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San Ysidro Health proposes to expand and enhance is successful Project Balance. This program is designed to serve racial and ethnic medically underserved adults (18 years and above) with substance use disorders (SUD) and/or co-occurring mental health condition (COD) who are at risk for or living with HIV. It is based in San Diego County, California, a priority jurisdiction under SAMHSA’s TI-23-008 grant. Latinx and Black/African Americans will represent the majority of Project Balance participants since they collectively account for over 50% of San Diego County’s people who live with HIV (PLWH); data monitoring will be conducted to identify other populations who are underrepresented in local public health programs related to SUD/COD/HIV care. SYHealth’s Project Balance proposal for 2023-2028 represents an expansion of its current program scope (2018-2023), currently focusing on Latinx and Black/African American men who have sex with men living in select county regions. With best practices gained from the past five years, SYHealth will expand Project Balance into a countywide program with a universal focus on minority populations regardless of HIV transmission risk. Project Balance is characterized by the support provided by its Case Management team, who is responsible for linking participants to mental health, SUD, and HIV services (including “warm handoffs” to in-house staff) and keeping them engaged in care (including a six-month follow-up post enrollment). Project Balance has a robust engagement protocol, characterized by frequent and systematic one-on-one contacts and ongoing support for participants. Within this framework, participants are linked to SYHealth’s in-house HIV and Behavioral Health Department programs and services for care. As part of planned program enhancements, SYHealth will pilot a new evidence-based practice (Contingency Management) into Project Balance’s model of care. The goal of Project Balance is to engage San Diego County racial/ethnic minorities with SUD/COD who are also living with (or at risk for) HIV into appropriate SUD, mental health, and/or HIV services. SYHealth specifically proposes the following objectives for 2023-2028. Objective #1: By end of Year 5, SYHealth will serve a total of 250 Project Balance participants, with an annual target of 50 participants. For purposes of this objective, participants will be inclusive of all racial/ethnic minority groups. Objectives #2a, #2b, #2c, #2d, #2e, and #2f: By end of each project year, SYHealth will: (a) Conduct 1,000 outreach calls. (b) Engage 80% of Project Balance participants into appropriate SUD and/or mental health care. (c) 80% of Project Balance participants will be tested for HIV, Hepatitis B, and/or Hepatitis C. (d) Engage 90% of Project Balance participants who test positive for HIV, Hepatitis B, and/or Hepatitis C for treatment within 30 days or less of diagnosis. (e) Provide health education and referrals for PrEP services to 80% of Project Balance participants who test negative for HIV. (f) SYHealth will achieve a 80% follow-up rate for enrolled Project Balance participants. Objective #3: By the end of Year 3, SYHealth will conduct a pilot to integrate the Contingency Management evidence-based practice (EBP) into Project Balance’s model of care.

ABSTRACT Summary. Abounding Prosperity, Inc. (AP, Inc.) is proposing a program to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV in Dallas County, TX. AP, Inc. will serve 600 unduplicated individuals annually with grant funds and 3,000 over the entire project period. Project name. Dallas MAI High Risk Program Populations to be served. The population of focus (POF) will be racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at risk for or with HIV; AP, Inc. will primarily target Black persons, including the high-risk MSM and transgender populations. The geographic catchment area where services will be delivered is Dallas County, TX. The catchment area is one of the localities included in Appendix M (Dallas County, TX). Strategies/interventions. Program activities will include: 1) SUD/COD treatment and recovery support services; 2) HIV rapid testing and on-site HIV testing; 3) Linkage to confirmatory testing; 4) case management, referral/linkages to follow-up care, and treatment for all clients who have a preliminary positive HIV and confirmatory HIV test results; 5) case management, referral/linkage to PrEP services for individuals who screen negative for HIV but are at increased risk of becoming infected with HIV; 6) education, case management, referral/linkage to Post-Exposure Prophylaxis (PEP) services for individuals who are at increased risk of exposure to HIV through exposure; 7) develop MOAs with primary HIV treatment and care providers; 8) screen and assess clients for the presence of CODs; 9) test all clients who are considered to be at risk for viral Hepatitis (B and C) on-site and during mobile outreach; 10) develop a continuous outreach strategy; 11) hire staff that represent the population of the community being served; 12) ensure translate tools and resources are available to recipients of services; 13) enhance access to services for people of all racial/ethnic/marginalized groups in the community; 14) adapt existing conflict and grievance resolutions processes to ensure they are culturally and linguistically appropriate; 15) report all positive viral hepatitis test results to the local and state health department(s); and 16) provide Peer Recovery Support Services. AP, Inc. will also implement the following EBPs: SBIRT; Motivational Interviewing (MI); and Seeking Safety. Project goals and measurable objectives. The program’s goal is to increase engagement in care for racial and ethnic medically underserved individuals with SUD and/or COD who are at risk for or with HIV. Objectives for the proposed program include: Objective 1: Conduct outreach and recruitment activities, reaching up to 1,500 persons from the POF per year Objective 2: Conduct HIV testing for 600 persons from the POF per year Objective 3: Conduct hepatitis B and C testing for 300 persons from the POF per year Objective 4: Provide linkage to care for 100% of clients testing positive for HIV per year Objective 5: Provide linkage to PrEP services to 75% of high-risk HIV negative persons from the POF per year Objective 6: Enroll 100 persons from the POF into case management per year Objective 7: Screen and assess 500 persons from the POF for COD per year Objective 8: Provide SUD/COD treatment and recovery support services to 90% of persons from the POF screening positive for SUD/COD per year Objective 9: Provide Seeking Safety for at least 60 participants with histories of trauma per year Objective 10: Provide Peer Recovery Support Services for at least 100 participants per year.

Project Name: Southwest Center – Recovery-Oriented Culturally Holistic Project. Southwest Center for HIV/AIDS (SWC) is prepared to strategically outreach and engage medically underserved racial and ethnic individuals at risk for or living with HIV through diverse partners and community linkages. SWC-ROCH project will expand services for substance use disorders (SUDs)/mental health conditions (COD) offering a status-neutral approach to deliver whole-person care – HIV/Viral Hep A&C services in Maricopa County, AZ. Population served: SWC-ROCH project specifically targets Black men, Latino men, Latino youth/young adults, and Black women at risk for or living with HIV in Maricopa County, Arizona (priority jurisdictions CDC - Ending the HIV Epidemic (EHE). Strategies/Interventions: Outreach, diverse network Chicanos Por La Causa and one-n-ten, testing/engagement, case management, peer navigators, SUD/COD treatment, and Evidence-Based Practices/Services (e.g., Matrix Model, SMART Recovery, Cognitive Behavioral Therapy, Intensive Outpatient Programs). Goals/Measurable Objectives: Goal 1) Expand ongoing efforts in Maricopa County, AZ to strategically engage medically underserved racial and ethnic individuals at risk for or living with HIV by offering a status-neutral approach to deliver whole-person care – a syndemic approach – weaving access to substance use disorders (SUDs), mental health conditions (COD), HIV, and viral hepatitis services, and treatments. Objective 1.1. Expand outreach strategic activities in diverse underserved communities to engage target population offering status-neutral SUDs and/or co-occurring SUDs/COD treatment and recovery support services as measured annually by 2 diverse partnerships, 4 outreach activities, 760 unduplicated clients, and 100 referrals for self-test kits. Objective 1.2. Expand capacity to provide evidence-based SUDs/COD treatment and recovery support services target population offering 2 Intensive Outpatient Programs (IOPs) 1) Adult IOPs LGBTQIA2S+ as measured by 60 adults annually served; and 2) Youth IOPs for ages 14-17 as measured by 30 youth annually served. Objective 1.3 Provide evidence-based SUD/COD treatment and recovery support services for target population as measured annually by 2,600 outpatient services (3 sessions per week) and 100 referrals to Valleywise FDA medications. Objective 1.4. Offer participants and their partners who use drugs and/or sexual partners HIV rapid prelim antibody testing rapid fourth-generation HIV testing as measured by 2,000 HIV tests. Goal 2) SWC aims to reduce prevalence of SUD/COD/HIV/Viral Hep A&C increasing access/linkage to HIV treatment for target population with SUDs living with HIV. Objective 2.1. Provide on-site prelim HIV testing to increase linkage when positive to confirmatory testing, status-neutral follow-up as measured annually by 2,000 screenings/assessments; 250 clients connected with SUD/COD services; 20 preliminary assessments of clients connected to Ryan White services; and 1,000 Hepatitis B and C tests. Objective 2.2. Provide education, case management, referrals/ linkages to PrEP services as measured by 300 clients with PrEP services (negative HIV) same-day appointments, 2,000 clients PrEP education, and 50% clients PrEP compliance. Objective 2.3. Provide education, case management, and referral/linkages to PEP services as measured by 55 clients same-day appointments with SWC providers, 55 clients PEP education, and 55 clients offered a transition to PrEP services. Objective 2.4. Provide SUD/COD certifications for EB practices and services including Matrix IOP, SMART Recovery as measured by completion of 2 certification. SWC-ROCH project will provide 4,300 unduplicated individuals with services during the 5-year project period.

