TI-19-008 Individual Grant Awards

PROCEED, Inc. (“PROCEED”) is a multicultural, 501(c)(3), non-profit agency that provides high-quality, culturally and linguistically competent and trauma-informed substance use disorder (“SUD”) and co-occurring SUD and mental disorders (“COD”) treatment, HIV and viral hepatitis prevention and testing, recovery support, and related services to residents of Union County, New Jersey since 1970. In response to documented increases in substance use in Union County by the NJ Substance Abuse and Monitoring System, data from the NJ Department of Health designating Union County as having the third highest number of HIV/AIDS cases, and the on-going disparity in risk, access, and use of SUD/COD and HIV treatment among Latino and African-American /Black men, PROCEED proposes the Motivated Men Project/El Proyecto de Motivación para Hombres (“MMP”). MMP is a comprehensive, bilingual/bicultural, multi-component substance use disorder/ co-occurring mental disorder (SUD/COD) treatment and HIV prevention program that seeks to expand the availability and accessibility of SUD/COD treatment services for Latino and African-American/Black men in the City of Elizabeth and greater Union County. Emphasis will be placed on engaging gay men and men-who-have-sex-with-men, and their partners who are living with HIV, or are at high-risk for HIV, and struggling with a substance use disorder (SUD) or co-occurring mental illness and SUD (COD). MMP will integrate SUD/COD diagnosis and treatment with onsite testing and linkage to care for HIV and viral hepatitis. PROCEED will weave the following evidence-based practices into improved engagement, retention, and completion of treatment for Latino and African-American/Black men: Motivational Interviewing (MI), Modelo de Intervención Psychomedica (MIP), Seeking Safety, Strengths-Based Case Management (SBCM) for Substance Users or Brief SBCM for Substance Users, Integrated Dual Diagnosis Treatment, Cultural Congruence, Wellness Self-Management. Outpatient Psychiatric Care and Case Management services will also be offered. The proposed MMP will serve 80 clients in Year 1, and 110 clients in Years 2 though 5, for a 5-year project total of 520 clients. It is anticipated that MMP will improve engagement and treatment outcomes with the population of focus based on the following NJ-SAMS data: Three-fourths (73.2%) of the Union County residents that sought SUD/COD treatment in 2017 , sought treatment in Elizabeth or one of two contiguous municipalities; 81% of individuals that sought SUD/COD treatment in Union originated in Union or Essex Counties; but only 43% had stopped using illicit drugs/alcohol at discharge. While Latinos and African-Americans constitute 78% of the Elizabeth population, only 24% of individuals seeking SUD/COD treatment in Union County were Latino, a strong indicator that Latinos are not being adequately served.

With PRIME (Prevention Recovery Integration for MSM Empowerment), St. John’s Well Child and Family Center proposes to reach a 5-year total of 2,500 low-income Black and Latino men who have sex with other men (BLMSM) who have a substance use disorder and/or co-occurring mental disorder (SUD/COD) and are living with or at elevated risk for HIV; 500 BLMSM will receive PRIME services annually. Disproportionately affected by SUD, HIV, hepatitis, homelessness, PTSD, stigma, discrimination, and justice system overrepresentation, the BLMSM to be served by PRIME are from South LA, an area of Los Angeles County impacted by epidemic poverty, crime, and low rates of educational attainment and degree of social cohesion. PRIME’s purpose is to develop and implement an integrated, culturally-competent treatment response to SUD/COD among BLMSM in South LA who are at-risk or living with HIV/AIDS and/or hepatitis. PRIME aims to improve health, functioning and stability of BLMSM through collaborative trauma-informed and recovery-based clinical and peer support services addressing behavioral and physical health. PRIME’s continuum of care includes: outreach/engagement to increase access to services; HIV/hepatitis testing & counseling, biomedical prevention, treatment and HAV/HBV vaccinations; screening, assessment and treatment of SUD/COD, including counseling, medication management, and peer-led implementation of the EBP Seeking Safety; care coordination/case management; medical home-based health care; and peer recovery support services. PRIME’s goals/objectives are: Goal 1: Promote recovery of SUD/COD for PRIME participants to improve health, functioning and stability. Objectives: 1.1) By the end of Year 5, 2,500 BLMSM will be screened for SUD/COD by staff. 1.2.a) Of those who screen positive (approx. 750), 95% will participate in GPRA intake; 85% of those will receive follow-up. 1.2.b) Of those who screen positive, 75% will be linked to and access ongoing individual/group counseling and/or psychiatric care; of those who initiate services, 75% will be retained in and/or adhere to recommended treatment. 1.3) By the end of Y1, a minimum of 100 BLMSM will be enrolled into the Seeking Safety group intervention. In Y2-5, a minimum of 125 BLMSM will be enrolled annually. An 85% retention rate will be achieved over the course of the grant. 1.4) By the end of Y5, 90% (approx. 540) of SUD/COD-positive screens will be linked to one or more recovery wraparound/support services; annually, 75% of who are engaged in care management will make progress on one or more individual service plan goals. 1.5) By the end of Y3, 70% of PRIME participants will report increased sense of hope, functioning, self-efficacy, social connection/inclusion and/or awareness of available support services. (As measured by evidence-based intervention evaluation tools.) Goal 2: Reduce HIV/hepatitis infection and transmission rates and improve overall health outcomes among BLMSM with SUD/COD. Objectives: 2.1) Annually, 100% of BLMSM with SUD/COD who do not know their status will receive rapid/confirmatory HIV/HCV testing at enrollment in PRIME services by staff or partners. 2.2) As a result, 95% of participants who test positive for HIV and/or HCV will be linked by Peer Recovery Specialist (PRS) to Program Coordinator (PC) for integrated PRIME collaborative care at SJWCFC. 2.3) By the end of Year 5, 90% of all BLMSM who are linked to HIV/HCV care will be retained in care at PRIME Specialty Clinic. 30% of high-risk negative BLMSM will be successfully linked to & start taking PrEP.

Guidance/Care Center (G/CC) is requesting 2,497,561 over five years to support G/CC’s The Other Side of the Fence (OSF) project provide substance use disorder treatment to individuals involved with the criminal justice system who are at risk for HIV or are HIV positive. The purpose of this program is to engage these individuals in care and reduce both the incidence of substance-related criminal recidivism and the spread of substance related HIV infections among adult offenders in rural Monroe County, Florida. This high-risk population was identified by the community and is supported by the Monroe County Sheriff’s Office, Public Defender’s Office, and States Attorney’s Office. This project will focus on serving 270 individuals over 5 years. The Other Side of the Fence (OSF) will provide treatment for substance use disorders and care managed services with needed recovery support and linkages for adult male offenders at high-risk for HIV or who are HIV positive and 1) have a substance use diagnosis with or without co-occurring mental health disorders, 2) have been incarcerated in the Monroe County Detention Center, and 3) are returning to or living in the Lower Keys of Monroe County. This population includes racial and ethnic minorities living with HIV/AIDS, along with those individuals who are at high risk for HIV/AIDS/HBV/HCV due to engaging in risky behaviors associated with mental illness and/or substance misuse. The target population includes heterosexual, gay, bisexual, and transgender persons, as well as previously incarcerated individuals. G/CC is a licensed provider and has outpatient mental health, SUD, COD, and primary care services in place. Goal 1: Reduce the disparity between the need for substance use disorder treatment and their availability to avert relapse and support sustained recovery following re-integration of the offender. Goal 2: Promote community and family safety through the prevention of criminal recidivism and enhance social and behavioral health functioning among offenders. GOAL 3: Reduce the spread of substance related HIV infections among adult offenders living in Monroe who have substance use and are living with or at risk of HIV/AIDS. Objectives include: (1.2) 75% of clients will complete the program successfully. (1.3) 75% of clients will be substance free during the 30 days prior to discharge, and 70% will remain abstinent at 6-months post intake. (2.1) 80% of the clients who successfully complete treatment and who did not have stable living arrangement at admission will have stable living arrangements at discharge, and 70% of those will maintain their living arrangements at 6-months post intake. (2.2) 80% of the clients who complete treatment will have improved social connectedness and family relationships at discharge, and 70% will maintain these improvements at 6-months post intake. (2.3) 80% of clients will not engage in new criminal activity at discharge, and 70% will not recidivate at 6-months post intake. (2.4) 80% of the clients who complete treatment will enroll in an educational/vocational program, be actively seeking employment, or be employed at discharge, and 70% will continue to remain enrolled, complete their education/training, or remain employed 6-months post intake. (3.1) Provide HIV Counseling and Testing to 270 adult offenders (45 in years 1 & 5; 60 in years 2-4) and refer 100% of individuals with a reactive HIV test for confirmatory testing. (3.2) 100% of those screened positive for HIV will receive a linkage for care and HIV treatment. (3.3) 70% of persons completing treatment, regardless of HIV status, will report a reduction in unprotected sex and decreased number of sexual partners within the 30 days prior to discharge, and 70% of those will continue to exhibit decreased risk behaviors at 6-months post admission. (3.4) 80% of persons completing treatment will demonstrate an increased knowledge of HIV risk behaviors.

