time, or 180 over five years. Enhanced services will be provided to 360 clients in the 5-year period, 120 in the first year and 60 each year thereafter. The Goals of this project are: HIV and hepatitis B and C testing and counseling for at least 90% of clients served, with case management for clients who test preliminary and confirmatory positive; a reduction in injection drug use of greater than 50% at 6-month follow-up; abstinence from drugs and alcohol by more than 75% at 6-months; increased involvement in employment and education by at least 25% at 6-months; a 25% improvement in social connectedness and a 25% improvement in housing status at 6-months; and increased access to primary care and mental health services. A robust network of community providers in South Los Angeles ensures that participants receive integrated care. The Matrix Institute has delivered TCE/HIV funded services successfully for sixteen years through 2017, allowing the agency to begin these proposed services uninterrupted, on notice of funding.

The Men's Access To Treatment (MATT) project will expand substance abuse treatment and outreach capacity, and enhance treatment services for low-income African American and Hispanic/Latina men who have sex with men (MSM) and Transgender (TG) men who are infected with, or at risk for, HIV/AIDS and who have multiple barriers to accessing substance abuse treatment services. This project is a collaborative effort among a group of community-based organizations with strong ties to the minority communities of Nashville Tennessee. The lead organization, Meharry Medical College (MMC) is the primary and often sole health care provider for low income families in the target area, within MMC three clinics are seeking to integrate HIV prevention and treatment with substance use disorder treatment to better meet the needs of African American MSM and TG that misuse substances and are at high risk for or living with HIV. The lead organization is the Center for Healthy Families (CHF) the MMC's family medicine clinics, along with the Elam Mental Health Center (EMHC), MMC's substance abuse and mental health treatment center, and the Meharry Community Wellness Center (MCWC), the MMC's HIV prevention and treatment clinic. These three clinics within MMC will partner with the Metropolitan Interdenominational Church's First Response Center (FRC), a faith based HIV prevention and treatment clinic which has a drop-in center in the heart of the minority community of Nashville, and a long history of community based intervention with the target population. This unique collaboration will expand and enhance services and support increased outreach capacity targeting African American MSM/TG in areas of Nashville with health indicators pointing to high-risk drug use and sexual behavior. Services will be enhanced through the addition of Mind Body Bridging Substance Abuse Programming (MBBSAP), Motivational Enhancement Therapy, SBIRT, Social Networking Outreach, and Seeking Safety. We will expand services through the addition of MSM/TG specific therapists and case-managers, a dedicated outreach worker, providing pre and post treatment services to continually engage at-risk participants, and expanded medication assisted therapy (MAT) for substance use disorders and pre-exposure prophylaxis (PrEP) offered through the CHF and MCWC respectively. Outreach and SBIRT expansion efforts will service approximately 2,400 members of the target population over the five-year life of this project; approximately 250 of these individuals will benefit from pretreatment and post treatment recovery services in the FRC, and 150 will receive enhanced treatment from the EMHC and CHF, recovery support from the FRC, and case-management services to ensure linkage to all services across the EMHC, CHF, MCWC, and FRC.

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.

AIDS Alabama proposes to establish the Living Well MISSION (LWM), a co-located (multiple services provided under the physical and administrative infrastructure of LWM and integrated (multidisciplinary service coordination) care model that includes psychiatric and psychological services, nursing, substance abuse treatment, vocational/recreational rehabilitation, HIV/Hepatitis prevention and testing, linkage to care, and case management to individuals who are both diagnosed with and at-risk of acquiring HIV/AIDS or HCV and have either substance use disorder or a co-occurring substance use and mental disorder(s) (COD). LWM will target disproportionately impacted populations in the Greater Birmingham Area and fill existing gaps in services for young men who have sex with men (YMSM) of color identified through AIDS Alabama’s Gamechangers program funded by the Centers for Disease Control, LGBTQ individuals identified through AIDS Alabama’s Ascension Project funded through the U.S. Department of Housing and Urban Development’s Continuum of Care program, and other individuals who have a SUD or COD who are either HIV positive or at high risk for HIV/AIDS. LWM includes four (4) unique levels of intervention tailored to individual client needs and focused on decreasing attrition rates SUD/COD treatment, medical care and psychiatric treatment. Level I (Rectory/Intensive Outpatient Program with Residential Support) and Level II (LIBCAP/ Intensive Outpatient Program without Residential Support) will target the enrollment and maintenance of 200 persons, a 100% increase over existing capacity, for LWM services over the course of and beyond the grant cycle (with an expected retention rate of 75%). Level I and Level II seeks to serve 370 unduplicated persons by the end of the grant. Level III (Maintenance) will provide Case Management and linkage to medical, substance abuse/mental health and vocational/ recreational services for a minimum of 200 persons during the grant cycle who are more stably enrolled in existing psychiatric and/or medical care than those eligible for Levels I and II. Level III seeks to serve 370 unduplicated persons by the end of the grant. Level IV (Prevention) will provide HIV and Hepatitis prevention education, testing and linkage to 500 individuals in per year for a total 2,000 unduplicated persons by the end of the grant. LWM will improve engagement, maintenance, access to medical and behavioral health services, and outcomes to to physical and mental health for underserved populations, specifically YMSM of color and individuals with co-existing, HIV, and Hepatitis conditions. Clients will receive 9 to 18 hours of services per week at Level 1 and eventual terminating with 2 hours of services per month during the Level 3 maintenance phase. LWM will increase identification of undiagnosed persons with HIV and Hepatitis who are receiving community-based treatment for a behavioral health issue or co-occurring disorder by providing testing with at least 40 new cases of HIV and HCV identified. LWM will improve overall quality of life in all major life areas by ensuring 70% of participants feeling ""greatly improved"", 70% will identify services as culturally competent, 80% of clients will report housing stability, and 75% of clients able to work will report employment at follow-up. AIDS Alabama currently utilizes multiple programs including Living in Balance, Therapeutic Goal Management, Intensive Case Management, and Motivational Interviewing. For the purpose of this application, LWM will provide services using the MISSION model, as it it is being implemented within the proposed expansion project. The MISSION Model will enhance current services and is designed to be delivered alongside, or following, primary MH, SU, or COD treatment.