ABSTRACT Summary. The North Jersey Community Research Initiative (NJCRI) is proposing a program to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV in Essex County, NJ, with a focus on Newark. NJCRI will serve 600 unduplicated individuals annually with grant funds and 3,000 over the entire project period. Project name. Essex County MAI High Risk Program Populations to be served. The populations of focus (POF) will be racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co- occurring SUDs and mental health conditions (COD) who are at risk for or with HIV. The geographic catchment area where services will be delivered is Essex County, NJ, with a focus on Newark. The catchment area is one of the localities included in Appendix M. Strategies/interventions. Program activities will include: 1) SUD/COD treatment and recovery support services; 2) HIV rapid testing and on-site HIV testing; 3) Linkage to confirmatory testing; 4) case management, referral/linkages to follow-up care, and treatment for all clients who have a preliminary positive HIV and confirmatory HIV test results; 5) case management, referral/linkage to PrEP services for individuals who screen negative for HIV but are at increased risk of becoming infected with HIV; 6) education, case management, referral/linkage to Post-Exposure Prophylaxis (PEP) services for individuals who are at increased risk of exposure to HIV through exposure; 7) develop MOAs with primary HIV treatment and care providers; 8) screen and assess clients for the presence of CODs; 9) test all clients who are considered to be at risk for viral Hepatitis (B and C) on-site and during mobile outreach; 10) develop a continuous outreach strategy; 11) hire staff that represent the population of the community being served; 12) ensure translate tools and resources are available to recipients of services; 13) enhance access to services for people of all racial/ethnic/marginalized groups in the community; 14) adapt existing conflict and grievance resolutions processes to ensure they are culturally and linguistically appropriate; and 15) report all positive viral hepatitis test results to the local and state health department(s). NJCRI will also implement the following EBPs: Screening, Brief Intervention, and Referral to Treatment (SBIRT); Motivational Interviewing (MI); and Cognitive behavioral therapy (CBT). Project goals and measurable objectives. The program’s goal is to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV. The program’s objectives are to: Objective 1: Conduct outreach and recruitment activities, reaching up to 1,500 persons from the POF per year; Objective 2: Conduct HIV testing for 600 persons from the POF per year; Objective 3: Conduct hepatitis B and C testing for 450 persons from the POF per year; Objective 4: Provide linkage to care for 100% of clients testing positive for HIV per year; Objective 5: Provide linkage to PrEP services to 75% of high-risk HIV negative persons from the POF per year; Objective 6: Enroll 100 persons from the POF into case management per year; Objective 7: Screen and assess 200 persons from the POF for COD per year; Objective 8: Provide SUD/COD treatment and recovery support services to 90% of persons from the POF screening positive for SUD/COD per year; Objective 9: Provide Peer Recovery Support Services for at least 100 participants per year.

Community Renewal Team, Inc. (CRT), a Central CT-based community action agency, seeks to start its Hartford-based HIV AIDS Risk Program (HARP). All individuals with substance use or co-occurring disorders who are at high risk of contracting HIV will be eligible for HARP. There will be a particular focus on low-income Black community members. Within this cohort, special emphasis will be placed on recruiting gay and bisexual men, men and women between the ages of 18-30, homeless adults, homeless or unstably housed youth (18-24) and transgender women. Per the CDC, the CT Dept. of Public Health, and the Hartford Transitional Grant Area (TGA), these 5 populations have HIV prevalence rates and HIV new diagnoses significantly higher than other groups. In addition, opioid deaths have skyrocketed in the Hartford area, with Black men having the highest mortality rate (up to 70% of the unintentional overdose deaths in 2021). Such statistics have led experts in the field to be concerned that the gains made in decreasing new cases of HIV will be reversed. HARP will work with individuals at high risk of contracting HIV and those who are HIV+ (including those deemed "lost to care"). The overarching goal of this initiative will be to decrease the spread of HIV and keep individuals engaged in care. To accomplish this goal, CRT's Behavioral Health Services (BHS) Division will utilize numerous evidence-based interventions, such as Cognitive Behavioral Therapy, Motivational Interviewing, Contingency Management, and Medication-Assisted Treatment (MAT) During the grant period, HARP staff will reach out to a minimum of 1,000 high-risk individuals and enroll 250, of whom at least 50% will be Black. We will do extensive in-reach through our adult and youth homeless services and our Ryan White Early Intervention program. These, plus our SAMHSA-funded MAT initiative, our contract with the LEO primary care clinic (which provides its services two days per week at CRT sites), an in-house pharmacy, and the agency's many ancillary services, will be major resources for HARP clientele. Over our history, CRT has also established over 300 partnerships with external organizations in Central CT, including the Hartford Area HIV/AIDS Planning Council, the Greater Hartford Area Coordinated Access Network for the homeless, and the Youth Engagement Team Initiative. We will recruit these and other partners to serve on our HARP Advisory Board, which will include people with lived experience. Our Project Director has lived experience. We will hire a program manager and two peer support specialists. The BHS Division will seek out employees who Black, male, in recovery, and/or are HIV+. this new personnel will add further diversity to a departmental staff that currently has over 50% people of color and 1/3 with lived experience. Although diverse, Black members of the community are still underrepresented in our and other BHS programs in the Hartford area. We, therefore, will contract with Dean Jones, MSW, a trusted messenger in the Black community with extensive experience working with Black youth. A Black UCONN-trained social worker, he grew up in the capital city and served time in prison. He is the Director of the COMPASS Youth Initiative's Peacebuilder program, the recipient of UCONN's School of Social Work's inaugural "Trailblazer" Award, and now also works with Project Longevity, a gun-violence prevention program in Hartford. Deeply committed to improving opportunities for Hartford youth, he often says that he is using his second chance to give you a first chance.