The University of Arkansas for Medical Sciences (UAMS) (applicant) and Better Community Development. (BCD) (sub-recipient) will lead Project HEAL to expand and enhance treatment and recovery support services among African American (AA) adult men and women who reside in the Pulaski County, Arkansas (AR) area and are involved in the criminal justice system, have a substance use disorder (SUD) particularly alcohol, marijuana, and/or opioid abuse, or co-occurring SUD/mental illness (COD), and are at high risk for HIV/Viral Hepatitis (VH) infection or transmission. We plan to serve 1,200 individuals over the five-year project (240 individuals annually). A large proportion of persons served are expected to have some type of criminal justice involvement and underrepresented minorities. BCD, a three decades old program serves as a catalyst to constructively meet central AR’s urgent needs in SUD/COD treatment and HIV prevention, filling a service gap by establishing services beyond SUD/COD treatment to include a Community Health Worker (CHW) and HIV education/testing/stigma reduction for all enrollees of their program. The CHW will assist project enrollees with client-centered emotional, tangible, informational, and appraisal supports focused on recovery. The BCD team will refer clients to licensed treatment partners as needed for direct COD treatment services, including MAT, HIV, and Hepatitis services. Evidence based interventions (in addition to MAT and CHW) will include Motivational Interviewing, Healthy Love, and Seeking Safety provided by BCD staff. According to CDC, AR is the state with the greatest frequency of binge drinking and highest number of drinks per binge episode. AR also has the second highest rate of opioid prescriptions issued and filled (115/100 population in 2017). AR also has high rates of poverty and reentry. According to CDC 500 Cities report (2018), LR alcohol binge drinking was 15.4 with rates in parts of the city up to 19.8 in 2016. CDC also reported 154 overdose (OD) deaths related to opiates in LR from 2014-2016; alcohol binge drinking has been associated with overdose deaths. Arkansas averages about 350 new HIV infections each year in a population of only 2.8 million people. The AA population of late stage diagnosis increased from 46.8% in 2016 to 51.3% in 2017. Project HEAL will provide outreach and engagement services and assist enrollees with development of an individualized Recovery Plan. Project HEAL participants will have access to a full continuum of acceptable, effective, and individualized SUD/COD treatment including MAT and recovery support services including substance abuse peer counseling and support groups, housing for homeless and low income individuals and families, violence prevention, prevention of incarceration and community re-entry, and HIV prevention and service coordination. Lessons learned will be shared with providers and policy-makers.

A leader in HIV Care in Philadelphia for over 25 years, the Drexel Partnership Comprehensive Care Practice (PCCP) is uniquely poised with its community partners to comprehensively address the current opioid epidemic. Philadelphia with 1100 opioid related deaths in 2018 has a clear need to increase services for individuals with Opioid Use Disorder (OUD). The PCCP in collaboration with the Public Health Management Corporation ( PHMC), Prevention Point, Caring Together, Pathways to Housing, Pennsylvania Alliance of Recovery Residences (PARR), Penn Center for AIDS Research (CFAR) and the Free Library of Philadelphia proposes to expand OUD prevention, engagement in care and MAT treatment by providing mobile integrated services for 500 individuals over 5 years and education about harm reduction (including naloxone training) and HIV and Hepatitis C treatment and prevention for the community. PCCP proposes to create a mobile team consisting of a medical provider, two peer specialist, a case manager and an outreach worker who would meet those in need and offer services via a mobile medical unit including: 1) MAT initiation and linkage to addiction and behavioral health services; 2) HIV and Hepatitis C screening and linkage to care; 3) PrEP initiation; and 4) naloxone distribution and harm reduction counseling. The mobile team will be strategically located near a branch of the Philadelphia Free Library in neighborhoods most impacted by opioid use, and with a focus on African American and Hispanic populations, since public libraries have found themselves on the front lines of the opioid epidemic. The library branches and their outreach teams will be able to promote the services offered by the PCCP mobile health team and the team can offer education to the community at the library. The Philadelphia Urban Health Collaborative consists of critical programs including 1) Outpatient MAT in several settings including PHMC, Prevention Point, Caring Together, Pathways to Housing; 2) Behavioral Health Services; 3) Recovery House permitting MAT (PARR); 4) Housing Services through Pathways; and 5) Medical care including provision of PrEP, HIV and Hepatitis C treatment at the PCCP. The Philadelphia Urban Health Collaborative proposes to 1) expand access to services including MAT and behavioral health for high risk individuals who have not yet linked into care; 2) create highly trained peer specialists to facilitate linkage to care and support at-risk individuals throughout the recovery process; 3) link individuals to HIV, Hepatitis C treatment and PrEP at the Drexel PCCP; 4) expand educational programs for the community through the public libraries about HIV, PrEP, Hepatitis C and opioid overdose and naloxone administration training; and 5) develop a real time data collection using REDCap to inform our interventions. Quantitative and qualitative data will be collected during initial contact with PCCP mobile services, during intake to services, 6-month postintake and at discharge to evaluate attainment of planned service provisions.

Population to be served: Ali Forney Center, the largest provider of comprehensive services and housing for homeless lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth in the nation, will engage those most in need of substance abuse treatment and mental health services and those most at-risk for contracting HIV in expanded treatment services: 18-24 year old homeless or unstably housed youth who identify as LGBTQ and are predominately people of color from across New York City. Strategies/Interventions: To address the high rates of substance use disorders (SUD) and/or co-occurring mental health disorders (COD), as well as HIV infections, among homeless LGBTQ youth, the program will expand treatment programming for racial/ethnic and minority at-risk youth at our 24/7 Drop-In Center in Harlem, New York City. The program will utilize HIV Prevention Evidence-Based Interventions, Substance Abuse Evidence-Based Interventions, Intensive Outpatient Treatment, Intensive Case Management, Trauma-Informed Care, Positive Youth Development, and Motivational Interviewing. Project Goals: The goals of our project are to: identify and connect racial/ethnic minority populations with SUD/COD to Intensive Case Management and/or Substance Abuse Counseling; retain population in care for follow-up and discharge assessments; retain population in care for HIV services; and achieve Viral Suppression. Measurable Objectives: 1. Identify and connect 100 racial/ethnic minority youth with SUD and/or COD who are at high risk for HIV or are HIV positive and receive services/treatment to Intensive Case management and/or Substance Abuse Counseling (500 over project lifetime). 2. Retain 80% in care for the 6-month follow-up and discharge assessments. 3: Retain 80% in care for HIV prevention and treatment services. 4: Achieve a 100% Viral Suppression rate for youth who are actively engaged with their Intensive Case Managers and/or Substance Use Counselors to address their SUD/COD, and who are also actively engaged in HIV care at the on-site medical clinic.

