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

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

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

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

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

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

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

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.

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.

Center Point, Inc. (CPI) is requesting $498,606 per year for up to five years from the SAMHSA Center for Substance Abuse Treatment to expand engagement and enhance comprehensive treatment, prevention, and recovery support services for racial and ethnic minority individuals with substance use and/or mental health disorders and who are at-risk of HIV/AIDS. CPI’s Treatment Link project will expand and enhance outreach and retention in outpatient and residential substance use disorder treatment services for substance abusing men and women in Marin County and the surrounding San Francisco Bay Area. The primary target population will be African Americans or Hispanics/Latinos who are homeless and/or who have been released from prisons and jails within the past year and who are at increased risk for HIV/AIDS due to IV substance use, unsafe needle use, and/or high-risk sexual behavior. The program will offer the necessary services to begin and succeed in emotional, physical, and mental health recovery, including effective and evidence-based outreach strategies and engagement services (Motivational Enhancement Therapy and Interventions); substance use disorder treatment (utilizing the Living in Balance and Seeking Safety curricula) and; primary and specialty medical, mental health, vocational, and educational programs. Treatment Link will utilize evidence-based practices, including providing integrated services (through a co-located FQHC) so that substance use and mental health disorders, primary health and HIV/AIDS services, and trauma and abuse can be treated in the most effective manner. Treatment Link is a component of The Manor, a CARF Accredited DHCS licensed and certified program (DHCS designated ASAM Level of Care 3.1 and 3.5; 1.0 and 2.1 outpatient programs) and is a DMC Certified provider. Over the five year grant period Center Point will: • Expand access to and enhance the quality and intensity of Outpatient and Residential substance use disorder treatment provided to an additional 10 participants per year. A total of 50 additional unduplicated participants will receive substance use disorder treatment services. • Enhance treatment, case management, and supportive services through the implementation of specialized gender-responsive, culturally competent, and trauma-informed programming. • Enhance the quality and intensity of integrated primary care, mental health, and specialty care provided to the 50 participants through expanded access to CPI’s co-located and integrated clinic (a partnership with Marin City Health and Wellness Center, FQHC) to include comprehensive multi-dimensional screening and assessments; HIV and viral hepatitis testing, treatment, and case management and; access to Medication Assisted Therapies. Treatment Link is managed by CPI in partnership with MCHWC and will serve as the primary provider of all substance use and mental health disorder treatment services and will provide case management and collateral support to those referred for confirmatory HIV testing and/or treatment. Center Point has more than forty-five years of experience providing multi-modal, comprehensive substance use and mental health disorder treatment and ancillary services throughout the San Francisco Bay Area.

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.

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.

Project Name: JWCH’s Los Angeles Substance Abuse Treatment (LAST) Project. The primary purpose of the project is to expand and enhance substance use disorder (SUD) and co-occurring mental disorders (COD) treatment, HIV, Hepatitis (B/C) testing, and linkage to HIV care/treatment, mental health, primary care, and wrap-around services. This will primarily be achieved at the project’s hub – JWCH Center for Community Health (CCH), which is the largest comprehensive community health center for the homeless, located in the Skid Row area of Los Angeles County. Population to be served: The geographic area to be served is the Skid Row section of Downtown Los Angeles. It is a 50-block area (and a more dense 17-block epicenter)—the largest community in the United States composed entirely of indigent, transient, and low-income residents, with a daily homeless population of about 14,000. The principle population of focus are Black/African American and Latino gay, bisexual men or men who have sex with men (MSM), transgender persons, and homeless men and women of ages 18 and above, in the Metro/Skid Row and surrounding areas of Los Angeles County. The majority of the homeless population in Skid Row is affected by chronic substance abuse and/or mental illness. Forty-three percent (43%) of the homeless population in LA County have experienced or been diagnosed with alcohol/drug problems (Greater LA Homeless Count, 2015). LAC represents the second most impacted metro city in the U.S. with more than 60,000 estimated persons living with HIV/AIDS. Skid Row (located in SPA 4) has among the highest HIV burden in LAC, the second highest; West Hollywood has the highest. JWCH proposes expansion and enhancement of SUD/COD and HIV care and treatment, and HIV, HCV, HBV testing and treatment services in Skid Row. Program interventions/services: In the first year, 66 clients will receive Matrix Model (MMT) SUD/COD treatment; 88 in subsequent years. To monitor treatment these clients will also receive Intensive Case Management (ICM). Treatment will be reinforced by Community PROMISE and Seeking Safety strategies. In year one 300 clients will receive HIV and Hepatitis C/B testing; 400 in subsequent years. A minimum of 90% of newly diagnosed HIV positive clients will be linked to HIV medical primary care. Also, 8 persons successfully completing the SUD/COD treatment will be trained as Peer Health Educators (Peers) using the Community PROMISE model. The total number of MSM and homeless individuals receiving SUD/COD treatment over the grant period will be 418, with a combined 8,618 receiving outreach, SUD/COD, HIV and Hepatitis services.

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 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.

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.

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.

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 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.

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

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

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

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

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