Kansas City CARE Clinic dba KC CARE Health Center (KC CARE) seeks to expand the breadth and depth of our HIV services through funding from SAMHSA's "Minority AIDS Initiative: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS." As a Ryan White recipient since 1993, KC CARE possesses both the experience and the infrastructure necessary to ensure successful stewardship of the funds requested. This award will support on-site rapid HIV and hepatitis C testing, conducted both in our clinical spaces and on a walk-in basis by prevention specialists. Hepatitis B testing will be available through our clinic. As injection drug use is a major contributing factor to HIV and viral hepatitis, KC CARE will focus this work on patients who access our harm reduction services, particularly those who identify as Black, Indigenous, or People of Color (BIPOC) and/or LGBTQ+. KC CARE also conducts testing on an outreach basis at numerous community locations, including shelters for the unhoused, long-term stay hotels, public libraries, charitable nutrition organizations, and more. People who test reactive at KC CARE, during an outreach event, or at one of our partner testing sites will immediately be put into contact with a linkage-to-care coordinator. Linkage-to-care coordinators are available 24/7 and respond in real time to new diagnoses of HIV and ensure patients who test reactive are linked to confirmatory testing. When an HIV diagnosis is confirmed, the linkage-to-care coordinator provides all necessary referrals for medical care, connects the patient to a peer educator, and provides intensive case management for the first 90 days after the patient's diagnosis. KC CARE's linkage-to-care coordinators work to ensure people newly diagnosed are linked to care within 30 days; however, KC CARE's Rapid Start program ensures many people leave our facility with antiretroviral medication the same day they test reactive. This evidence-based practice dramatically increases the likelihood that people who are newly diagnosed will be able to achieve viral suppression quickly. Once someone newly diagnosed with HIV completes their first 90 days of treatment, they will transition to one of KC CARE's medical case managers. Case managers are assigned to best meet the needs of each individual patient. Both linkage-to-care coordinators and case managers also help patients access oral and behavioral healthcare through KC CARE, and behavioral health consultants respond in real time to patients with and without HIV who exhibit signs or disclose symptoms during medical and dental appointments. KC CARE's therapists are experienced at providing treatment for patients who wish to decrease or discontinue their substance use, and we are working to increase the availability of medication-assisted treatment for opioid use disorder. Those who test reactive for viral hepatitis will similarly receive referrals to KC CARE's Primary Care Program for treatment. KC CARE operates one of the most robust viral hepatitis treatment clinics in the region. Patients who attend clinical visits at KC CARE and do not have HIV but disclose behaviors that increase their likelihood of acquiring HIV will be referred to the PrEP Navigator. The PrEP Navigator will respond in real time whenever possible. KC CARE staff are also knowledgeable about PEP and can link patients to medication quickly through our on-site pharmacy. This status-neutral approach ensures patients who visit KC CARE will receive the knowledge and care necessary to live a healthy and fulfilling life, with or without HIV. This is critical to "Ending the HIV Epidemic," a primary concern of KC CARE, as Missouri is listed as one of the primary jurisdictions.

The Care and Access for Rural Engagement (CARES) Project builds on the ongoing work and existing strong community partnerships by Five Horizons Health Services to expand HIV and substance use prevention and care in 53 counties across West and South Alabama (37 counties) and East Mississippi (16 counties). The project area includes over 2.1 million people, representing about 26% of the combined population of Alabama and Mississippi and is mainly rural. Most of the residents in the target area are listed as being in persistent poverty. By the end of the project, we will reach approximately 80,000 individuals and provide HIV tests, substance use/mental health assessment to over 12,000 individuals. The CARES project will expand care to mainly underserved rural populations in Alabama and East Mississippi, by addressing the salient barriers to care and prevention among individuals with or at risk of HIV and its related comorbidities including SU/MHD. The following goals and objectives will guide the project: Goal 1: Reduce new HIV infections and related comorbidities by increasing access to screening, testing, and care for individuals at risk for HIV, through targeted outreach efforts and reducing barriers to care resulting in early access to treatment and prevention. By the end of the project, the CARES outreach team will conduct outreach events in all 53 counties and reach at least 80,000 people from medically underserved racial and ethnic communities disproportionately affected by HIV/AIDS and HIV-related disparities. By the end of year 5, the outreach team will offer preliminary HIV testing to all individuals attending outreach events or visiting FHHS, resulting in at least 12,000 of individuals (15%) attending outreach events or visiting FHHS clinics getting tested for HIV. By the end of year 5, the case management team will ensure that at least 95% of clients screening positive for HIV at any of our events receive confirmatory HIV testing and 95% of those confirmed to be positive are linked to and maintained in HIV care. Goal 2: Reduce SU/MHD risk among individuals with or at risk of HIV, by implementing an ongoing strategy to reach and provide evidence-based SU/MHD services. Objectives: By the end of year 5, the outreach team will offer screening for SU/MHD as indicated to individuals with or at risk for HIV attending outreach events FHHS, resulting in at least 15% of attendees being screened for SU/MHD. By the end of year 5, the behavioral health team (BHT) will diagnose and develop an individualized treatment plan for at least 80% of individuals who screen positive for SU/MHDs. By the end of year 5, the BHT will connect 100% of individuals receiving a diagnosis for SU/MHD to the in-house treatment team or partner agencies and ensure that at least 80% receive evidence-based treatment and are maintained in care. Goal 3: Reduce risk for new infections for HIV and other STIs by increasing access to PrEP, Post-Exposure Prophylaxis (PEP), and STI treatment and care to individuals at risk for HIV and /or STI. By the end of year 5, individuals identified as being at risk for HIV will be provided with supports including education, case management and referral to in-house PrEP and STI treatment and care to ensure that at least 50% of individuals at risk and eligible are initiated and maintained in PrEP and/or STI treatment and care. By the end of year 5, 100% of individuals reporting increased risk for HIV will be provided supports including education, case management and referral to HIV clinic to receive PEP services, including being provided with PEP medication within 72 hours to ensure that at least 95% of identified individuals at risk due to exposure are initiated on PEP and maintained in care. By the end of year 5, 100% of individuals tested positive for viral Hepatitis B and C will be reported to the department of public health. Goal 4: Conduct program evaluation to measure performance on objectives and program success.

San Francisco Community Health Center (SFCHC) - a well-established, multi-service, community-focused federally qualified health center (FQHC) with robust peer outreach and substance use treatment programs - requests funding through the SAMHSA FY 2023 Minority AIDS Initiative: High Risk Populations grant program (TI-23-008) to implement Project REACT (Responsive Equitable Action for Community Treatment). Project REACT is an innovative, peer-focused, community-driven initiative which will take a syndemic approach to addressing the interwoven crises of substance use, HIV infection, and STI and viral hepatitis infection among homeless and unstably housed persons of color living in San Francisco’s hard-hit Tenderloin neighborhood, with a primary focus on Black/African American and Latinx substance users and on transgender substance users of color. Fully one-third of the Tenderloin’s nearly 35,000 residents live below the federal poverty level, while more than 60% of SF’s entire homeless population resides in this neighborhood. SFCHC will conduct extensive street and community-based outreach and engagement activities using established peer and street medicine teams, while engaging additional clients and providing innovative on-site services through our two new, state-of-the-art homeless and transgender drop-in centers. Clients enrolling in the program will complete a minimum 4-month course of treatment that incorporates ongoing case management; participation in weekly treatment groups for at least 16 weeks; peer-based social support services; individual mental health therapy; and socialization and recreational events. All clients will also receive HIV, sexually transmitted infection (STI), and viral hepatitis testing, while being linked to comprehensive medical and treatment services within our co-located FQHC medical, behavioral, and dental clinics, including on-site post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) treatment. The overarching goal of the program will be to increase engagement in culturally competent, trauma-informed medical and behavioral health treatment for underserved persons of color with SUDs and/or co-occurring mental health conditions who are at high risk of or living with HIV infection. Over the course of the 5-year grant period, Project REACT will conduct preliminary HIV risk and SUD screening for a minimum of 450 homeless, unstably housed, and/or transgender persons of color; enroll at least 340 of these persons in a 16-week SUD treatment program; ensure that all clients receive preliminary HIV and viral hepatitis testing, while linking all positive clients to treatment through SFCHC’s on-site FQHC primary medical clinic; and provide education on and linkage to PEP and PrEP treatment and support services for clients who test negative for HIV. Key outcome objectives to be achieved by the end of the project period include: a) ensuring that at least 60% of project clients complete the full 16-week intervention; b) documenting self-reported reductions in the frequency and severity of substance use 6 months following admission for at least 50% of clients who complete the full 16-week treatment intervention; c) documenting significantly enhanced mental health status and improved outlook 6 months following program admission for at least 60% of clients who complete the full intervention; d) identifying and linking to care within 14 days at least 25 newly diagnosed persons with HIV; e) identifying and referring to on-site treatment at least 40 newly diagnosed persons with hepatitis B or C; and f) linking at least 75 persons at high risk for HIV to PEP and/or PrEP treatment through the SFCHC medical clinic. SFCHC will implement a comprehensive, multi-faceted data collection and reporting system for Project REACT that includes timely fulfillment of all federal reporting requirements under the GPRA Modernization Act of 2010, along with development of a local evaluation plan.