The Association for the Advancement of Mexican Americans (AAMA) proposes to implement the Minority Action Program (MAP) focus on minority MSM, people of trans-experience, and minority high-risk heterosexual adults residing in Houston, Texas. AAMA has identified a need for increased engagement in care among the target population, specifically for those individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for HIV or living with HIV that receive HIV services/treatment. As the 4th largest city in the Nation, Houston faces problems characteristic of major cities including high HIV- and substance use-related infections and risk behaviors. Data from the 2017 HIV Surveillance Report by the Texas Department of State Health Services (TDSHS) indicates that of the 254 counties in Texas, Harris County holds 1st place within the state with highest HIV diagnoses, AIDS, and People Living with HIV rates. Further evidence of risk is apparent through the high number of substance-use related deaths and inpatient utilization for the County. Based on data from the CDC in 2016, Houston ranked number one out of 254 counties in Texas for the highest rate of drug overdoses. Furthermore, the most recent data from DSHS on inpatient utilization for Alcohol/Drug Use or Induced Mental Disorders, found that in Harris County, the rate of inpatient utilization for 2013 was 1,844 per 100,000; nearly three times higher than the State inpatient utilization rate of 662. The following are the measurable goals and objectives for the project: 1) By September 2024, Project MAP will recruit and enroll 650 participants for the life of the project and deliver the selected, and approved evidence-based prevention services. 2) By September 2024, Project MAP will have conducted 50 outreach contacts a month over the life of the project. 3) By September 2024, Project MAP will screen all 650 participants for the presence of COD and develop treatment plans accordingly. 4) By September 2024, increase Hepatitis B/C status awareness and linkage to care by screening all 650 participants. 5) By September 2024, all 650 participants will complete the baseline GPRA, of which 80% will complete a follow-up at six months of intake. 6) Beginning October 2019 and ongoing, evaluate, analyze, and report on project processes and outcomes as measured by successful collection of GPRA, dosage, and other local data. Project MAP will achieve the proposed goals/objectives by hiring a Project Director (PD), Project Coordinator (PC), one Licensed Chemical Dependency Counselors (LCDC), one Licensed Professional Counselor (LPC), two Recovery Support Coordinators (RSC), one Outreach Worker (OW), and an external evaluator.

Tarzana Treatment Centers, Inc. (TTC) will implement Project LinC (Linkages in Care), an enhanced patient navigation program aimed at increased access to integrated substance use disorder (SUD) treatment, co-occurring mental health services, recovery support services, and HIV care and prevention services among racial/ethnic minorities at risk for HIV or living with HIV in Los Angeles County (LAC). TTC’s population of focus will be young (ages 18-39) racial/ethnic minority men who have sex with men (MSM) and others at risk for HIV and Hepatitis, including injection drug users (IDU), who have been diagnosed with an SUD or co-occurring substance use and mental disorders (COD). The intervention site will be TTC’s HIV Clinic in the San Fernando Valley or the northwestern section of LAC, which provides comprehensive HIV primary care and prevention services and co-located outpatient behavioral health services for the target population. Young minority MSM in LAC are at highest risk for HIV, and having an SUD or COD places them at even greater risk. TTC has long sought to address this issue by co-locating behavioral health and HIV services, but due to limited funding for patient navigation and non-medical case management, HIV clinic patients may be engaged in HIV care or PrEP services but not consistently screened for SUD/COD and referred to on-site outpatient behavioral health services. Project LinC will address this service gap and increase engagement in SUD/COD treatment and HIV care or prevention services among those most at risk for HIV or living with HIV by offering enhanced patient navigation and a comprehensive integrated program of evidence-based, culturally competent SUD treatment, co-occurring mental health services, recovery support, and HIV primary care and prevention services. The specific goals of the project are to: 1) Increase engagement of young minority MSM with SUD or COD in behavioral health care, including mental health services and medication assisted treatment (MAT); 2) Increase the number of young minority MSM with SUD or COD who are aware of their HIV and Hepatitis status; 3) Increase the number of young minority MSM with SUD or COD who are in treatment for HIV and chronic Hepatitis; 4) Increase access to biomedical HIV prevention services for young minority MSM with SUD or COD; and 5) Increase access to social support for young minority MSM with SUD or COD. Project LinC will accomplish these goals through the following specific objectives: 1) screening and assessing all HIV Clinic patients for SUD/COD using SBIRT; 2) enrolling all those at risk or living with HIV and diagnosed with an SUD and/or COD in a program of enhanced patient navigation and case management services; 3) testing all participants who are unaware of their status for HIV and Hepatitis; 5) enrolling 80-90% of participants in on-site HIV prevention (PrEP) and treatment services; 6) enrolling all participants in on-site evidence-based behavioral health care; and 7) linking 80% of participants to recovery support services. TTC anticipates serving 60-80 high-risk SUD or COD patients annually for a total of 380 individuals served over the course of the five-year project period.

Project Abstract: The Argus Community Minority AIDS Initiative will remediate a serious gap in the system of care: recently engaged or re-engaged racial/ethnic minority recipients of substance use disorder services in Manhattan and Brooklyn do not have direct access to services for HIV/HCV prevention education and rapid testing. Argus received SAMHSA NYS block grant support in 2016 from NYS Office of Alcoholism and Substance Abuse Services (OASAS) to conduct an Early Intervention Services (EIS) HIV prevention and rapid testing program for a small number of OASAS-licensed programs in Harlem. With OASAS permission, EIS expanded to Lower Manhattan and Brooklyn, and now serves 23 OASAS-licensed sites. The MAI project will expand total program capacity to 60 sites in the two boroughs. Services to be provided will include HIV prevention education and rapid testing, Hepatitis prevention education and rapid testing, access to confirmatory testing and comprehensive medical care if positive, assessment for substance use disorders and co-occurring mental health disorders (SUD/COD), placement in SUD/COD treatment and evidence-based practices, and tobacco cessation education and referral. There will be no delay in startup: the MAI expands capacity for an existing successful program model that has a comprehensive network of support services and medical care services in place. Argus has provided SUD treatment services for 50 years, operates five bilingual and culturally competent OASAS-licensed programs, provides recovery housing for more than 500 formerly homeless SUD/COD men and women, and provides HIV/AIDS care management for more than 1,000 persons, including a Ryan White Care Coordination program. The MAI will add 15 new, additional partnership outreach sites in each of the first two project years. In full annual operation, the MAI will provide 3,400 HIV rapid tests with 14,500 over the five-year project period. Over five years, 5,400 persons will receive HCV rapid tests, 1,700 will receive HAV/HBV education and linkage to services, 2,950 will receive screening for SUD/COD with linkage to detailed assessment and placement in treatment and EBPs, 5,900 will receive tobacco cessation education and treatment access, and 80% of persons testing HIV+ or placed in SUD/COD treatment will receive GPRA assessment at baseline, 6-months, and 12-months/discharge. Over the five-year project, 20,000 persons will receive bilingual HIV prevention education and access to project services. Based upon EIS data, the population to be served will be 55% Black, 36% Latinx of any race, and 28% female at birth. In 2017, there were 62,922 PLWHA in Manhattan and Brooklyn, with 402 new infections in Manhattan and 640 in Brooklyn. Brooklyn has had NYC’s highest incidence every year since 2011. At least 20 of the proposed 30 new sites will be in Brooklyn, serving populations that are entirely or predominantly persons with SUD, including programs for LGBTQ, formerly homeless, and recently incarcerated. The project goal of meeting this service system gap for persons with SUD is essential to reaching the national goal of Zero New Infections.

Newark NJ is the third neediest city in the US where residents live with high rates of HIV infection and addiction 87pct of those HIV are of minority status 66pct African American and 21pct Hispanic Latino. New Jersey is also at the center of the national opioid health crisis with Newark having the highest rate of heroin use in the state. Team Management 2000 Inc. TM2K is committed to improving the lives of these citizens with the Project Heal. The use of highly effective evidence based interventions will enhance engagement and retention among high risk minority populations improving medical compliance and sobriety. TM2K is a community based behavioral health treatment provider with 20 years of service delivery experience with diverse populations 95pct of clients are minority. They are a current high performing SAMHSA grantee for ten years serving individuals in Essex and Bergen and Passaic counties in New Jersey and are a 20 year Ryan White provider in three counties. This program will increase engagement in care for racial and ethnic minority individuals with substance use disorders SUD and COD mental disorders or Severely Mentally Ill SMI who are at risk for HIV or are HIV positive that receive HIV services treatment. TM2K is concentrating on those consumers most likely to disengage from care and their partners. This includes those men and women who are IDU heroin and methamphetamines users men who have sex with men MSM and those who are coinfected with viral hepatitis B and C. Special attention will be paid to individuals aged 18 to 35. Since the beginning of the HIV epidemic HIVAIDS has been concentrated largely among racial ethnic minorities in northern New Jersey with African Americans most affected but Hispanic Latino individuals a growing proportion with HIV and AIDS Substance use particularly opioid injection drug use IDU has been a leading exposure category for HIVAIDS infection in this community. TM2K will serve 55 unduplicated clients each year for a total of 275 clients over the entire grant period. The overarching goals of Project Heal are to increase the number of high risk or HIV individuals who receive SUD or COD treatment and primary care to increase the number of these individuals retained in SUD treatment and mental healthcare with medication adherence with consistent follow up to primary care to improve overall physical and mental health outcomes. TM2K will accomplish these goals by providing HIV and VH testing initial outpatient behavioral healthcare screening ASI assessment MAT Treatment Plan and case management with linkage to all community support services for this high risk population and their peers or partners. Services will include an integrated package of evidence based treatment interventions and supports inclusive of IDDT with Motivational Interviewing Seeking Safety and WILLOW Peer Education. TM2K will also expand Medication Assistance and adherence treatment MAT to increase retention of those affected by heroin and other opioid addiction