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.

The Community Rehabilitation Center (CRC) proposes to implement Project STAR (Seeking Treatment And Recovery) to enhance and expand CRC’s current treatment model in response to the great risks and disparities faced by African American young men who have sex with men (YMSM) and heterosexual young adults at risk for HIV infection who are also affected by substance abuse (SUD) or co-occurring substance abuse and mental health disorders (COD). Project STAR will target primarily YMSM, ages 18-29, who meet DSM-5 criteria SUD or COD and secondarily, heterosexual young adults, ages 18-29, who meet DSM-5 criteria or SUD/COD and are at high-risk for HIV infection. CRC serves primarily the Urban Core (Health Zone 1) of Jacksonville which demonstrates large disparities in socioeconomic factors and health outcomes compared to other health zones in the city and the country. Health Zone 1 has higher levels of poverty, lower level of educational attainment, and higher rates of cancer, diabetes, and heart disease to mention few. In 2016, five of the six ZIP Codes in Health Zone 1 earned a Community Need Index of 5.0 – the highest possible value. Based on CRC’s experience with the current CSAP program in partnership with the Minority Serving Institution and on the significant increase in HIV positive YMSMs approaching CRC for services, funds are being requested to further expand CRC’s current treatment model to better fit the needs of YMSM and other young adults at risk. The purpose of Project STAR is to expand and enhance the capacity of CRC to increase services to primarily minority YMSM. Project STAR will expand the capacity of its current substance abuse/mental health outpatient treatment program by 50 added slots per year and enhance its current services with the addition evidence-based interventions targeting YMSMs and a case management component. CRC will hire a Project Director at 0.20 FTE, a Project Coordinator at 1.0 FTE, a Licensed Mental Health Counselor/Certified Addictions Professional (1.0 FTE), a Mental Health Counselor (1.0 FTE), and a case manager/outreach worker (1.0 FTE) to fulfill the following goals: 1) to develop capacity and infrastructure for the delivery of integrated, collocated services, to YMSM and young heterosexual adults with a SUD or COD; 2) implement integrated services and supports designed to address the specific needs of YMSM and young heterosexual individuals who experience SUD and COD and are HIV positive or at risk; and 3) monitor progress and performance on achieving the goals and objectives of Project STAR. Multiple evidence-based interventions will be delivered as part of the project to create a fully integrated array of services to meet the varied needs of Minority YMSMs including: Counseling, Testing, and Linkage, Many Men Many Voices, Matrix Model, Cognitive Behavioral Therapy –behavioral health treatment, and Seeking Safety. Project STAR will build upon CRC’s current scope of behavioral health services. A comprehensive Evaluation Plan will be adopted by Project STAR which includes clear performance and outcome measures and data management procedures to ensure expeditious and reliable collection, processing, analyses, and reporting of program data.