In response to TI-23-008, McDermott Center, DBA Haymarket Center, proposes “Haymarket MAI-HRP.” Over five years, Haymarket MAI-HRP will use motivational interviewing, contingency management, and care navigation to promote viral suppression and prevent new viral infections among 676 adult residents of Cook County, IL who are living with substance use disorder (SUD) and at least one of the following: HIV, hepatitis C (HCV), or hepatitis B (HBV). Goal 1: By 9/29/2028, help to achieve or maintain viral suppression among 676 unique project participants who are living with at least one of the following: HIV, HCV, HBV. Objective 1.1: Test 9,500 individuals for HIV (1,500 in YR 1 and 2,000 in each of YRs 2-5). Objective 1.2: Test 9,500 individuals for HCV (1,500 in YR 1 and 2,000 in each of YRs 2-5). Objective 1.3: Test 9,500 individuals for HBV (1,500 in YR 1 and 2,000 in each of YRs 2-5). Testing entails preliminary testing, confirmatory testing, and reporting to all relevant public health officials. Objective 1.4: Connect 356 project participants living with HIV to care for HIV (56 in YR1, 75 in each of YRs 2-5). Objective 1.5: Connect 304 project participants living with HCV to care for HCV (48 in YR 1, 64 in each of YRs 2-5). Objective 1.6: Connect 52 project participants living with HBV to care for HBV (8 in YR 1, 11 in each of YRs 2-5). Goal 2: By 9/29/2028, prevent the acquisition of viral co-infections among the 676 unique project participants (e.g., help prevent someone living with HIV from contracting HCV). Objective 2.1: Provide PrEP navigation to 261 participants who are vulnerable to HIV (41 in YR 1, 55 in each of YRs 2-5). Objective 2.2: Provide education about preventing HIV, HCV, and HBV among 608 participants (96 in YR 1, 128 in YRs 2-5). Objective 2.3: Provide harm reduction supplies to 608 participants (96 in YR 1, 128 in YRs 2-5). Goal 3: Enhance behavioral determinants of health for 676 project participants living with or vulnerable to HIV and hepatitis. Objective 3.1: Assess 642 participants for SUD and COD (102 in YR 1, 135 in YRs 2-5). Objective 3.2: Provide SUD treatment to 608 participants (96 in YR 1, 128 in YRs 2-5). Objective 3.3: Provide co-occurring mental health disorder (COD) services to 366 participants (58 in YR 1, 77 in YRs 2-5).

Gay Men’s Health Crisis (GMHC) will provide a range of behavioral health and recovery support services to increase engagement in care for racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at-risk for or living with HIV. In close collaboration with key partners, including Housing Works, which operates two (2) NYS Office of Addiction Services and Supports (OASAS)-licensed treatment facilities, GMHC will take a syndemic approach to SUD, HIV, and viral hepatitis by providing SUD treatment to medically underserved racial and ethnic individuals at-risk for or living with HIV. GMHC will serve the EHE U.S. Priority Jurisdiction: New York (Bronx County, Kings County, New York County, and Queens County), and we will serve a total of 1,200 individuals over 5 years.

Purpose: We are proud to share our innovative initiative, Project THRIVE (Transforming Health Resources for Inclusivity, Vitality, and Empowerment). THRIVE represents our goal of creating a supportive and inclusive environment where Black MSM and Black Trans women can access the resources they need to live healthy and empowered lives. The purpose of this project is to increase engagement in substance use/mental health treatment for racial and ethnic underrepresented individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for or are living with HIV/AIDS. We have positioned ourselves within a network of providers to ensure that our program participants receive culturally affirming HIV/AIDS prevention and treatment; primary medical care; and mental health & substance abuse treatment. Population to Be Served: Fortunately, the project will ensure the delivery of treatment and enhanced access for our target population by licensed agencies in the community, this high impact prevention/care project will address the prevention/care needs of prioritized target populations in the St. Louis metropolitan statistical area (that includes two Missouri counties and St. Clair County Illinois or the Metro-East region of Southern Illinois). These targeted populations encompass low-income communities of color with limited literacy skills and a variety of health disparities. Below is a full demographic profile of our population of focus: *Sexual Orientation, Gender Identity, & Sex: BMSM, Black Trans women, non-identified BMSM, bi- sexual Black men, and BMSM/Transgender women who have a substance uses disorders (SUDs) or co- occurring disorders (COD) or who are HIV positive or at risk for HIV/AIDS. *Age: 18 and up *Race: The project will serve African American/Blacks in East St. Louis, St. Clair County, Illinois, and the Metropolitan St. Louis Area. Ethnicity: The ethnicity of the population to be served is Black-Non-Hispanic. *Language: English is the language spoken by all the BMSM/Trans women to be served by the project. Socioeconomic Characteristics: East St. Louis, areas of St. Clair County, and various St. Louis city and county regions to be served are economically devastated. Some areas received the “Enterprise Community” designation from HUD, an indicator of extreme poverty. Strategies/Interventions: Project staff are familiar with the use of Recovery-Oriented Systems of Care, trauma informed care, implementing EBP around behavioral health interventions and CDC HIV prevention/care interventions. Recruitment through social network strategies (SNS) will be conducted to ensure that the targeted population is reached in sufficient numbers throughout the funding period. The project evaluator will collect and analyze data, including the GPRA and the Consumer Outcome Study, and provide periodic feedback to help monitor and improve outcomes. Project goals: The goals of the project are to increase access and availability of services to 12635 participants over the 5-year project. Goal 1. Provide at least 300 GIPRA screenings for substance use and/or co-occurring substance use and mental health disorders and active internal or external referrals to all appropriate programming. Goal 2 Provide CDC approved comprehensive health screenings and linkage to care services to 2490 targeted project participants. Goal 3. Provide 2345 behavioral interventions and linkage of treatment services for targeted project participants. Goal 4: Provide condom distribution services to 7500 project participants. Measurable objectives: Provide screenings for co-occurring conditions to at least 300 participants over 5-year project. 80% of participants will receive follow up assessments. 90% of participants with a mental health/Substance Abuse diagnoses will be connected to treatment services. Overall, goal is 50% of all treatment referrals to successfully complete mental health/substance abuse treatment.

CLARE MATRIX (C M) and its partners will build on its past success as a grantee of SAMHSA Targeted Capacity Expansion: HIV funding to serve a catchment area of more than 1Million individuals in California's South and Central Los Angeles area. The population of focus for this project will be predominantly African American and Latinx adults with opioid use disorder (OUD) who are injection drug users residing in Los Angeles County (LAC) at risk for HIV/AIDS and viral Hepatitis. C M's MAI project will expand access to MAT for OUD and screening for HIV and viral Hepatitis using an In-House Implementation model for OUD services. Treatment services for HIV and viral Hepatitis will be referral-based and facilitated through MOAs. With this blended approach, C M and its partners will impact the disparate rates of injection drug use and HIV/hepatitis infection rates in LAC, an EHE priority jurisdiction. By the end of the project, 430 people will receive treatment that will reduce drug use, drug injecting, and the practice of risky behaviors. These services will be enhanced with additional services that increase participant awareness of HIV and viral Hepatitis status, access to treatment, and access to antiretroviral therapy (ART) and other medical care. Care for co-occurring mental health disorders will be provided via specialty care and case management. C M will also impact community rates of overdose and infectious disease related to injection drug use through 260 harm reduction engagements, 120 health and wellness groups, and 200 community education and awareness events. These goals will be accomplished by a team of 3.15 clinical, program, and contracted staff. A project director will ensure successful implementation, and an evaluator will provide regular reports to ensure all quality and access goals are met.