The Multidisciplinary Approach Stabilizing Treatment & Empowering Recovery (MASTER) project aims 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 are HIV positive and reside in the Miami-Dade County Eligible Metropolitan Area (EMA). Thus, the population of focus for the MASTER project consists of ethnic and/or racial minority injection drug users, men who have sex with men (MSM), and individuals who engage in other high-risk behaviors e.g. sexual relationships with injection drug users, sexual exchange for money or drugs). According to the Center for Disease Control, Miami-Dade County, the geographic catchment area where services will be delivered, is the Metropolitan Statistical Area (MSA) with the highest rate of HIV incidence in the nation (47.0 per 100,000 population) and third in the nation for AIDS prevalence (18.9 per 100,000 population). As it pertains to the population of focus, the overwhelming majority of the 1,195 new HIV infections in the EMA are among minority individuals, namely Hispanics (59%) and Blacks/African Americans (32%), and the epidemic continues to be driven by MSM, who account for 84% of new HIV diagnoses in the EMA. The highest incidence of COD is found among Blacks/African Americans (34%: SDIS, 2018). Over a five-year period, the MASTER project intends to provide 1,075 unduplicated, high-risk minority individuals with services including, but not limited to: 1) community outreach; 2) screening; 3) HIV and viral hepatitis testing; 4) comprehensive case management; 5) referrals and linkages to care; and 6) evidence-based outpatient and residential substance abuse treatment. Furthermore, the MASTER project aims to conduct a minimum of 500 screenings per year to identify and enroll at least 150 unduplicated high-risk individuals in appropriate care e.g. SUD treatment, HIV/Hepatitis treatment) in year one, 175 in year two, 200 in year three, 250 in year four, and 300 in year five of the project. The MASTER project will provide SUD/COD treatment and recovery support services for the population of focus through engagement in evidence-based outpatient and/or residential treatment curriculums. All MASTER project participants deemed appropriate for FDA-approved medication assisted treatment (MAT), will be offered such services. Additionally, all MASTER project participants will be offered recovery support services throughout treatment and post-discharge, including: comprehensive case management, care coordination and housing assistance, primary care and benefits enrollment, and employment services. The MASTER project will refer 100% and link 80% of discharged clients to comprehensive follow-up care resources. Close collaboration with partners including the Borinquen Health Centers; Florida Department of Health; University of Miami Infectious Disease Elimination Act (IDEA Exchange) Needle Exchange Program; Banyan Health Systems; Citrus Health Network; and Certified Peer Specialists, will help to comprehensively serve and provide linkages of care for the population of focus.

Volunteers of America Southeast Louisiana (VOASELA) is uniquely positioned and qualified to increase engagement in care and reduce high-risk behaviors associated with men having sex with men (MSM) and African American men and women (AAMW) with substance use (SUD) and/or co-occurring mental (COD) disorders who are at risk for HIV or are HIV positive and receive HIV services/treatment. VOASELA, formerly known as Volunteers of America Greater New Orleans (VOAGNO), has served parishes in and around the New Orleans Metropolitan Statistical Area since 1896. It has demonstrated a strong commitment to providing high-quality, evidence-based interventions with a special emphasis on individuals with HIV, SUD and COD, veterans and other vulnerable populations. VOASELA has been serving individuals through Ryan White and HOPWA funding since 1998. In FY2017-18, VOASELA served more than 54,000 individuals. Nationally, Louisiana is ranked 4th for HIV case rates, 5th in the Baton Rouge MSA, and 4th in the New Orleans MSA. African Americans in Louisiana are experiencing a severe health disparity related to HIV, SUD and COD. In 2017, 69% of newly diagnosed HIV cases and 71% of newly diagnosed AIDS cases were African American, with the primary risk factor involving MSM. 25% of all new HIV diagnoses occurred among persons 13-24 and 37% occurred among persons 25-34. These statistics are staggering and demonstrate an unmistakable need for the expansion of the community-based case management/health navigation services focusing on community resources, community outreach, HIV/STD/Hepatitis testing and warm “hand-offs” between social service agencies and medical facilities where SUMSM and AAMW can access services. (December 2018 Louisiana HIV/AIDS, and Early Syphilis Surveillance Quarterly Report) Many SUMSM and AAMW do not seek treatment reinforcing the need to develop interventions outside of traditional treatment settings. Combination approaches SUMSM and AAMW are needed to reduce and/or modify high-risk behaviors. Evidence based practices (EBP) and interventions that will be adopted include Cognitive Behavioral Therapy, Motivational Interviewing; Many Men, Many Voices; and the Matrix substance abuse model. These EBPs will be delivered in community-based settings, in 16 parishes in Southeast Louisiana, for SUMSM and AAMW who are at highrisk or have been diagnosed with HIV and could benefit from this program. (U.S. Dept. of Health and Human Services/Secretary’s Minority AIDS Initiative Fund National HIV/AIDS Strategy: Updated to 2020) In coordination with the NHAS and Louisiana’s 2017-2021 Integrated HIV Prevention & Care Work Plan, VOASELA’s goals are to reduce the number of new HIV infections, increase access to care, and reduce HIV-related disparities and health inequities. VOASELA proposes serving 355 individuals (65 during year 1-2; 75 during years 3-5.)

Alliance for Positive Change's proposed Open Doors Project (ODP) will serve HIV+/high risk persons who are assessed as having substance use disorder (SUD) and may also have one or more co-occurring disorders, e.g., mental illness, homelessness, or criminal justice involvement. The primary population served will be low-income, underserved African-American and/or Latino Men who have Sex with Men (MSM) (gay/bisexual men, and men who do not identify as either), and subpopulations of women of color, including transgender women. Based at Alliance's Northern Manhattan site, some services also will be provided in Midtown Manhattan, Lower East Side, and East Village. ODP Goals are: 1) Serve 250 clients in Year 1, 300/year in Years 2-4, and 200 in Year 5; 2) All clients are aware of their HIV/Hep-B/Hep-C status and are receiving appropriate care; 3) Decrease clients' substance abuse via via evidence based, trauma informed SUD programming; 4) Improve access to/usage of services addressing HIV/Hep-B/Hep-C nfection and Social Determinants of Health related to poverty that impact recovery; 5)Improve data trackng, analytics and reporting to increase program efficacy. ODP will use the Prochaska-DiClemente Transtheoretical Model of Behavior Change, which posits that health behavior change involves progress through five stages of motivational readiness to modify ""problem behaviors"". This model will use a peer-mediated, ""open door"" approach that provides access to SUD/HIV/hepatitis treatment and counseling/testing/referral services to engage clients wherever they are on the recovery continuum and support their journey from active user to long-term abstinence/sobriety/ wellness. Services will include: 1) Evidence-Based Programs (EBPs): Seeking Safety, Living in Balance, Healthy Relationships, and CLEAR (Choosing Life: Empowerment! Action! Results!); 2) enabling enrollment in Alliance's NYS-licensed OASAS SUD treatment program or other inpatient/outpatient program; 3) HIV/Hep-C testing/referral to treatment and Hep-A/Hep-B testing/vaccine; 4) 4) recovery support, e.g., Medication Assisted Therapy, targeted interventions, support groups, sober social events, and vocational development; and 5) connection to mental health counseling, supportive services, and medical treatment services through referral follow-up with program partners.