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 Service for Groups (SSG)/APAIT proposes RECLAIM (Recovery, Empowerment, CLarity, and Acceptance In Myself), a program that will integrate trauma-informed substance use disorder treatment with services for co-occurring mental health conditions (particularly trauma), HIV/AIDS, and viral hepatitis. The RECLAIM program will serve racial/ethnic minority men who have sex with men (MSM), ages 30 years and older, and transgender individuals, ages 18 years and older, in the contiguous region of Long Beach (southernmost part of Los Angeles County) and Orange County, with a focus on the high-risk areas of northern Orange County. SSG/APAIT has identified a shortage of substance use and HIV treatment services in this catchment area, especially providers who are culturally and linguistically competent. Underutilization of services results in elevated rates of substance use, co-occurring mental health disorders, and HIV and hepatitis infection among the populations of focus. Therefore, RECLAIM aims to increase engagement in care among racial/ethnic minority MSM and transgender persons by providing culturally-appropriate and trauma-informed comprehensive services that include outpatient substance abuse treatment; mental health counseling; HIV testing and case management services; linkage to care; hepatitis testing, vaccination, and referral/linkage for treatment; and other social and supportive services, including housing support. RECLAIM will use the evidence-based practice Trauma Recovery and Empowerment Model (TREM), which addresses the link between substance use and mental health, while teaching essential coping skills that empower clients to reduce risky substance use and sexual behaviors. Accordingly, RECLAIM proposes to achieve the following goals: (a) enhance capacity to improve services for the populations of focus; (b) increase access to culturally appropriate substance use and co-occurring mental health disorder treatment; (c) increase availability of HIV and hepatitis testing and related linkage and retention to care; and (d) increase access to housing and other supportive services through case management. In order to meet the proposed goals, SSG/APAIT aims to accomplish the following process objectives: (1) train 100% of program staff in the evidence-based practice Trauma Recovery and Empowerment Model (TREM) by end of Month 3 of Year 1; (2) provide trauma-informed substance use treatment services (TREM and case management) to 80 MSM and transgender individuals per year (prorated to 60 clients in Year 1), with a total of 380 clients over five years; (3) provide rapid HIV testing and counseling to 100% of eligible clients; (4) provide hepatitis B/C testing and hepatitis A/B vaccinations to 100% of eligible clients; (5) link 100% of clients who screened negative for HIV/hepatitis to risk-reduction education; (6) link 100% of clients with a preliminary or confirmed HIV diagnosis to care within 30 days, where 90% will be engaged in care; and (7) provide case management to 100% of clients, and of those who are HIV-positive, link 90% of eligible clients to housing services, as appropriate.

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 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).

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.

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.

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 Minority Treatment Access for the Rio Grande Valley (MTA-RGV) is a collaborative effort between Behavioral Health Solutions of South Texas (Behavioral Health Solutions), Valley Aids Council, and the Department of Family and Community Medicine at Baylor College of Medicine. The project is focused on expanding substance use disorder treatment and outreach capacity while enhancing treatment services for low-income Hispanic/Latino and other minority men and women who have a history of opiate or substance use, are infected with or at risk for HIV/AIDS, and experience multiple barriers to accessing substance abuse treatment services. While the project will serve individuals throughout the Rio Grande Valley area of southern Texas, specific communities will be targeted due to high levels of need and low levels of service access. The proposed project will provide culturally appropriate, trauma-informed services to the population of focus who will receive evidence-based interventions, as well as, linkage to an array of medical services and HIV/STI/HCV-related care and support services. The goals for this collaborative are to: (1) identify, engage, and support minority men and women who have a history of disparate access, use, outcomes for services with health indicators pointing to high-risk drug use and sexual behavior; and (2) solidify and augment the system of care for men and women in need of substance use disorder treatment and recovery support services during the challenging transition that occurs following experiences of homelessness, incarceration, and/or commercial sex work through the implementation of evidence-based interventions. Evidence-based interventions include: trauma-informed care, medication-assisted treatments, gender-specific curriculum-based services with all interventions rooted in the spirit of Motivational Interviewing. The project will achieve the following individual-level objectives: (1) increase the likelihood of entering and staying in substance use disorder treatment and HIV services; (2) increase motivation and self-efficacy related to harm reduction strategies; (3) reduce use of alcohol and other drugs; (4) decrease frequency of HIV/STI and HCV risk behaviors; (5) increase self-sufficiency and psychosocial functioning in relation to: employment, housing stability, legal problems/criminal justice involvement, health status, and medical problems; and (6) decrease the frequency of mental health and trauma symptoms. The systems-level objective is to formalize and expand upon existing collaborations to improve the target population's access to substance use disorder treatment, and recovery support services to reduce the health disparities in HIV that primarily affect Rio Grande Valley's minority communities. Outreach expansion efforts will serve approximately 400 annually and 2,000 members of the target population over the five-year life of this project; approximately 240 individuals annually and 1,200 for the life of the project will benefit from improved pretreatment services, and outpatient substance use disorder treatment services will be expanded to serve an additional 60 annually for a total of 300 for the life of the project.

