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Mental illness increases the risk of HIV risk behaviors and acquisition by 4 to 10-fold. People experiencing homelessness (PEH) in Alameda County face multiple intersectional vulnerabilities and are amongst the most heavily impacted by the HIV, sexually transmitted infections (STI), hepatitis C (HCV), substance use, and mental illness. On any given night, >9,700 people experience homelessness in Alameda County, with an estimated >15,000 people who were without a home in the past year. The population of PEH in Alameda County increased by 241% from 2015 to 2022. While homelessness occurs across the county, it is highly concentrated in Oakland, CA (~8000 people). Almost half of (49%) of PEH are experiencing psychiatric or emotional conditions, PTSD (42%), drug or alcohol abuse (30%), and HIV/AIDS related illness (2%). Twenty-seven percent of PEH reported that mental health assistance might have prevented homelessness. The number of PEH reported as living with HIV was 98, however, the number of late diagnoses of HIV with a diagnosis of AIDS within one year, from 2019-2021 of the overall population was 21-24%. Mental illness and substance use impact HIV outcomes. There are gaps in access to and in the uptake of effective traditional mental health and substance use screening and treatment resources among the homeless population. Mobile health clinics (MHC) serve communities by delivering convenient and necessary services directly to clients in their proximal environment, overcoming barriers in access to care for those who lack resources, time, or safety to travel to traditional clinics. Therefore, we will use community-based participatory research principles and the Equity-Focused Implementation Research Framework to guide us in implementing and evaluating a portable based mental health and substance use disorder prevention and treatment intervention. This intervention will be an expansion of the HOPE MHC HIV syndemic prevention and treatment engagement services among PEH. Our project goals are to: A). Implement, refine, and evaluate a culturally tailored street-based mental health and substance use screening, treatment, referral pilot program integrated with the existing HOPE mobile status-neutral HIV, STI, and HCV prevention and treatment program for PEH in Alameda County. B). Provide an APRN clinical immersion site available to all students interested in under-served and marginalized populations. C). Document best practices and lessons learned while implementing integrated care using the enhanced HOPE model and disseminate findings from the pilot program.

Terros Health, located in Phoenix, Arizona, looks forward to continuing to meet specific community needs as they arise through the expansion of services in our Terros Health Portable Clinical Care Pilot Project to serve the U.S. Interagency Council on Homelessness’s (USICH) ALL INside Initiative Jurisdiction of the Phoenix Metro catchment area. The service focus population is racial and ethnic underserved people experiencing unsheltered homelessness, with a focus on those at high risk of HIV, SUD, or other infectious diseases. The data shows an increasing prevalence of homelessness in the Phoenix metro region. The official “Point-in-Time” count in January 2022 reported by the U.S. Department of Housing and Urban Development (HUD) shows the number of homeless people in Maricopa County, Arizona (which includes the Phoenix Metro area) surged 35% over the previous two years amid a housing crisis and economic hardship caused by the coronavirus pandemic. Of the 425 people who died of heat-related causes in 2022 in Phoenix, at least 178, or 48% of the total heat related deaths, were experiencing homelessness,. The data also demonstrates disparities which include a significantly larger proportion of the unhoused population identifying as Black (29%) compared to the overall Maricopa County population from the 2020 Decennial Census (6%). From April 2022 to March 2023, there were 20 new people experiencing homelessness for every 10 people finding housing in Maricopa County. Over the three year project period of the grant, we will address health disparities and health equity for those who are disproportionately underserved while offering outreach and case management, comprehensive and connected primary health care, evidence-based substance use disorder and mental health care, harm reduction services, (including Narcan, fentanyl testing strips, safe sex kits and other items) social determinant of health services, and transportation for more than 465 individuals who agree to ongoing, consistent care and treatment. One time services of infectious disease testing, crisis intervention, hydration, nutrition, wound care and other emergent care will be provided to many others near “The Zone,” in other encampments across the city, and in the areas of greatest need (West Phoenix, South Phoenix, Sunnyslope and the area around Sky Harbor Airport). Project goals include: 1) Provide comprehensive healthcare for medically underserved people experiencing unsheltered homelessness through portable clinical care that integrates BH and HIV treatment and prevention services 2) connect participants with SDoH resource needs including stable housing and 3) Provide community-based harm reduction services. Project objectives include 1) engage, at least three new participants each week in ongoing portable clinical care 2) for those participants that we engage in services, 100% will be offered and at minimum 20% will receive infectious disease testing 3) for those participants that we assess and identify with an infectious disease (including HIV/AIDS, STI, viral hepatitis, Mpox, or Tuberculosis), 90% will receive a referral for follow-up treatment 4) engage 75% enrolled participants with housing support through our Terros health case management team/housing specialist 5) beginning during year two, we will connect at minimum 10 participants a month with short- or long-term housing 6) provide 100 individuals each month (and 150 individuals each month beginning in year two) with at least one SDoH resource (which may include food, clothing, personal care items, or housing resources) and 7) provide weekly Narcan education and distribution (which includes safe needle exchange and education – not funded as a part of this grant) to reach at least 10 individuals each month.

In order to address the growing need in our community to provide healthcare to the unhoused, The City of Vernon is partnering with and MLK Hospital Street Medicine and Wellness Equity Alliance to implement our On-The-Streets Portable Clinical Care IBHPC+HIV Care Program. This program combines the best practices of Integrated Behavioral Health and Primary Care and HIV/AIDS prevention and treatment interventions with the promising practice of Street Medicine to provide comprehensive services to unsheltered people experiencing homelessness. On-The-Streets provides direct patient care through multi-disciplinary teams who conduct walking rounds and pop up clinics for the unsheltered homeless population in the Greater Vernon Area. Our implementation strategy for this program is built on a foundation trust-building, flexibility, and respect for the unsheltered individuals’ unique experiences and wishes. We recognize that unsheltered individuals have many of the same medical issues as the general population, we also recognize that traditional doctor-patient relationship in brick and mortar practices does not meet the needs of this population. We firmly believe that quality healthcare is a fundamental right that should be accessible to every person, irrespective of their housing situation and we are experienced in addressing the unique needs and challenges faced by unhoused individuals, particularly those who have been living on the streets or encampments for extended lengths of time and those with complex co-morbidity issues. On the Streets will improve health outcomes of those who do not readily utilize shelters or the adjunctive services co-located within shelters by providing direct patient care to unsheltered individuals experiencing homelessness. The Street Medicine Team is a roaming multi-disciplinary team will be a with “relationship-based” model including frequent/re-occurring contact with patients. The team will be comprised a Psychiatric Nurse Practitioner, a Medical Assistant, Community Health Worker SUD Counselor, Community Health Worker/HIV Counselor/Tester and a Consulting Psychiatrist.