The NeuroMusculoskeletal Institute at Rowan School of Osteopathic Medicine, which has been designated by the State of New Jersey as a Center of Excellence for Medication Assisted Treatment for individuals with opiate use disorders, proposes a partnership with Maryville Addiction Treatment Center to engage 300 high-risk African American and Hispanic men into substance use treatment, including recovery support, HIV/hepatitis testing, and linkage to care. In 2017, drug overdoses killed more than 70,000 individuals nationwide. According to the Centers for Disease Control and Prevention, in 2017, the drug overdose death rate in New Jersey increased 29% from the previous year, the largest in the nation. In the same year, New Jersey ranked eighth in the nation with 37,411 people living with HIV. The geographic catchment area for the project will be eight counties in New Jersey with the highest opiate overdose deaths and highest HIV rates. These counties include Essex, Hudson, Union, Passaic, Mercer, Camden, Atlantic, and Cumberland. Of New Jerseys 21 counties, these eight counties accounted for 49% of all drug overdose deaths, 48% of all admissions to substance use disorders treatment, and 45% (16,800) of all people living with HIV in New Jersey. African American and Hispanic men are disproportionately affected by HIV in New Jersey, with 37% living in the eight-county region. Community surveillance has identified a sub-population of men in New Jersey who simultaneously inject opiates (to relieve pain) and inhale crack cocaine (to increase sexual arousal) and participate in unprotected, receptive anal sex with African American and Hispanic men in exchange for money or drugs who are targeted through the project. The goals of this project are designed to align with the required activities listed in the funding opportunity announcement, including 1) engaging 300 African American and Hispanic men of New Jersey with substance use disorders and co-occurring substance use and mental health disorders that are living with or at high-risk for HIV into treatment at Maryville Addiction Treatment Center; 2) increasing the number of men with substance use disorders who know their HIV and hepatitis B/C status and are linked to medical care based on their status; and 3) providing recovery support for the men throughout their continuum of care and into the community for up to one year using an evidence-based recovery coaching model that integrates strength-based case management with motivational interviewing and contingency management. All participants will have access to FDA-approved medications for treatment of substance use and mental health disorders and will receive overdose prevention education as part of their treatment program. The project has formed a large collaborative of major health systems in New Jersey that can provide medical care to the men. Rowans NeuroMusculoskeletal Institute will provide access to HIV and hepatitis testing and access to MAT. Maryville will provide substance use disorders treatment based on the mens assessed level of need and recovery coaching. The project will be evaluated by the Rutgers University Center for Prevention Science.

Mile High Behavioral Healthcare (MHBHC), serving the metropolitan Denver area proposes the Knowledge Is Freedom project to support client engagement in HIV preventative, medical, and behavioral health care, decrease risk-taking behaviors and improve behavioral health treatment outcomes. Over 5 years, 300 clients will receive trauma-informed, ""one-stop"" peer-informed preliminary and confirmatory testing, SBIRT, and behavioral health treatment services. . The population of focus is 300 (60/yr) racially/ethnically diverse individuals with substance use disorder (SUD) and SUD with co-occurring mental health disorders (MHD) who are homeless or are at risk of homelessness, as well as the LGBTQ+ and transgender populations. 33.8% will identify as Hispanic, 11.8% as African American, and 5.9% as Native American / Alaskan Native. As the Denver area's only provider of Ryan White services dually licensed by the Colorado Office of Behavioral Health as a mental health ad substance use disorder treatment provider with a specialty clinic designation for LGBTQ+ subpopulations, clients will be enrolled through two branches of the organization: LGBTQ+ behavioral health programs and emergency, day, and transitional housing programs. Knowledge Is Freedom will attain the following goals: 1) Increase behavioral health and medical treatment engagement by building MHBHC'c capacity to conduct trauma-informed, culturally relevant, peer-supported in-house, onsite HIV, HBV, and HCV rapid and confirmatory testing with linkage to medical care; ; 2) Using a Treatment as Prevention (TasP) approach, increase access to and retention in SUD/MHD and medical treatment for racially and ethnically clients who test positive for HIV, HVB, and/or HVC; 3) Increase access to and retention in behavioral health treatment for racially and ethnically diverse high risk clients who test negative for HIV, HVB, and/or HVC. These goals will be achieved through staff expansion to include a 1.0 FTE onsite phlebotomist, 1.0 FTE case manager/project coordinator, 1.0 peer recovery specialist and 2.0 FTE licensed therapists. Evidence based practices will be delivered through MHBHC's harm reduction, person-centered treatment philosophy and delivered by a peer-led workforce and include fourth-generation HIV testing and on-site PrEP service as well as Colorado SBIRT for clients in MHBHC homeless programs. . In addition, Sisters Informing Sisters about Topics on AIDS (SISTA)/Transgender Women being Informed by Sisters about Topics on AIDS (TWISTA), Healthy Relationships, Spiritual Self-Schema (3-S), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Seeking Safety (SS), intensive case management (ICM), telehealth and medication assisted treatment will be provided. Key outcomes include number of clients served (including new clients served as a result of this funding) and tests completed, number of clients with HIV linked to HIV services, diagnoses, reduction of viral load, PrEP adherence, treatment access, retention and engagement, reduction in viral load, decreased SUD/MHD symptoms and improved psychosocial functioning including improved social connectedness.

The Montrose Center will serve at least 30/year gay and bi men and transwomen African American and Latino 18 years old and older in Harris County, Texas who engage in chemsex putting them at very high risk for contracting and transmitting HIV and hepatitis. Participants will be living with HIV or at high risk of contracting HIV through sexual activity. Chemsex means the participant has been sexually active, often without condoms or other protect, while using drugs. The project will used an enhanced Integrated Treatment Program (E-ITP) adding Sexual Health in Recovery (SHIR) component. SHIR will include education about sexual health addressing the frequent interaction between sexual behavior and substance use disorders. The particular drugs used include methamphetamine, GHB/GBL, MDMA, cocaine, ketamine and sometimes erectile dysfunction medication. Goal 1 Begin providing HIV/hepatitis testing & linkage services the 4th mo of the contract. Obj. 1-1 By the end of the 3rd month the QI team will update all on-site testing protocols and train the Prevention Specialist on EITP-SHIR study protocols.. Goal 2 Begin providing EITP-SHIR services the 4th mo of the contract. Obj. 2-1 Consistent with ITP process evaluation protocol, monthly, during the 1st 4 mos of funding, the QI team will complete the ITP readiness assessment checklist to determine preparedness to begin service delivery. The QI team consists of the Center’s ED & CAC, and the UTHealth Evaluator. Obj. 2-2 By the end of the 3rd mo, the QI team will train recovery coaches as well as community agencies that serve as a referral source to services on how to refer and link potential consumers for EITP-SHIR intake. Goal 3 Enroll and retain 30 unduplicated clients each year for a total of 150 unduplicated clients. Obj. 3-1 At mo 4, enroll on average 2.7 new consumers in EITP-SHIR, so that 150 new consumers are enrolled in EITP-SHIR by the end of year 4 + month 3 and able to complete 6-month follow-up assessments. Obj. 3-2 At mo 4, complete the intake/initial evaluation process for 90% of new consumers within 10 business days. Obj. 3-3 At mo 6, retain at least 80% of consumers who enroll in EITP-SHIR for a minimum of 6 mos. Obj. 3-4 At 1-, 3- and 6-mos from baseline, 80% of consumers will complete follow-up assessments. Obj. 3-5 At mo. 4, identify the most common SUD and MH diagnoses among participants enrolled in EITP-SHIR. Goal 4 Implement a quality improvement process. Obj. 4-1 At mo 5, the QI team will participate in monthly process and quality improvement meetings to review analyses and use findings to inform changes to service delivery protocols, documenting changes and the reason for the changes. Obj. 4-2 Consistent with EITP-SHIR process evaluation protocol, by the end of the 6th mo and thereafter every six mos, the QI team will collect process improvement data using the integrated fidelity scale, general organizational index, and various measures of cultural competency. Obj. 4-3 Every 6 mos, the QI team will facilitate a community advisory meeting, review results of available analyses and solicit recommendations for program improvement, documenting changes and the reason for the changes.