Project Name: Turning the Tide (T3). Applicant: Terros Inc., dba Terros Health, an integrated health care agency that provides a full continuum of prevention, behavioral health and primary care services. The purpose of T3 is to improve health outcomes of participants, engage individuals who have not accessed a full continuum of health services previously, and engage and educate individuals who might not be aware of their HIV status and/or health and resource services that are available. The T3 program will engage populations at high-risk for HIV and those who are HIV positive and are Latino, Black and Native American MSM, ages 18-30, with a current substance use disorder and/or co-occurring substance use and mental health disorder (COD). T3 is a continuum of services including: outreach and engagement, screening, assessment, education, care navigation, primary and behavioral health services, and participation in LIFT, an evidenced based protocol for individuals who are HIV positive. Individuals will participate in peer led support groups to address psychosocial, cultural and environmental situations. The foundation of success for T3 is that participants will partner with a Care Navigator to support them through their recovery and assist them in accessing health care to improve their health status. They will also be connected to wraparound services such as benefit programs, employment support, housing, and Ryan White services. Goals: 1) Individuals will increase access to relevant medical and behavioral health care including treatment related to substance use disorders and co-occurring disorders and HIV/HCV medical care; 2) Individuals who are at high risk will be engaged through the use of HIV Prevention tools; 3) Individuals will increase their awareness about HIV and the biopsychosocial effects of high-risk behaviors. 4) Participants will increase knowledge and skills to make healthy choices about their sexual health and whole person care. Measurable Objectives. 1) Maintain an 85% rate of program participation. 2) 80% of participants will complete LIFT. 3) 80% of patients will participate in a 6-month follow-up. 4)75% of participants will be included in a 12-month follow-up. 5) 60% of participants will be included in an 18-month follow-up. 6) 100% of participants will be tested for HIV/HCV. 6) 90% of participants referred to medical services, will attend their first medical appointment. 7) 90% of participants who tested positive for HIV will be virally suppressed. 8) 90% of those connected to care will be retained in care for at least one year. T3 anticipates that outreach will be completed with 1200-2400 participants with a total of 250-500 individuals participating in treatment annually. There will be a total of 10,800 outreach efforts resulting in a total of 2,250 participants in treatment over the term of the project. The Maricopa County LGBTQ Advisory Board will act in an advisory role to the project.

Project Title: SUD/COD Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS at Venice Family Clinic (SAMHSA- TI-17-011) Venice Family Clinic (VFC) was founded in 1970 to provide accessible, affordable, higher-quality primary care to residents in need of services on the Westside of Los Angeles, and is now the principal primary care and behavioral health care provider for the underserved in our area. With this grant, VFC seeks to expand its capacity to identify and serve an additional 500 people battling drug and alcohol addiction within our patient population who are currently not receiving treatment. VFC’s target population has always been the low-income, uninsured, and homeless people on the Westside from all racial and ethnic backgrounds. Almost all of our patients live below 200% of the federal poverty level; 58% are Hispanic/Latino, and 10% are African American. 13% are homeless. There are very few options for substance use services on the Westside of Los Angeles for the low-income and homeless population we serve. Since 2010, VFC has provided Medically Assisted Treatment to its patients with substance use diagnoses, and has provided care to those at risk for or living with HIV for decades. In recent years, there has been a significant boom in heroin and opioid abuse in Los Angeles, which has translated to an increasing demand for substance use services, and VFC’s low-barrier to access these services are critical for Los Angeles County residents who have few other options, especially those with low-incomes or no insurance. With integrated primary and behavioral health care in place, a strong, evidence-based substance use program, and robust services for HIV and viral Hepatitis B and C, we believe we are primed to be able to expand our capacity to identify and treat those in need of substance use services, including many in our homeless community or needle exchange programs and racial and ethnic minorities. With this funding, we will work to strengthen and expand our core substance use, HIV, and viral Hepatitis B and C services by adding new staff to identify our patients in need and get them into treatment; strengthen our internal capacity through trainings and workshops in substance use screening and treatment, harm reduction, and motivational interviewing; and conduct outreach into the needle exchange program and all of our clinical sites, with a particular focus on racial and ethnic minority patients. We hope to serve an additional 500 people total over the five-year grant period with this grant. Measurable objectives include an increase in screening rates, attendance at substance use group sessions, and linkages to behavioral health care; an increase in HIV testing at substance use group sessions; inclusion of rapid HIV testing during intake at the needle exchange program; an increase in routine Hepatitis B and C screening during primary care visits; an increase in staff trained to provide training to patients with an opioid diagnosis in naloxone administration, and an increase in patients who receive this training; more staff trained in harm reduction, motivational interviewing, and trauma-informed care; and an increase in the percentage of behavioral health encounters for those who screen positive for substance use.