ABSTRACT Summary. After Hours Project (AHP) is proposing a program to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV in Brooklyn, NY. AHP will serve 600 unduplicated individuals annually with grant funds and 3,000 over the entire project period. Project name. Brooklyn MAI High Risk Program Populations to be served. The populations of focus (POF) will be racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at risk for or with HIV. The geographic catchment area where services will be delivered is Brooklyn, NY, with a focus on the high-need areas of Central Brooklyn (Bedford Stuyvesant, Crown Heights, and Brownsville), East New York, Bushwick. The catchment area is one of the localities included in Appendix M (Kings County, NY). Strategies/interventions. Program activities will include: 1) SUD/COD treatment and recovery support services; 2) HIV rapid testing and on-site HIV testing; 3) Linkage to confirmatory testing; 4) case management, referral/linkages to follow-up care, and treatment for all clients who have a preliminary positive HIV and confirmatory HIV test results; 5) case management, referral/linkage to PrEP services for individuals who screen negative for HIV but are at increased risk of becoming infected with HIV; 6) education, case management, referral/linkage to Post-Exposure Prophylaxis (PEP) services for individuals who are at increased risk of exposure to HIV through exposure; 7) develop MOAs with primary HIV treatment and care providers; 8) screen and assess clients for the presence of CODs; 9) test all clients who are considered to be at risk for viral Hepatitis (B and C) on-site and during mobile outreach; 10) develop a continuous outreach strategy; 11) hire staff that represent the population of the community being served; 12) ensure translate tools and resources are available to recipients of services; 13) enhance access to services for people of all racial/ethnic/marginalized groups in the community; 14) adapt existing conflict and grievance resolutions processes to ensure they are culturally and linguistically appropriate; and15) report all positive viral hepatitis test results to the local and state health department(s). AHP will also implement the following EBPs: SBIRT, Motivational Interviewing (MI), Seeking Safety, and Cognitive Behavioral Therapy (CBT). Project goals and measurable objectives. The program’s goal is to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV. The program’s objectives are to: 1) Conduct outreach and recruitment activities, reaching up to 1,500 persons from the POF per year; 2) Conduct HIV testing for 600 persons from the POF per year; 3) Conduct hepatitis B and C testing for 300 persons from the POF per year; 4) Provide linkage to care for 100% of clients testing positive for HIV per year; 5) Provide case management, education and referral for 95% of clients testing positive for HIV per year; 6) Provide education, case management, referral/linkage to PrEP services to 75% of high-risk HIV negative persons from the POF per year; 7) Provide education, case management, referral/linkage to PEP services to 75% of high-risk HIV negative persons from the POF per year; 8) Screen and assess 400 persons from the POF for COD per year; 9) Provide SUD/COD treatment and recovery support services to 90% of persons from the POF screening positive for SUD/COD per year; and 10) Provide Peer Recovery Support Services for at least 100 participants per year.

Summary. Hinds Behavioral Health Services a licensed substance use treatment and mental health provider with 51 years of experience and a 16-year proven track record of serving racial and ethnic populations at great risk for HIV and viral hepatitis, will implement the Comprehensive Access to Recovery and Empowerment (CARE) program in partnership with My Brothers Keeper to increase engagement in care for racial and ethnic medically underserved individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for, or are living with HIV/AIDS and receive HIV/AIDS services, treatment and reside in Hinds County. Project Name: CARE. Population: Ages 18+ in need of SUD and/or COD outpatient treatment; 100% trauma-involved; 40% COD; 20% HIV+; 3% viral hepatitis+; 85% African American; 5% Multiracial; 3% Hispanic/Latinx; 85% Male (YMSM and/or MSM); 2% Transgender; and/or 8% Bisexual, Gender Non-Confirming. Strategies/Interventions: Behavioral health screening and assessment, trauma-informed SUD/COD outpatient treatment (in-person and telehealth videoconferencing) coupled with strengths-based case management and care coordination, HIV, viral hepatitis testing, diagnosis and linkage to HIV/AIDS case management, HIV medical care and ART, PrEP; primary care; and wraparound culturally and trauma-informed peer recovery support and linkages to housing, education/employment. EBPs: Motivational Interviewing (MI); Strengths-Based Case Management (SBCM); HIV Navigation Services (for HIV+); Living in the Face of Trauma (LIFT for HIV+); Seeking Safety (High-Risk negatives); Many Men Many Voices (3MV); Affirmative Therapy (Transgender); MATRIX Model; Living in Balance; peer-led Many Men Many Voices (3MV) and Wellness Recovery Action Plan (WRAP). Goals: 1) Prevent New HIV Infections and Increase Engagement in Care; 2) Improve HIV-related health outcomes of racial/ethnic minorities living with HIV; 3) Reduce HIV-related disparities and health inequities; 4) Improve abstinence; 5) Ensure individualized trauma-informed recovery-oriented wraparound care; 6) Improve care coordination and treatment retention; and 7) Achieve integrated, coordinated efforts that address the HIV epidemic. Measurable Objectives: 1) 100% of clients screened for SUD/COD, HIV, and viral hepatitis at intake and 100% of drug-using and/or sexual partners will be linked to HIV and viral hepatitis testing; 2) 100% of clients testing HIV negative will be immediately linked to PrEP, PEP, STI and HIV risk reduction education; 3) 100% of clients testing HIV + will be immediately linked to HIV/AIDS treatment; 4) 100% of clients will be screened for viral hepatitis and will be immediately linked to Hepatitis (B and C) vaccination; 5) 80% will improve abstinence; 6) 80% will improve health/behavioral/social consequences 7) 80% of clients will improve social connectedness and retention; 8) 80% of clients will improve education and/or employment status; 9) 80% will reduce criminal justice involvement; 10) 80% of clients reporting housing needs will improve housing stability; 11) 80% will be retained in care; and 12) 100% timely biannual reporting. # To be served: 50 (Year(s) 1-5), totaling 250 within five years.

Summary. Alliance Care 360 (AC360) is proposing The Caring Steps linkage and substance misuse navigation model designed to provide Coordinated, caring, and compassionate SUD Treatment, community Engagement and Peer driven Strategies to achieve healthy recovery outcomes (Caring STEPS), a program to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV in south and west Chicago and Suburban Cook County, IL. AC360 will serve 600 unduplicated individuals annually. Project name. Caring STEPS Populations to be served. The populations of focus (POF) will be racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co- occurring SUDs and mental health conditions (COD) who are at risk for or with HIV; AC360 will primarily target persons of color, including high-risk and HIV positive youth adult and aging African American, Latinx and Asian Pacific Islander MSM (South-East region), transgender men and women and non-binary populations. The geographic catchment area where services will be delivered is high prevalence, underserved community neighborhood areas of south and west Chicago and Suburban Cook County. Strategies/interventions. Program activities will include: 1) SUD/COD treatment and recovery support services; 2) HIV rapid testing and on-site HIV testing; 3) Linkage to confirmatory testing; 4) case management, referral/linkages to follow-up care, and treatment for all clients who have a preliminary positive HIV and confirmatory HIV test results; 5) case management, referral/linkage to PrEP services for individuals who screen negative for HIV but are at increased risk of becoming infected with HIV; 6) education, case management, referral/linkage to non-Post-Exposure Prophylaxis (nPEP) services for individuals who are at increased risk of exposure to HIV through exposure; 7) expand MOAs with primary HIV treatment and care providers; 8) screen and assess clients for the presence of CODs; 9) test all clients who are considered to be at risk for viral Hepatitis (B and C) on-site and during mobile outreach; 10) develop a continuous outreach strategy; 11) hire staff that represent the population being served; 12) ensure translate tools and resources are available; and 13) enhance access to services for all groups, AC360 will also implement the following EBPs: Motivational Interviewing (MI), Adapted Relapse Prevention Therapy, Cognitive Behavior Therapy with Behavioral Activation and Contingency Management (CM). Project goals and measurable objectives. The program’s goal is to increase engagement in care for racial and ethnic medically underserved individuals with SUDs and/or COD who are at risk for or with HIV. Objectives for the proposed program include: 1) Conduct outreach and recruitment activities, reaching up to 1,500 persons from the POF per year: 2) Conduct HIV testing for 600 persons from the POF per year; 3) Conduct hepatitis B and C testing for 300 persons from the POF per year; 4) Provide linkage to and retention in care for at least 95% of clients testing positive for HIV per year; 5) Provide case management, education and referral for 95% of clients testing positive for HIV per year; 6) Provide education, case management, referral/linkage to PrEP services to 75% of high-risk HIV negative persons from the POF per year; 7) Provide education, case management, referral/linkage to nPEP services to 75% of high-risk HIV negative persons from the POF per year; 8) Screen and assess 400 persons from the POF for COD per year; 9) Provide SUD/COD treatment and recovery support services to 90% of persons from the POF screening positive for SUD/COD per year; and 10) Provide evidence-based programming for at least 100 program participants per year.