Abstract FACES NY, Inc. as the sole grantee is proposing to implement Dynamic Regeneration Effective Amongst Minorities [D.R.E.A.M] Project with two locally established partners in the fields of comprehensive medical services and behavioral health so as to facilitate a cohesive flow of services and prevent delays. Our project partners are Citicare, a medical and mental health provider; with locations in close proximity to FACES, Reality House, a substance use/behavioral health provider that provides services on-site at FACES and The Bridge, Inc., a comprehensive behavioral health provided that offers mental health and substance abuse treatment, housing, vocational training, job placement etc., with sites in close proximity to FACES. Project Dream, through its partners will use a strengths-based continuum of care model to provide immediate access to culturally appropriate, trauma-informed substance abuse/co-occurring mental health treatment and HIV/viral hepatitis services. The Project will assist in meeting SAMHSA’s and FACES goal to increase engagement in care for racial and ethnic minority individuals with substance use disorders and/or co-occurring substance use and mental disorders who are at risk for HIV or are HIV positive that receive HIV services/treatment. Each proposed partner affiliated with Project Dream has over 20 years of providing specialized and quality services to the NYC community and the implementation of EBPs. These combined levels of expertise will provide synergy in addressing HIV/AIDS risk and/or care accompanied with access to treatment for substance use and substance use and co-occurring mental health disorders for project participants. The Project will serve 1200 individuals throughout the grant for five years. Goals and Objectives: Goal 1: Reduce the rate of infection for HIV, STI and viral hepatitis among population of focus . Objective A: 100% of participants and where appropriate their sex partners, will be tested for HIV and where applicable Hepatitis A, B, C through FACES NY’s Objective B: 80% of participants who test positive will be linked to primary care for confirmatory testing and treatment Objective C: 100% of participants will be screened for HIV risk factors and educated on safer sex practices Objective D: 80% of participants will engage in Motivational Interviewing (MI) counseling Objective E: Refer 80% of individuals testing negative to FACES’ Linkage to PrEP/PEP program Goal 2: Address and reduce substance use including alcohol, cocaine and injecting drugs, by referring participants to substance abuse treatment and recovery services for short and long term inpatient/outpatient care. Objective A: Screen and assess 100% participants for SUD/COD Objective B Educate at least 80% of participants with SUD/COD, about the permeating negative impact of substance abuse on the individual and family Objective C: Utilize MI intervention to encourage motivation to change Objective D: Refer at minimum 80% of participants to culturally and linguistically appropriate, trauma informed, evidence-based substance use/mental health treatment services; Objective E: Monitor 100% participants to ensure treatment fidelity Objective F: 80% of participants will participate in Seeking Safety EBI. Goal 3: Improve health and social outcomes for population of focus. Objective A: Screen and assess psychosocial needs of 100% participants Objective B: Assist participants to access culturally and linguistically appropriate social services Objective C: Convene an annual summit of community providers and stake holders Objective D: Assess available resources in the community and implement strategies for improved access and support of new interventions.

The St. Luke's-Roosevelt Hospital Center's Coming Home Program (CHP) located in the Morningside Clinic at St. Luke's Hospital in Harlem, New York City, aims to reduce health disparities by providing primary healthcare, mental health, evidence-based interventions and social services to New York City's formerly incarcerated adult populations, primarily African American and Latino, who are re-entering the community upon release from NYC/NYS jails and prisons. The CHP will screen and treat for HIV, HBV/HCV, substance use and/or co-occurring mental disorders (SUD/COD). The CHP will partner with community-based organizations to refer CHP patients for needed support services such as housing, employment training, education support, legal services and family reunification services. The CHP will provide services to 300 formerly incarcerated individuals over a 5-year project period, or 60 formerly incarcerated individuals annually. The majority of NYC's justice-involved population are people of color, with 53.2% being African American and 33.1% being Hispanic. Among NYC's jail inmates, roughly 48% self-report substance abuse upon admission, and 43% need mental health treatment. New York State has the largest percentage of prisoners who have HIV (3.5%) in their custody population, and third largest total number of inmates (1,820) who are HIV positive. It is further estimated that 33% of all people with Hepatitis C pass through the correctional system. The goals and main objectives of the CHP are: Goal 1: Increase the number of formerly incarcerated adults in NYC who receive substance use and mental health treatment and recovery services, by engaging with 60 new formerly incarcerated patients annually in SUD/COD treatment; Goal 2: Enhance the quality/intensity of treatment for patients with substance abuse disorders with/without co-occurring mental health disorders by providing evidence-based treatment interventions to 80% of clients screening positive for SUD and/or COD, including SBIRT, Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Mindfulness-Based Relapse Prevention (MBRP), Seeking Safety, and/or Medication Assisted Treatment (MAT); Goal 3: Enhance and expand screening referral and treatment for HIV and Hepatitis B/C infection among formerly incarcerated adults in NYC by implementing universal HIV/HBV/HCV screening for 100% formerly incarcerated patients and linking patients who test positive to medical care within the Morningside Clinic; and Goal 4: Enhance case management services to address barriers to care, facilitate linkages to follow-up care, and increase access to critical wraparound support services for formerly incarcerated individuals. The CHP will provide case management to 100% of clients enrolled in the CHP, including those patients who are HIV+ or at risk for HIV; the social workers will assist clients with getting health insurance, facilitating internal referrals for medical, mental health and other support services and link them with community partners for other wraparound services.

Neighborhood House Project HANDLE MAI-SUD will address an unmet need for substance use disorder (SUD) and/or co-occurring disorder (COD) treatment for under-served groups in Seattle and King County, WA. We will focus on US and foreign-born Black and Latinx adults who are low-income or homeless and HIV and/or Hepatitis C positive, or high-risk. Seattle and King County have been severely impacted by the opioid epidemic; our area also experiences a high rate of methamphetamine use. Additionally, our state has some of the nation's highest rates of mental health issues. Black and Latinx adults in King County are disproportionately impacted by poverty, homelessness, and HIV/AIDS. Despite these needs, our geographic area has limited availability of linguistically and culturally appropriate SUD/COD treatment programs for U.S. and foreign-born Blacks and Latinx who are HIV/HCV positive or high risk. The service gap is particularly acute for those with limited English proficiency. Barriers to accessing care include stigma of HIV and HIV testing; lack of outreach and trust with providers; limited follow-up for client retention in SUD/COD, HIV adherence and SUD/COD treatment and recovery; transportation barriers; lack of integration of HCV services into existing HIV programs; and lack of culturally appropriate SUD and COD treatment services. We propose to integrate SUD, COD, outreach, HIV/Hepatitis services and other wraparound services in and around our the behavioral health facility of our partner, Navos. We will also partner with Country Doctor Community Health Centers, a Ryan White provider, for HIV and Hepatitis care. Strategies and EBPs to be used in our project include SBIRT, Motivational Interviewing, Cognitive Behavioral Therapy, Moral Reconation Therapy, and Social Network Strategy. These EBPs have already been shown to be effective with our populations of focus and will not require any modifications. We propose to reach 780 unduplicated individuals from the population of focus via outreach in our catchment area during the five years of the project: 120 in Year 1, 190 in Year 2, 190 in Year 3, 190 in Year 4, 120 in Year 5. We propose to enroll 580 unduplicated clients from our population of focus during the five years of the project: 80 in Year 1, 140 in Year 2, 140 in Year 3, 140 in Year 4, 80 in Year 5.

Meta House's (MH) Prevention, Access, Treatment, and Health (PATH) program will serve women with the highest risk of HIV infection in Milwaukee, Wisconsin: women (primarily minority women) with substance use disorders (SUDs) and co-occurring disorders (CODs). The proposed outpatient program will integrate SUD treatment, trauma and mental health treatment, HIV/Hepatitis testing and risk reduction, Hepatitis vaccination, health education, case management, recovery support services, and a comprehensive array of wraparound services into MH's outpatient program. The program expects to serve 250 women during the five years of the grant (50 each year of the grant). The women served will be racially/ethnically diverse, low-income, and typically have multiple special needs in addition to SUDS and CODs, such trauma history, low literacy, unstable housing/homelessness, and employability concerns. The goals/objectives of the PATH project are to: 1) serve primarily African-American and other racial/ethnic minority women who have SUDs and are at risk for contracting HIV in outpatient SUD/COD treatment; 2) provide population appropriate, evidence based, trauma informed treatment for women (specifically, that all women will be screened for trauma and receive trauma services, 80% of women will receive peer services, all women and their partners will be offered testing for HIV and Hepatitis, 80% of the women will receive HIV/Hepatitis testing and risk-reduction services, and all those with positive results will be receive confirmatory testing and receive follow-up counseling, case management, and medical care); 3) improve women's level of functioning related to recovery from substance use, mental health and trauma symptoms, and access to health care (specifically, women will show statistically significant decrease in substance use and mental health/trauma symptoms and will have access to health care at follow-up), 4) reduce women's risk of HIV/Hepatitis infection and transmission (specifically, women will show decreased risk behaviors). Meta House has provided gender-responsive, trauma-informed, culturally-competent substance abuse and mental health treatment for 55 years. To achieve these goals, the PATH project will collaborate with Ascension (an experienced health care provider) to integrate the following evidence-based practices into its outpatient treatment program: 1) Motivational Interviewing to treat SUDs and reduce substance-related risk behaviors; 2) Seeking Safety to reduce substance use, the effects of trauma, and risk behaviors associated with both substance use and violence/trauma exposure; and 3) RESPECT to address HIV/Hepatitis risk behaviors.. The performance assessment for the PATH project will be conducted by an external evaluator with more than 25 years of experience evaluating SAMHSA grants. The performance assessment will use findings from intake and 12 month follow-up interviews, as well as qualitative and process data, to examine the extent to which the PATH project meets its goals.