Abstract: SAMHSA TCE-HIV High Risk Populations Los Angeles Centers for Alcohol and Drug Abuse HIV infections in L.A. County disproportionately affect Latino and African American men who have sex with men (MSM). The hardest hit are substance-using MSM of color who experience higher rates of HIV infection, later diagnosis, and worse health outcomes. Los Angeles Centers for Alcohol and Drug Abuse (LA CADA) will expand our existing HIV prevention and testing programs in two high-risk communities – metro L.A. and L.A. County Service Planning Area (SPA)7 – to include behavioral health treatment with intensive support for recovery and HIV care. The project will serve substance-using Black and Latino YMSM ages 18-29 and MSM ages 30 and older. Program expansion will provide HIV/HCV testing with enhanced street and community outreach, intensive assessment and case management, and evidence-based SUD/COD treatment that is integrated with culturally-congruent, high-impact HIV behavioral interventions. L.A. CADA is a grassroots community agency providing state-licensed and certified residential and outpatient treatment for disadvantaged populations. We established an HIV prevention division in 1985 – L.A. County’s first such program located within a treatment agency. L.A. CADA’s services include operation of the L.A. County Men’s Central Jail SUD treatment program for gay, bisexual, and transgender inmates. We are also the subcontractor for the HOPWA SPA 7 Regional Specialist Office funded by the L.A. Homeless Services Authority. During the five-year life of the project, L.A. CADA will serve 375 unduplicated substance-using YMSM and MSM at highest risk for HIV or progression to AIDS (75 annually). California ranks second in the U.S. in the number of HIV infections. In L.A. County, the epidemic has put African American and Latino MSM at shocking risk – 87% of persons living with HIV are male, 24% are African American, and 45% are Latino. Of men diagnosed with HIV here, 83% are MSM and an additional 2% are MSM injection drug users. Black men are diagnosed with HIV at three times the rate of Whites, and they comprise L.A. County’s highest number of Stage 3 diagnoses (AIDS). Metro Los Angeles, where L.A. CADA primarily serves Black MSM, has the county’s largest number of persons living with HIV. America’s largest Latino community lives in L.A. County, and the largest Latino population here is in SPA 7 – up to 97% of residents in some cities. Latinos comprise the majority (40.3%) of persons living with HIV/AIDS in L.A. County. This group had the highest increase in HIV diagnoses from 2008 to 2011 (more than double that of African Americans and Whites), as well as the highest rates of viral hepatitis and substance abuse in the county. Over 73% of persons living with AIDs in SPA 7 are Latino. In addition to HIV/AIDS, African American and Latino residents of L.A. County have high rates of admission to publicly-funded substance abuse treatment at 24.8% and 41.4% respectively. Substance use has been a known risk factor since the HIV epidemic began, and it is now the single largest factor in the spread of HIV infection in the U.S. Alcohol and drug use seriously impact HIV infection and disease progression by reducing inhibitions, impairing judgment, increasing HIV risk behaviors, fueling health neglect, and exacerbating health problems. An addict’s chronically chaotic lifestyle makes MSM with substance use disorders (and COD) the least likely to be diagnosed or in treatment for HIV. L.A. County urgently needs more culturally-congruent resources in order to achieve World Health Organization 90-90-90 targets. Here, 30% of persons living with HIV are not linked to care within three month of diagnosis, 39% are not linked to care at all, 49% are not retained in care, and 50% are not virally-suppressed.

The Coastal Bend Wellness Foundation (CBWF) proposes to implement Project PHASES (Providing HIV/AIDS and Substance Abuse Expansion/Enhancement Services) to enhance and expand its current substance abuse treatment services to Young Latino MSM, ages 18-29, who meet DSM-5 criteria for a substance use disorder (SUD) or co-occurring substance use and mental health disorders (COD) and who are HIV+ or at risk for infection. Adult Latino MSM (ages 30 and older), adult sex workers, and adult bisexual or transgender individuals, who also meet criteria for DSM-5 SUD or COD and are HIV+ or at high risk for infection will be targeted as secondary population of focus. Project PHASES’ primary purpose is trifold: expand the number of treatment slots available, expand the populations that are targeted, and enhance staff’s capacity to provide trauma-informed, integrated, and collocated treatment. To fulfill the purpose of the grant CBWF will assign and hire experienced and competent staff that includes a Project Director, Project Coordinator, two Licensed Chemical Dependency Counselor, a care coordinator, and an external evaluator. Project PHASES goals include: To expand current substance abuse treatment services by increasing current census capacity, prioritizing minority YMSM, minority adult MSM, sex workers, and other LGBTQ individuals who HIV+ or at-risk for infection and have a SUD or COD diagnosis to enhance current intensive outpatient (IO) substance abuse treatment by integrating case management/care coordination, adopt a trauma-informed model, and offering detox, residential treatment, and MAT services to a total number of clients of 425 by the end of the 5-year funding-period; and to evaluate and measure project accountability and impact. Direct service implementation will begin on the fourth month of funding. Potential clients will be recruited mainly from in-house initiatives and the CBWF’s HIV and Primary Care clinic. Project PHASES plans to enroll 425 clients for the life of the program (50 yr one, 100 yrs two thru four, and 75 yr five). Direct substance abuse treatment target goals among those recruited are: 10 detox services (two per year), 35 residential (seven per year), and approximately 15 Medication Assistance Treatment (MAT) – the number depends of the amount of funds utilized. CBWF proposes the following EBPs: Living in Balance, Seeking Safety, Cognitive Behavioral Therapy, Fundamentals of Counseling and Testing, Personalized Cognitive Counseling (PCC). A comprehensive Evaluation Plan will be adopted by Project PHASES which includes clear performance and outcome measures and data management procedures to ensure expeditious and reliable collection, processing, analyses, and reporting of program data.