Us Helping Us, People Into Living, Inc. (Us Helping Us) submits the grant application entitled, “For Me. For You. For Us.”, in response to SAMHSA’s Minority AIDS Initiative: High Risk Populations NOFO #TI-23-008 and seeks $500,000 per year over the five (5) year grant period. Us Helping Us operates two office locations within the Washington DC Metro Area and has an organizational infrastructure containing four complementary divisions that creates an integrated community-clinical services approach for the provision of comprehensive, HIV status neutral services (SAMHSA Level 5). The core foundation of these medical, behavioral, and social services are based on active and continuous client engagement and are buttressed by Us Helping Us’ client-centered care coordination team. Us Helping Us' core activities are culturally relevant and appropriate, span the HIV and PrEP/PEP continua, and comprehensively address the inequities in health experienced by Black gay, bisexual, MSM, other sexual and gender minorities (e.g., transgender women), people living with HIV/AIDS, and persons with substance use and mental health disorders. The population of focus to be served by funding opportunity are Black men who have sex with men (MSM) ages 13 and above with substance use and/or mental health disorders, who are living with HIV or are vulnerable to HIV, and who live, work, worship, socialize, and age in Washington DC. Us Helping Us will utilize the Peer Assisted Treatment of HIV and Substance (PATHS) Model as the evidence-based practice (EBP) for this funding opportunity. This approach closely mirrors Us Helping Us’ current peer navigator approach. Coupled with the documented success of the PATHS Model and Us Helping Us’ wide array of existing programs and services, Us Helping Us will utilize a dynamic marketing and community outreach strategy entitled “For Me. For You. For Us.”. The new “For Me. For You. For Us.” outreach strategy will highlight knowing an individual’s status (HIV, STI, Hep, SUD, mental health) and subsequent treatment adherence as a personal responsibility to oneself (For Me.), a collective responsibility to their friends and social networks (For You.), and as a collective responsibility to the community at large (For Us.). Us Helping Us will expand current in-person outreach and community education and mobilization efforts as well as media campaigns (social media and radio) to reach the population of focus with messaging. Using peer navigators with similar lived experiences to engage the population of focus and offer testing services in a variety of settings is an effective way to reach individuals who may not otherwise seek out healthcare services or have limited access to such services. The availability of immediate testing or follow-up testing options through Us Helping Us' mobile medical units or office locations as well as HIV self-testing in a location convenient to the potential client provides individuals with multiple options for testing that accommodate their privacy and convenience preferences. Goal: By the end of the 5-year grant period, at least one thousand (1,000) new unduplicated Black MSM with substance use and/or mental health disorders and who have HIV or are highly vulnerable to HIV from Washington DC will have experienced reduced or eliminated barriers to accessing HIV, STI, HepB&C, prevention, treatment and care and SUD and behavioral health services, ultimately ensuring at least 25% (250) of clients remain engaged in treatment for six (6) months or more, as appropriate.

Access to and staying in OUD treatment remains a significant challenge due to substantial service gaps and a lack of coordination of care. There were approximately 1400 patients cared for in the University of Pennsylvania Health Systems' Emergency Departments. Post ED visit and hospital discharge provide opportunities for a multidisciplinary team consisting of a case manager and peer recovery specialists to facilitate linkage to MOUD care and address syndemic factors to enhance linkage to care. Barriers to MOUD care entry include: 1) engaging individuals in a timely manner due to wait times for MOUD appointments; 2) limited warm hand off services; 3) lack of provider knowledge and willingness to prescribe MOUD; 4) lack of integrated treatment for co-occurring psychiatric and medical disorders; and 5) limited bed availability and time-consuming referral process for inpatient OUD treatment. There is a clear need to facilitate engagement in MOUD care by providing coordinated care addressing social determinants of health such as transportation, lack of insurance and lack of housing in addition to streamlined linkage with warm hand offs with continued follow up by peer recover specialist to maximize sustained participation in recovery.

Substance misuse and abuse are significant public health challenges for young African American adults, ages 18 - 25. To reduce the onset and progression of substance misuse and its related problems, the Substance Abuse Resources and Disability Issues (SARDI) program in the Boonshoft School of Medicine at Wright State University will partner with the administrations at Central State University (CSU) and Wilberforce University, two Historically Black Colleges and Universities (HBCUs) located in Greene County Ohio, to create the Leading Efforts to Advance Prevention (LEAP) project. The chief academic officers (i.e., the Provosts) at these two HBCUs will serve as co-investigators (Co-Is) on this LEAP project with SARDI leadership, prevention, and evaluation staff. This project will be guided by SAMHSA’s Strategic Prevention Framework (SPF) to build and strengthen community-level prevention capacity to address substance use and mental health concerns in African American students ages 18 – 25 on both campuses whose populations are primarily Black, indigenous or people of color (CSU = 73% and Wilberforce = 99%). LEAP will integrate infrastructure development and capacity building, direct prevention services, and environmental/community strategies to impact individual behavior, as well as community risk perceptions that influence norms, behavior, and health practices. The goals of the LEAP project align with the five steps of the SPF process: 1) complete the Assessment step of the SPF process, identifying prevention priorities on each campus; 2) complete the Capacity Building step, in order to develop a successful prevention program on each campus; 3) complete the Planning step, including development of an implementation plan and a strategic prevention plan; 4) complete the Implementation step, delivering prevention services on the CSU and Wilberforce campuses; and 5) complete the Evaluation step, establishing a rapid-cycle quality improvement process for the prevention programming on each campus. To implement the SPF process, SARDI staff and Co-Is will identify a LEAP team of 10-12 members from CSU and Wilberforce University, including 5-6 administrators, faculty leaders, and student leaders from each institution. The LEAP team, led by SARDI and Co-Is, will use the SPF to identify and address up to three data driven community substance misuse prevention or mental health promotion priorities. Once the priorities are identified, the LEAP team will select appropriate evidence-based programming based on the needs of the target population, and then implement and evaluate the programs starting by the end of month 6 of the project. The LEAP project will provide a number of different strategies in order to complete the SPF process and implement services to impact community and individual change. A minimum of 350 African American students will receive direct prevention interventions in the form of curriculum education sessions. The project will also implement a media campaign that will include both social media and print media reaching over 9,700 students total (2,200 with social media and 7,500 with print media). Peer Advocates from each HBCU will be selected to create 16 role model stories, and the role model stories and other prevention messages will be distributed to 1,600 peers on both campuses. To measure community change, a preliminary Needs Assessment will be conducted with 300 students in Year 1 with follow-up assessments with an additional 300 students in each of Years 3 and 5. SARDI’s 30 years of experience in prevention education, curriculum design, assessing community needs, and evaluation give us, along with our partnering HBCUs, the capacity and expertise to successfully meet the goals of this important LEAP project.

Damien Center, Inc. will implement the CARE (Comprehensive Access to Recovery and Empowerment) project to increase engagement in care for racial and ethnic underrepresented individuals ages 18+ with substance use disorders (SUD) and/or co-occurring substance use and mental health disorders (COD) who are at risk for or living with HIV/AIDS. CARE will be provided in the Indianapolis Transitional Grant Area, which includes Marion County, Indiana, and nine surrounding counties. Marion County is an EHE Priority Jurisdiction. The primary population for CARE is serving those racial/ethnic minorities most impacted by HIV, including gay, bisexual, and other men who have sex with men (MSM), transgender individuals, and those HIV negative individuals at increased risk for HIV acquisition who are Black and/or Latino/Hispanic. These groups are prioritized in the Marion County Indiana Ending the Epidemic Plan, which emphasizes the need for prioritization of those most impacted by social inequities, those who experience the greatest barriers, who have the least access, those who are afraid to come forward for care due to stigma, mistrust, and traumatization. The overarching goal of CARE is to reduce Substance Use Disorder (SUD), Co-occurring SUD/Mental Health Conditions (CODs), HIV/AIDS, Hepatitis and other related problems among racial/ethnic minority adults. To achieve this, CARE will meet three primary goals for clients that are referred internally and participate in Damien Center and Damien Cares in-house programming. 1) Expand treatment and recovery services for those with SUD and COD 2) Increase linkages to and utilization of primary HIV care and antiretroviral therapy 3) Reduce the incidence of new HIV and hepatitis B and C infections Each of these goals includes numerous measurable objectives. A total of 171 individuals will be served through internal SUD treatment and 1,450 through HIV/STI and Hepatitis Testing throughout the five-year program. This includes: • SUD or COD Screening and risk assessment for 300 individuals annually (250 in Y1) • SUD/COD treatment services to 36 individuals annually (27 in Y1) • Peer Recovery Support to 36 individuals annually (27 in Y1) • HIV testing for 300 individuals annually (250 in Y1) • Hepatitis testing for 300 individuals annually (250 in Y1) • PrEP for all individuals at high risk for HIV and linkages to HIV/hepatitis treatment services for clients who test positive. These goals and outputs will be achieved through the implementation of several Evidence-Based and Best Practices, including provision of an Intensive Outpatient Program, Motivational Interviewing, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Medication Assisted Treatment, and Peer Recovery Services.