Volunteers of America of Los Angeles (VOALA) will provide residential substance abuse treatment (and subsequent step-down outpatient) with integrated mental health, HIV and medical care, and comprehensive recovery support services for 225 racial and ethnic minority adult women with SUD and/or co-occurring SUD and mental health disorders who are at risk for HIV or are HIV positive in Los Angeles County, California with a focus on SPA 8, South Bay. Population: The project will provide residential treatment for adult females ages 18 and older of which it is anticipated that 75% of participants will be racial/ethnic minority populations with the predominant populations being African American/Black and Hispanic/Latina women. The primary drugs of choice for the targeted population are alcohol and/or methamphetamines. The project will address a service gap in disparities to treatment access, use, and outcomes. Interventions: The project will incorporate the EBPs of the Matrix Model, Seeking Safety and Healthy Living Project for People Living with HIV with Motivational Interviewing and trauma-informed care integrated throughout all interventions. These EBPs have been shown to be effective in decreasing SUD, co-occurring trauma and/or mental health disorders, as well as reducing risky behaviors and treatment adherence while also being effective with minority women. In addition to residential SUD treatment with step-down outpatient, clients will receive integrated mental health and trauma-informed care (including IPV groups), HIV prevention/testing and care, medical care, case management, and wraparound recovery-oriented supportive services, and three months of aftercare to promote stability and improved outcomes. Goals & Objectives: The project will serve 45 clients annually for a total of 225 clients over the 5-year period. Goals for the targeted population include: 1) Improve the health of racial/ ethnic minority adult women by implementing a trauma-informed, evidence-based residential SUD treatment program (and stepdown outpatient) with integrated mental health and HIV/health care; 2) Improve the stability of racial/ethnic minority adult women by providing and/or coordinating comprehensive recovery services; and 3) Improve effective project implementation and evaluation by conducting continuous quality improvement activities Objectives for clients served by the end of each year include: 100% will be offered HIV testing and will link clients who test positive to case management/follow-up care; 65% will increase abstinence from alcohol and/or substance use; 65% with COD will participate in mental health counseling; 100% who are at-risk for viral hepatitis will be offered testing, vaccination, and linkages to treatment; 40% who are engaged in tobacco cessation will reduce their past 30-day use; 50% will improve their housing stability; 70% will increase use of recovery/peer support services; 50% will improve their education and/or employment status, and/or access to disability benefits; and 60% will decrease criminal justice involvement. The project will also conduct quarterly meetings to monitor project outcomes. Morehead State University will conduct an independent evaluation.

The Fulton County Department of Behavioral Health and Developmental Disabilities (DBHDD) proposes a program to increase engagement in care for Black and Latino men who have sex with men (MSM) ages 18-40 with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for HIV or who are HIV positive and receiving HIV services/treatment in Fulton County, Georgia. Data from the US Census shows the combined population of the service area is 1,010,420 and 44.1% are Black/African-American; 45% White non-Hispanic; 7.4% Hispanic/Latino; and Asian 6.7%. Epidemiologists at the Georgia Department of Health estimate that there are 17,316 MSM residing in Fulton County and further document that 9,983 were HIV positive in 2017. DBHDD will be responsible for financial and program administration and oversight. DBHDD will hire all staff for the Fulton County Community Linkage Adherence Support Services (CLASS) program. DBHDD will oversee the day-to-day operations of the CLASS program and work, in collaboration with its partners (Fulton County Board of Health [FCBOH], River Edge, and CHRIS180) to provide safe and appropriate services to Black and Latino MSM with SUD/COD who are at risk for HIV or are HIV positive and receiving HIV services/treatment. DBHDD, through service provider partners (River Edge and CHRIS 180), will provide evidence-based SUD/COD treatment and recovery support services to individuals at risk for or living with HIV, including screening/assessment, outpatient services, intensive outpatient services, and the use of FDA-approved medication for the treatment of SUD/COD. Newly diagnosed Black and Latino MSM and those previously diagnosed but lost to care and found through outreach will receive professional social work services that will mitigate social and behavioral health barriers to linkage and retention to HIV care. FCBOH will use A youth focused case management intervention to engage and retain young gay men of color in care to deliver intensive case management services to promote engagement and retention in care. FCBOH will provide direct services (Ryan White funded HIV treatment and HIV testing) through its Sexual Health Clinic as well as viral hepatitis B and C on site testing and referrals to treatment. CLASS goals include: 1) increasing engagement and re-engagement in care for Black and Latino MSM with SUD/COD who are at risk for HIV or are HIV positive and receiving HIV services and treatment and 2) increasing retention in care rates and viral suppression rates among the POF. DBHDD plans to serve a minimum of 500 Black and Latino MSM ages 18-40 with SUD/COD who are at risk for HIV or who are HIV positive and receiving HIV services/treatment in Fulton County, Georgia over the five year grant period (72 in year 1 and 107 annually years 2-5).

Serving Children and Adults in Need Inc. (SCAN) is proposing to implement its Healthy Border Initiative Project in Webb County, Texas, located along the Texas-Mexico border. The population of focus is Hispanic females and males 18 years of age and older at high risk for HIV/Hepatitis infection who meet the criteria for a substance use disorder (SUD) or co-occurring substance use and mental health disorders (CODs). The project will provide behavioral care to a total of 500 clients using evidence based practices over the life of the project (100 participants per year). In addition, a total of 1,250 high-risk individuals (250 per year) and their partners will be tested for HIV and hepatitis. The project will implement five evidence-based practices (EBPs) which are: Acceptance and Commitment Therapy (ACT), Motivational Interviewing (MI), Seeking Safety, the Matrix Model, and RESPECT. These (EBPs) will be part of a holistic approach that will focus on the substance use, gender, sexual orientation, mental health, traumatic stress, HIV/Hepatitis, and recovery needs of participants. The EBPs will address the diverse behavioral needs of the population of focus and will meet the population's linguistic and cultural needs. These evidence-based practices will focus on engagement, retention and motivation to treatment; substance use; traumatic stress and substance use; co-occurring substance use and mental health disorders; and HIV/Hepatitis prevention. EBPs will be delivered in a continuum of services that integrates the project's resources (behavioral care with HIV and hepatitis testing, hepatitis vaccinations, FDA approved medication) with HIV/Hepatitis medical care and SCAN's other services and the resources in the community. The goals of the project are: 1) Prevent the spread of HIV by providing HIV preliminary antibody testing at program enrollment; 2) Provide onsite and offsite HIV testing in accordance with state and local requirements; 3) Provide case management, referral/linkages to follow-up care, and treatment for all clients who have preliminary positive and confirmatory HIV test results; 4) Develop memoranda of agreement with primary HIV treatment and HIV care providers to strengthen integration of care through case management; 5) Screen and assess clients at high risk for HIV infection or HIV positive for the presence of co-occurring disorders (CODs) and develop appropriate treatment approaches utilizing evidence-based practices (EBPs); 6) Prevent the spread of viral hepatitis by providing timely testing and linkages to treatment; 7) Facilitate recovery, foster physical health and improve participants' lives by demonstrating positive outcomes at discharge and 6-month follow-up based on GPRA data; 8) Collect quality data efficiently and consistently to ensure the best positive clinical outcomes, timely reporting and program improvement; and 9) Develop a culturally and linguistically-informed project to meet the specific cultural and linguistic needs of participants from the border region.