StrongARM (Addiction Recovery for Men) will expand and enhance substance abuse treatment, behavioral health, and HIV services for 400 adult racial/ethnic minority men with substance use/co-occurring disorders, especially young men who have sex with men (YMSM), in Bexar County, Texas who are at risk or living with HIV/AIDS through the use of screening, Seeking Safety, Brief strength based case management, Peer Navigation, Peer Recovery Support, and trauma-related services. Population: StrongARM will serve 400 adult racial/ethnic minority men, predominately Black and Hispanic YMSM (ages 18-29 years), who have substance use or co-occurring substance use and mental health disorders and are living with or at risk for HIV/AIDS and reside in Bexar County, Texas. Fifty men will be enrolled in YR01, 100 in YR02, 100 in YR03, 100 in YR04, and 50 in YR05. Recruitment will take place through varied referral sources. Interventions: Prospective clients will be screened for substance use using the GAIN Short Screener. If a man screens positive, he will be offered the opportunity to enroll in StrongARM, onsite HIV testing, and given a comprehensive intake assessment, utilizing the GAIN-I-Lite, the GPRA tool, and other local measures. After intake, participants will be eligible to receive a multicomponent, culturally competent, and trauma-informed services from University Health System staff and partner organizations, namely Lifetime Recovery, San Antonio AIDS Foundation, and San Antonio Council on Alcohol and Drug Abuse. The integrated services include, Seeking Safety, Peer Navigation, brief strength-based case management, peer recovery support, trauma-related services, and HIV and viral Hepatitis testing and linkage to care. Clients will complete 6- and 12-month follow-up assessments and receive a $25 gift card for completing each follow-up. Goals and Objectives: The primary goal of StrongARM is to prevent/reduce the use of substance use among StrongARM clients (Goal #1). It is expected that at 6- and 12-month follow-up a significantly lower proportion of YMSM will report risk behaviors associated with binge drinking and illegal drug use as well as report fewer episodes of binge drinking and drug use compared to baseline. By 6- and 12-month follow-up it is also expected that clients will report increased access and engagement in HIV to care and improved quality of life compared to baseline(Goal #2). Finally, StrongARM seeks to reduce HCV/HIV risk among clients through the HIV/HBV/HCV testing and linkage to HIV prevention education (Goal #3).

Brandywine Counseling & Community Services (BCCS) proposes to implement IMPACT (Individuals Matter; People Accessing Care and Treatment) a comprehensive integrated project to enhance substance use disorder (SUD) treatment for racial/ethnic minorities at high risk for or HIV positive in Wilmington, DE especially men who have sex with men (MSM) who represent 47% of new HIV infections. IMPACT will serve 90 adults per year or 450 adults in 5 years. Population of Focus: IMPACT will serve (1) Men who have sex with men (MSM) ages 18+; (2) Gay, bisexual, and transgender individuals; and (3) Adult heterosexual women & men who are at risk for, or infected with, HIV and/or Viral hepatitis and may also be challenged by co-occurring SUD and mental health disorders (COD). IMPACT will place special emphasis on recruiting minorities who are disproportionately affected by HIV/AIDS and Viral hepatitis in Delaware to reduce the impact of behavioral health problems, reduce HIV risk and incidence, and increase access to treatment for these individuals. Strategies: IMPACT includes an interconnected design of services to create a seamless transition at various stages of readiness to enter SUD treatment, related medical treatment, and related case management and recovery support services. We plan to recruit in our Methadone Clinic as well as engage individuals in our population of focus, especially MSM, using street level and web-based outreach strategies. All will be offered HIV, HCV, and HBV testing and linked to our on-site infectious disease and psychiatric clinic if appropriate. Additionally we will implement the Community-Friendly Health Recovery Program (CHRP) a four session evidence based intervention designed to reduce HIV risk behaviors among drug users in treatment. Goals: The overarching goal is to reduce SUD, CODs, HIV/AIDS, Hepatitis and other related problems among racial/ethnic minority adults. Goal 1: Increase access to and retention in treatment for behavioral health problems: At least 80% of clients will complete prescribed treatment/services. Goal 2. Reduce new HIV and viral hepatitis infections: Reduce client substance use especially injecting drug use by 75%. Goal 3. Improve outcomes for behavioral health clients at risk of or living with HIV: At least 65% of clients will experience improved criminal justice, substance abuse, mental health, housing, educational, medical/health, social connectedness, employment and health, behavioral/social consequences. Goal 4. Increase recovery support services: Retain 70% of participants in aftercare/recovery support services for at least 6 months. Goal 5: Increase Linkage to HIV/ Hepatitis Medical care: At least 75% of HIV and/or Hepatitis positive participants will adhere to both behavioral and medical treatment.