Mercy Care is a Federally Qualified Health Center serving nearly 16,000 homeless and economically or socially disenfranchised individuals and families annually in Georgia’s Fulton and DeKalb counties, including the City of Atlanta. Mercy Care provides primary, behavioral, dental, and vision care; primary HIV treatment and care; case management; peer support; and support from Outreach and Enrollment Specialists and Community Health Workers, all in one integrated setting. The population of focus for this grant is individuals living with or at risk for HIV/AIDS who have, or are at risk for, substance use disorder (SUD) or SUD with co-occurring mental health conditions (COD), specifically homeless, low-income, and/or uninsured Black heterosexuals and men who have sex with men (MSM) who live in high-need catchment areas of Fulton and DeKalb counties. The purpose of this project is to increase engagement in care by achieving the following goals: expand screening for HIV, Hepatitis B and C, SUD, and CODs to prevent new infections and identify more patients in need of services; increase linkage to care for those newly diagnosed with HIV to improve HIV-related outcomes; improve treatment adherence and viral load suppression among those receiving HIV care to improve HIV-related outcomes; improve symptoms of CODs in patients diagnosed with CODs; improve staff competencies in evidence-based screening methods; and address barriers that prevent clients from receiving hepatitis care, primarily continued IV drug use, transiency, non-adherence, and limited resources. Mercy Care expects to serve 38,500 people over the course of the five-year project.

Family Guidance Centers, Inc. is a not-for-profit community-based organization that is licensed by the State of Illinois to provide residential and outpatient medication assisted treatment (MAT) and other substance use disorder (SUD) treatment services. The population of focus of our MAI-High Risk Populations grant is African American adult residents of City of Chicago west and south side community areas who are at risk of, or living with HIV/AIDS, and are diagnosed with opioid use disorders (OUD). Over the five years of SAMHSA/CSAT funding, an unduplicated count of at least 1,400 minority adults who are admitted to FGC MAT services will receive expanded HIV and viral hepatitis (VH) testing, referral, prevention, and treatment services. Chicago is in Cook County, Illinois which is among the localities listed in this NOFO that have been hardest hit by the HIV epidemic. Priority will be placed on inclusion of persons in our target population who report injection drug use. The catchment area of our MAI grant will be 27 of Chicago’s 77 community areas that comprise the major portions of the west and south sides of the city. In 2020 these communities had a total population of 666,900 with a race/ethnic breakdown of 84.1% (533,503) African American, 7.0% Latinx, 3.7% White Non-Hispanic (NH) 2.7% other/mixed race (U.S. Census Bureau, 2020). High-risk Latinx adult residents with OUD will also be eligible for participation in this grant. According to the U.S. Census American Community Survey, while 51.2% of Chicago residents identify as female, 57.6% of residents in our catchment area identify as female. The communities in our catchment area collectively had a 2020 population rate of new diagnosed HIV infections that was over 75% higher than the Chicago citywide rate, and a population rate of PLWHI that was nearly 30% higher than the Chicago citywide rate. NH Blacks accounted for 48% of the late HIV diagnoses in the city in 2020, and 55% of the NH Black PLWHI during that year were virally suppressed, compared to 71% of the city’s White PLWHI. This data, coupled with the relatively higher rates of new HIV infections and PLWHI among residents of the communities in our catchment area are seen to provide evidence of the HIV/AIDS racial minority-based early diagnosis and care service gaps that this grant is designed to address. All three forms of FDA-approved medications for the treatment of OUD will be available to participants, and both outpatient and intensive outpatient will be available based upon clinical diagnostic findings. The routine assessment process will include screening for cooccurring mental health issues, histories of trauma, and tobacco use. FGC staff will offer HIV and viral hepatitis (VH) testing to each admitted participant, as well as their drug using and/or sexual partners. Persons who test positive for HIV and/or VH will be referred for treatment to University of Illinois (UI) Health clinics located in our catchment area. Persons who test negative for HIV will be referred to UI Health clinics for Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) services. The MAT services provided to participants will be enhanced through use of the Motivational Interviewing and Seeking Safety evidence-based practices. A summary is provided of FGC’s organizational and key staff qualifications and experience. A plan is provided which commits to compliance with SAMHSA/CSAT GPRA data collection and performance measurement expectations, as well as the collection of data to assess achievement of this grant’s expanded HIV/VH testing, referral, prevention, and treatment objectives. FGC is requesting $500,000 in MAI-High Risk Populations funding in each of five years. The proposed services will be coordinated with related Illinois Department of Human Services, Division of Substance Use Prevention and Recovery initiatives.

Georgia Harm Reduction Coalition, Inc., (GHRC) formerly known as Atlanta Harm Reduction Coalition, Inc in partnership with Odyssey Family Counseling Center (OFCC) is requesting funding to support its Substance Use (SU), Co-Occurring Disorders (COD), harm reduction, and HIV/VH/STI services to help reduce adverse effects of SU, COD, overdose and HIV/VH/STI by delivering individual and group mental health and SU counseling, SU and sexual health evidence-based interventions, outpatient SU treatment services, linkage to essential, supportive, and medical services including telehealth, HIV/VH/STI screening and treatment, Medication Assisted Treatment (MAT), syringe services including Narcan and fentanyl test strip distribution to at-risk African American men and women ages 18-44 and partners in southwest Atlanta. Toward these ends, the six main objectives of this project are as follows: 1. By 9/29/2024, GHRC will provide rapid HIV preliminary testing to at least 250 unduplicated at-risk African American men and women ages 18-44 and partners per annum. 2. By 9/29/2024, GHRC and OFCC will increase knowledge and prevention skills in at-risk African American men and women ages 18-44 and partners within the catchment area by providing evidence-based HIV and SU prevention programming including Motivational Interviewing, Matrix Model, Strengthen Based Case Management, CLEAR, PROMISE, and Trauma Informed Care to at least 75 unduplicated at-risk African American men and women ages 18-44 and partners within the catchment area per annum. 3. By 9/29/2024, GHRC and OFCC will increase awareness of SU and COD treatment, harm reduction, recovery support, and HIV/VH/STI services and anti-stigma campaigns through strategic media campaigns to reach at least 2500 unduplicated at-risk African American men and women ages 18-44 and partners per annum. This will utilize comprehensive peer driven social media and advertisement strategies. 4. By 9/29/2024, GHRC will increase SU, COD, and harm reduction education and services by conducting outreach, syringe exchange, Narcan, Fentanyl test strips, HIV self-Testing, safety drug using and condom kits distribution, immunization, and linkage to essential, supportive, and medical services to at least 150 unduplicated at-risk African American men and women ages 18-44 and partners within catchment area per annum. 5. By 9/29/2024, GHRC will increase access of HIV/VH/STI treatment services, PrEP/nPEP, and low threshold MAT for 40 unduplicated African American men and women ages 18-44 and partners within the catchment area identified through screening, outreach, and GHRC evidence- based curricula by providing linkage connections to appropriate medical, supportive, and essential services within and outside of GHRC. 6. By 9/29/2024, OFCC will increase access of outpatient SU and COD for 20 unduplicated African American men and women ages 18-44 and partners within the catchment area identified through screening and OFCC evidence- based curricula. Our main target population are African American men and women ages 18-44 and partners who have traditionally been the most disconnected from services and the hardest to reach, including people who use/inject drugs, LGBTQ, racial/ethnic minority, and those who live in rural areas. By fully integrating our services, our program will reach and assist populations that have fallen through the cracks of traditional fragmented service delivery systems, thereby increasing system capacity to effectively prevent HIV/VH/STI, SU, COD, and overdose and provide better access to care.