Odyssey House Louisiana (OHL) proposes to increase engagement in care and expand access to evidence-based treatment for African American and other racial/ethnic minority men who have substance use disorders (SUD), opioid use disorders (OUD) and/or co-occurring substance use and mental disorders (COD), and who are at risk for or living with HIV/AIDS. The objective of the Odyssey House Minority Empowerment Group for Addiction (OHMEGA) project is to provide a trauma-informed, culturally competent treatment program that addresses the unique service needs of high-risk minority men. The project will serve 35 unduplicated participants in year one and 45 each in years two and three (125 total). Project services will be delivered in New Orleans, LA, and the project’s catchment area is the New Orleans-Metairie-Kenner Metropolitan Statistical Area, which includes eight parishes (i.e. counties) known collectively as Greater New Orleans. The project’s key staff include a Project Director, Program Manager, Program Coordinator, Licensed Counselors, and an Outreach Coordinator; additional support will be provided by a Case Manager, Nurse and Patient Care Coordinator. Clinical staff will be trained on the “Seeking Safety” and “M-TREM” trauma-informed curriculum, as well as additional evidence-based practices including Medication Assisted Treatment (MAT) for clients with OUD. Participants will primarily be recruited from OHL’s Adult Inpatient Program and Medically Assisted Detox Program, and will be enrolled in 1-6 months of Intensive Outpatient (IOP) services with transitional housing. Project activities will increase engagement in SUD/OUD/COD care; increase housing stability, income and social connectedness; and increase community capacity for HIV rapid preliminary antibody testing, viral hepatitis testing, outreach, prevention, and referrals/linkages to follow-up care. Project participants will demonstrate higher rates of retention in care, lower rates of substance use and risk behaviors, and higher rates of housing stability, employment and social connectedness. This service expansion and enhancement project will ensure that every high-risk minority man and woman with SUD, OUD and/or COD entering OHL's long-term program (approximately 90 individuals per year) will have access to trauma-informed, gender-specific, and culturally relevant treatment options.

Stanley Street Treatment and Resources (SSTAR) intends to serve 325 Hispanic Latino individuals with Substance Use Disorder at risk for or living with HIV in Fall River and New Bedford, Massachusetts through the proposed project, Fuerza Latina. Fall River and New Bedford have opioid addiction rates that exceed the state and national averages. Latinos in Massachusetts continue to be disproportionally impacted by HIV, representing 29 percent of all new infections from 2012-2014 despite being only 9.6 percent of the state population in 2010. Fuerza Latina will provide rapid HIV testing to 100 Latinos with SUD and their partners through targeted mobile outreach and within SSTAR MAT clinic. Referrals to PrEP and HCV testing and treatment for eligible clients will be made. Partnerships with local agencies serving Latinos at risk for SUD are in place. We will link newly diagnosed HIV clients to HIV treatment and medical case management at SSTAR FQHC or our partner Ryan White provider in New Bedford. We will increase the engagement in MAT and mental health counseling of Latinos with SUD by 65 new enrollments per year. Nurse care management will be utilized to retain people in SUD treatment thereby reducing illicit and prescription opioid abuse among Latinos in our area. The program will address cultural and language barriers among our population through targeted outreach to Latino communities, relationship building with Latino groups, and programming offered by bilingual staff. We will provide evidence-based services including Rapid HIV Testing, ARTAS Linkage to Care, MAT, MI, and MET. Participants will complete data collection for evaluation at intake, 6 months, and discharge, managed by Program Evaluator, Dr. Allison Minugh.

Epidaurus dba Amity Foundation’s Almas de Amistad project (Almas) proposes this project to increase engagement in care for racial and ethnic minority women with substance use disorders and or co-occurring substance use and mental disorders who are at risk for HIV or are HIV positive that receive HIV/AIDS services/treatment in Albuquerque Metropolitan Area inclusive the Five Sandoval Indian Pueblos, and the Santo Domingo Pueblo, both federally recognized tribes. Almas will provide a women-specific, trauma-informed, evidence based substance abuse and trauma curriculum (Seeking Safety) group and individual counseling; veteran-specific groups, 12-step meetings; referrals; onsite rapid HIV testing, referrals for confirmatory testing and treatment; referrals for viral hepatitis B and C testing and treatment referrals; referrals for hepatitis A & B Vaccinations; evidence-base interventions for HIV/AIDS (Amigas), assistance with finding housing; adult basic education including GED prep classes, tutoring and testing; access to vocational training; workshops; and job readiness. In addition, women will receive parenting classes, family sessions, and seminars on women-specific topics such as domestic violence. Almas will also provide referrals for primary medical care, prenatal education and care, childcare education services, mental health services, and, as needed, housing assistance, food and clothing assistance, education and vocational assessments and placements as well as other wrap around services. Treatment length will vary from 3 to 12 months. Almas will collaborate with community based outreach partners that are rooted in the culture of our population of focus to conduct outreach. All of Almas’ services will be bilingual (Spanish/English) and will be inclusive of individuals regardless of age, gender, race, ethnicity, culture, literacy, sexual orientation, or disability. The unduplicated total of women we plan to serve is 450 over three years (90 per year). Expected objectives/outcomes are: • 90% of clients demonstrating risky behaviors for HIV will receive HIV rapid preliminary antibody testing at enrollment in accordance with state and local requirements • 100% of clients testing positive will receive HIV confirmatory testing and status follow-up and medical care within 30 days • 75% will be compliant with ART medications and will be virally suppressed • 75% of clients engaged in care for HIV will be compliant with recommended treatment • 90% of clients demonstrating risky behaviors for Hep B&C will receive Hep B&C testing; • 90% clients testing negative for Hep B will be receive Hep A & B vaccinations • 75% will report decrease or abstinence in substance use • 75% of those with intake HITS score over 10 will report decreased HITS score at 6mo follow-up (decrease of IPV risk) • 75% of women served at Almas will report an increase in condom usage

COPE Community Services, Inc. (COPE) proposes to implement Project TELA (Treatment Engagement Linking At-risk Women) to address the critical need for engagement-focused substance use/co-occurring mental disorder (SUD/COD) treatment in Pima County, AZ. TELA Project will serve 285 minority women over five years and will increase engagement in care for minority women at increased risk for HIV/AIDS who need SUD/COD treatment and reduce disparities by improving behavioral health outcomes. The TELA Project’s goals are as follows: 1) expand program engagement services for minority women in Pima County; 2) increase engagement in care for minority women with SUD/COD at risk for HIV or who are HIV positive in Pima County; and 3) reduce health disparities by improving behavioral health outcomes among TELA Project’s clients. COPE will serve adult racial/ethnic minority women with SUD/COD who are positive with or at risk for HIV. All clients will be screened for history of substance use, mental health disorders, and HIV/hepatitis status. Based on county demographics and previous programs, the client population is anticipated to be approximately 50% Hispanic/Latina, 10% African American, 20% Native American, and the remainder Multi-Racial. The most vulnerable of these women exhibit high rates of substance use, risky sexual behaviors, and a lack of access to care: a risk profile further shaped by a disproportionate burden of HIV. In 2017, the rate of emergent HIV cases for Hispanics was nearly twice the rate of emergent cases for Whites, and the rate of emergent cases for African Americans was five times that of Whites. In addition, risky substance use is on the rise in Pima County among the Hispanic population (18.6% reported binge drinking in 2017). Compounding this need, minority populations show the lowest rates of engagement in care for both HIV and SUD/COD treatment. In combination with best practices for outreach, engagement, and retention, COPE will implement evidence-based treatment programs designed to achieve the targeted outcomes. TELA Project’s services will center on engaging and retaining clients in care – meeting a critical need. All enrolled clients will receive engagement services: case management, HIV/hepatitis testing, linkage to medical care as necessary. By co-creating individualized service plans with case managers, clients will develop ownership over their care and treatment. COPE will implement three evidence-based practices: Helping Women Recover, Motivational Interviewing, and Cognitive Behavioral Therapy. TELA Project’s goals and objectives are structured to achieve its purpose: To increase engagement in care, reduce substance abuse, HIV and hepatitis risk, and reduce health-related disparities among minority women TELA Project will use measurable objectives to evaluate attainment of these goals. TELA Project will serve 60 women per year (45 in Year One), for a total of 285 women over the five-year life of the grant.