The AIDS Action Coalition (AAC), proposes continuation of “The Den” (previously known as “SYSTTYM”) – a substance abuse treatment program focusing on high risk populations including racial//ethnic/ minority populations, such as 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 substance use disorder (SUD) or co-occurring disorder (COD) who are HIV positive or at risk for HIV/AIDS throughout our 12-county Northern Alabama service area. Since 2012, AIDS Action Coalition has been funded to provide this program under SAMHSA FOA# TI-12-007. The AIDS Action Coalition has been successful with meeting progress for treating young minority MSMs in the community. Adding additional ages, additional risk factors such as bi-sexual and transgender and co-occurring disorders will assist AAC in meeting the target population goals. The Den project will utilize a clinic-based intake treatment intervention (ASSERT) to identify and refer clients to The Den’s own outpatient treatment program or other partnering resources. AAC will utilize the Matrix Model, an intensive outpatient treatment approach for stimulant abuse and dependence that was developed through 20 years of experience in real-world treatment settings. The intervention consists of relapse-prevention groups, education groups, social-support groups, individual counseling, urine and breath testing, and positive behavior reinforcements. Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, become familiar with self-help programs, and are monitored for drug use by urine testing. The Den project seeks to engage and retain this very high-risk subpopulation into culturally competent and appropriate substance abuse treatment, thereby reducing risky behaviors and the transmission of HIV. Co-occurring mental health disorders will also be addressed in the outpatient treatment program, utilizing both IOP and individual mental health treatment. Additionally, linkages will be made to HIV testing and treatment, Hepatitis screening and treatment, PrEP awareness and treatment and other health and employment resources. During year one of the Den project, AAC will serve 80 clients with its two-prong treatment approach; over the five-year term of the project, 400 clients will receive treatment services.

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.~

Test Positive Aware Network (TPAN) and its partners, Howard Brown Health at TPAN (HBH), Southwood Interventions (Southwood) and Haymarket Center (Haymarket), propose the Empowering Positive Innovative Change (EPIC) program to address gaps in services for young African American and gay men in Chicago, Illinois. EPIC aims to decrease substance abuse, and HIV and hepatitis transmission by providing education, interventions, HIV and hepatitis testing, and substance abuse treatment. EPIC will address the unmet needs of Chicago’s underserved population. Rates of substance abuse and HIV among the Black population in Chicago, Illinois are alarming. The population of focus for EPIC is young Black men who have sex with men (MSM) and older MSM who have substance use disorders or co-occurring disorders. These populations have systematically experienced greater obstacles to health based on their racial group; socioeconomic status; and sexual orientation or gender identity. EPIC focuses on primary and secondary HIV prevention by addressing the needs of the target population.) who are at risk for HIV or already infected. Participants will be recruited from other TPAN programs, through outreach activities and from referrals from the program’s partnering organizations EPIC is projected to provide educational material on HIV and drug use to more than 2,750 members of the target population over the next 5 years, provide evidence-based interventions including an adaptation of the group level intervention Holistic Health Recovery Program (HHRP) and treatment for substance use and co-occurring disorders to 575 clients over the next five years. TPAN, HBH, Southwood, and Haymarket will use their experience providing culturally competent services to the target population to reach the program goals. The goals of EPIC include: Increasing pretreatment services; providing educational materials to 550 participants each year (2,750 total); providing outpatient and residential drug treatment to 22 participants the first year and 42 participants each year thereafter (190 total); delivering a group level intervention to 45 participants the first year and 85 participants each year thereafter (385 total); retaining participants in treatment; providing HIV and hepatitis testing; decreasing substance use and risky sexual behaviors; increasing adherence to HIV medications; decreasing mental health problems; and improving living conditions, employment, and support recovery. EPIC will reach these goals by employing a comprehensive strategy of outreach, education, assessment, case management, group level intervention, and treatment. Participants will be screened to determine their level of need, If an individual needs treatment, he will be assessed and directed to the group therapy sessions or treatment regimen designed to meet his specific needs.

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.