RAP, Inc. will implement Ending HIV in DC (EH-DC), a comprehensive program to increase access to substance use disorder (SUD) and co-occurring SUD and mental health disorder (COD) treatment integrated with HIV prevention and treatment for 90 adults (450 individuals over 5 years) aged 18 years and older, living with or at risk of HIV in Washington, D.C. (a US HIV Priority Area). The project will address D.C.'s unmet SUD/ COD treatment needs and reduce one of the highest HIV rates in the nation. The population of focus is residents of Washington, D.C., aged 18 years and older, engaged in evidence-based treatment for SUD or COD who are at risk for or living with HIV/ AIDS. RAP will prioritize adults that comprise the majority of new and existing HIV diagnoses in D.C., including Black and Latino adults, men who have sex with men, members of the LGBTQ+ community, injection drug users, and adult men and women who are living with or at risk of HIV and/ or viral hepatitis. RAP will place special emphasis on engaging and treating racial/ ethnic underserved populations who are disproportionately affected by HIV/ AIDS and viral hepatitis in D.C. to reduce the impact of behavioral health challenges, reduce risk and incidence of HIV, and increase access to treatment for those at highest risk. Interventions: EH-DC 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. Consistent with the CDC's Ending the HIV Epidemic (EHE) initiative and its four pillars, RAP's activities will be focused on the rapid diagnosis, treatment, prevention, and response to HIV using proven interventions. In addition to providing evidence-based SUD/ COD treatment, including FDA-approved MAT, RAP will employ a multidisciplinary care team responsible for staging recovery-oriented, trauma-informed, and behavioral health equity-based interventions. Both in-house and via referral, RAP will provide rapid and confirmatory HIV and hepatitis testing for all admissions, treatment for HIV and viral hepatitis, PrEP and PEP services, peer support, education, case management, and linkage to follow-up care. With a focus on equity, services will be accessible by people with limited English proficiency, veterans, and LBGTQ+ individuals. Measurable Goals: The overarching goal is to reduce SUD, CODs, HIV/AIDS and other related problems among racial/ ethnic minority adults. Goal 1: Increase access to and retention in treatment for behavioral health diagnoses-- at least 80% of clients will complete prescribed treatment/ services. Goal 2: Reduce new HIV and viral hepatitis infections-- Reduce client substance use, especially injection 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 CJ, SUD, MH, housing, educational, medical/ health, social connectedness, or employment. Goal 4: Increase recovery support services-- Retain a minimum of 70% of participants in aftercare/ recovery support services for at least six (6) months. Goal 5: Increase linkage to HIV/ hepatitis medical care-- At least 75% of HIV and/ or HEP-positive participants will adhere to both behavioral and medical treatment.

Catholic Charities (CC) of the Archdiocese of Miami, Inc. is proposing a Minority AIDS Initiative to increase the engagement in care for 100 individuals annually, for a total of 500 individuals throughout the lifetime of the project. The program will reduce the prevalence of substance use disorders, HIV and viral Hepatitis while increasing access and linkages to HIV treatment for racial and ethnic underrepresented individuals with a SUD that are living with HIV. The target population are racially and ethnically underrepresented individuals residing in Miami-Dade County who have substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are also at risk for, or are living with, HIV or viral Hepatitis. This five-year project will include outreach and referrals, screening and assessment, case management, evidence-based treatment, testing, medical health and medication supports, Recovery Supportive Housing for Spanish speaking clients, and partnering with our established collaborating partners, including the two Ryan White providers, Miami Beach Community Health Center and Care Resource. The first goal of the project is to increase engagement in care for medically underserved minorities to reduce the high-risk behaviors that may contribute to Substance Use Disorder (SUD) or HIV and Hepatitis by; 1) Providing comprehensive, coordinated, evidenced-based services to 500 unduplicated individuals across the 5-year funding period, with at least 50% being underserved Spanish speaking clients; 2) Providing rapid HIV and Hepatitis C testing along with RESPECT: Brief and Enhanced Client-focused HIV Prevention Counseling Interventions to 100% of clients at-risk of HIV and Hepatitis and engaging in SUD/COD services, as well as their partners, and refer for Post-Exposure Prophylaxis (PEP) testing; 3) Providing coordination of care that includes education and referral for PrEP, HIV and Hepatitis treatment, primary medical care providers, mental health, pharmacy services, Medication Assisted Treatment, and recovery support to 90% of clients engaging in high-risk behaviors with SUD/COD. 4) 70% of clients participating in SUD/COD services will complete treatment; 5) 70% of clients completing treatment will exhibit decreased mental health symptoms at discharge, and 70% of those will maintain improvements/show additional decreases at 6-months post admission; 6) Of the clients having an SUD and completing treatment, 90% will be substance-free during the 30 days prior to discharge, and 60% of those will report a reduction in difficulties related to drug abuse at 6-months post admission; and 7) 100% of HIV positive clients will be linked to HIV medical care. The second goal is to reduce the disparity in availability of SUD/COD recovery supportive housing and recovery services for Spanish speaking clients at high risk for HIV and Hepatitis by; 1) Expanding Recovery Supportive Housing for Spanish speaking clients who have completed residential treatment and are high-risk of HIV/Hepatitis and homelessness, for 24 clients annually for five years; 2) Expanding recovery supportive services including culturally appropriate outpatient treatment, case management and peer support services for 24 Spanish speaking clients annually for five years; and 3) Providing case management services to ensure that 70% of Spanish speaking clients will remain in supportive or permanent housing at three (3) month follow-up.

The goal of the EmpowHER: Empowering Minority Populations of Women at risk for HIV/AIDS for Equity in Recovery project is to increase engagement in care for racial and ethnic medically underserved women with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at risk for or living with HIV. The EmpowHER project builds on the existing partnership between Santa Maria Hostel (SMH) and Baylor College of Medicine's (BCM) Department of Family and Community Medicine (DFCM) whose addiction medicine faculty currently provide onsite medically managed withdrawal (detox) and limited office-based opioid use disorder treatment (OBOT) services for SMH clients. SMH, a regional safety net for lower income, uninsured, and indigent women, and primary referral for gender-specific (female) SUD treatment for 13-county Texas Public Health Region 6, serves primarily (>90%) uninsured women and their families through state-funded residential, outpatient, and OBOT services. SMH clients have high rates of sex work, sexual assault, and trafficking, in addition to injection drug use, resulting in high risk for HIV and viral hepatitis. EmpowHER will achieve its goal through attainment of the following objectives: 1. Provide comprehensive, evidence-based SUD/COD treatment and recovery support services, including needed screening, assessment, outpatient, residential, and medication treatments, supportive housing, recovery coaching, educational and career planning, parenting skills training, and trauma therapy services to 280 racial and ethnic medically underserved women with SUDs and/or COD who are at risk for or living with HIV. 2. Offer 100% of EmpowHER participants HIV and viral hepatitis testing on site at SMH and provide >=90% of participants testing during their first week of program enrollment. 3. Offer 100% of participants testing positive for HIV and/or viral hepatitis referral to HIV and/or hepatitis treatment providers in the community, facilitating participant acceptance of referral through motivational interviewing and peer recovery coaching. 4. Successfully link >=95% of participants testing positive for HIV and/or viral hepatitis to HIV/viral hepatitis treatment providers in the community within 30 days of positive screening test, through intensive case management and use of barrier buster funds, when needed, to cover costs such as lost ID replacement and transportation for eligibility and medical appointments. 5. Provide 100% of participants testing negative for HIV and viral hepatitis risk reduction education, case management, and referral to PrEP/PEP community service providers within 30 days of program enrollment. EmpowHER will help alleviate the high burden of HIV risk factors and unaddressed SUD/COD of racial and medically underserved women in Texas Public Health Region 6.