The Substance Use Treatment HIV Enhancement (SUTHE) project will integrate HIV and Hepatitis C testing; linkages to Hepatitis B testing, Hepatitis A and B vaccinations, and primary care; HIV case management; and an HIV-prevention evidence-based practice into the agency’s Joe Healy Detoxification Program (JHDP). The target population for SUTHE is adult residents of San Francisco with SUD and/or COD who are HIV-positive or at high risk for HIV with unknown status with a focus on ethnic minority individuals. The program particularly targets underserved populations including homeless individuals, African Americans, and injecting drug users. The result of these activities will be a decrease in undiagnosed HIV and Hepatitis B and C, an increase in immunity to Hepatitis A and B, a decrease in HIV transmission due to untreated HIV infection, and a decrease in HIV-risk behavior among adults with substance use disorder in the City of San Francisco. The project will increase the number of individuals from high-risk populations that are tested for HIV, increasing the number of people living with HIV who are diagnosed. SUTHE will link HIV-positive individuals to primary care and antiretroviral treatment, following up at six months to track their progress regarding adherence to treatment. Finally, through efforts to retain clients in care over the long term, SUTHE will increase the number of people with HIV in treatment with fully suppressed viral loads. Baker Places, Inc. (BP) will serve a total of 1,382 unduplicated individuals over the five-year project period. This includes 244 in year one; 325 each year in years two, three, and four; and 163 in year five. All of these clients will receive HIV testing and the evidence-based intervention. BP anticipates that 25 percent of the clients will receive Hepatitis C testing and five percent will be linked to Hepatitis B testing based on risk factors. Approximately 20 clients in years one and five and 40 clients in years two through four will be linked to Hepatitis A and/or B vaccinations. BP is anticipating a two percent positivity rate for HIV testing therefore 28 HIV-positive individuals will be identified over the five-year project period. One hundred percent (100%) of these individuals will, be successfully linked to HIV confirmatory testing, receive HIV case management, and be referred and successfully linked to HIV primary care. BP predicts a five percent positivity rate for Hepatitis C. One hundred percent (100%) will be successfully linked to Hepatitis C confirmatory testing and referred to Hepatitis C care. Ninety percent (90%) will be successfully linked to Hepatitis C care. BP will ensure that at least 80 percent of clients participate in the six-month follow-up survey. Of these, 80 percent of HIV-positive individuals will report treatment adherence and 80 percent of HIV-negative individuals will report they are maintaining decreased risk behaviors.

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.

Housing Works Community Healthcare, Inc. (Housing Works) proposes to implement a substance abuse and HIV/AIDS prevention project with Black and Hispanic/Latinx young men who have sex with men (YMSM) ages 13-29, transgender women, and MSM of color older than 30 years of age, living in the East New York (ENY) and Central Brooklyn neighborhoods in Brooklyn. The project aims to: 1) increase engagement in care to reduce substance use, 2) improve coping mechanisms and mental health, and 3) decrease HIV and HCV transmission among the populations of focus by simultaneously targeting substance use, promoting healthy sexual behaviors, and addressing the unique sociocultural needs this high risk population faces. A total of almost 521,000 people reside in Housing Works’ East New York and Central Brooklyn service areas. There are more females (55%) than males (45%) and 24% are between the ages of 10 and 24 in East New York and 20% in Central Brooklyn. Close to 30,000 young adults in ENY and Central Brooklyn identify themselves as LGBT. The economic conditions in East New York and Central Brooklyn are among the poorest in all of NYC. In 2015, more than 11,000 people were living with HIV/AIDS in these communities; 11% of new HIV infections were among youth age 13-29 and 94% of new infections were among Blacks and/or Hispanics/ Latinx. Most of the HIV infections among transgender individuals in NYC in 2015 were among transgender females (99%); 55% of new diagnoses were among youth between the ages of 13 and 29 and 98% were among Blacks and Hispanics/Latinx. HCV incidence is also on the rise in NYC, increasing three-fold over 10 years among HIV-positive MSM. Regarding mental health, in 2015, 6.3% of adults in North and Central Brooklyn reported experiencing psychological distress, and of these, 20.4% did not get the mental health care they needed. In 2014, heroin use was highest among people living in high-poverty neighborhoods, and among Black and Hispanic/Latinx individuals. Smoking rates are also moderately high in the service area, ranging from 12.3% to 17.9%. LGBT youth may be more likely to use substances to cope with bias and stress, and also fare worse with mental health compared to their straight peers. Housing Works’ will implement 1) targeted outreach, education and HIV and HCV testing events; 2) a social marketing campaign to address social norms; and 3) three evidence-based interventions—Transgender Sisters Informing Sisters about Topics on AIDS (T-SISTA) (10 cycles, 100 clients total); Personalized Cognitive Counseling (PCC) (375 clients); and Seeking Safety (20 cycles, 200 clients). Project outcomes and impact will be measured via GPRA Intake and Follow-up Assessment data (200 in Year 1 and 240 in Years 2-5, for a total of 1,160); an independent evaluation of T-SISTA, PCC, Seeking Safety, and the social marketing campaign; and HIV (150 each year, 750 total) and HCV test (150 each year, 750 total) results.