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The Pima Prevention Partnership's (PPP) Axios (axios is Greek for worthy) "I am Worthy" Project (Axios Project) to serve youth 10-17 years of age at risk for entering the juvenile justice system in Tucson, AZ Metro Area, located in Pima County (PC), AZ's second most populous county. With a total population of 1,035,063, 21% are under the age of 18, and half (50.6%) of the population is Female. 38% of the population identifies as Hispanic or Latino and 50.4% of population identify as White, 3.4% of the population identifies as Black or African American, 3.6% as America Indian and Alaska Native (AI/AN), 2.8% as Asian. According to the US Census, 27.3% of the population speaks a language other than English. Educational attainment in Pima County in general, is low, with only 70.7% of individuals graduating from high school in 2021 (AZ DOE). By providing education, skill building, and pro-social activities, the Axios Project aims to prevent youth from entering the juvenile justice system. The Axios Project seeks to achieve the following three goals: -Build collaborative partnerships among relevant agencies; -Build community capacity; and -Divert youth from juvenile justice or criminal justice systems to community-based mental health and substance use disorder (SUD) services and other support services in a culturally competent manner. In collaboration with partners COPE Community Services (Thrive Youth and Family Services), as the adolescent mental health and substance use treatment provider and the Pima County Juvenile Court Center (PCJCC), the Axios Project will serve over 575 youth and parent/guardians. Youth Axios Project participants will be provided with a warm hand off for mental illness or co-occurring disorder (COD) treatment services by a Pathways Coach of the Axios Project. Each youth participant will also work one-on-one with a Pathways Coach to set goals and identify their individual needs in order to divert them from the juvenile justice system. Axios Project participants will also participate in evidence-based curricula based on youths' needs and assessment data to address potential contributing factors for juvenile delinquency. The Axios Project to convene a Behavioral Health Partnership Workgroup (BHPW) to coordinate strategies into the existing system of care. The Axios Project also to complete a Sequential Intercept Mapping (SIM) matrix to inform Pima County policies, protocols, and resources. The BHPW will consist of members from juvenile justice, law enforcement, schools, behavioral health, child welfare system, civil first responders, family members with lived experience, youth and young adults with lived experience.

The WRAP Early Diversion program will expand programs that divert adults and youth with a mental illness or a co-occurring disorder (COD) from the criminal or juvenile justice system to community-based mental health and substance use disorder services (SUD) and other supports prior to arrest and booking in Adair, Cherokee, and Wagoner Counties of Oklahoma. WRAP intends to serve a minimum of 10% of veterans.

Coastal Horizons Center (CHC), in partnership with the New Hanover County Sheriff’s Office (NHCSO), the Wilmington Police Department (WPD), & Fayetteville Police Department (FPD) proposes to expand the treatment & recovery support services provided by two Law Enforcement Assisted Diversion (LEAD) programs located in Wilmington & Fayetteville, NC. LEAD “…is a pre-arrest criminal justice diversion program for people living in the community who use drugs & are at risk of being charged with low-level criminal offenses…” in addition to above partners, this project will be carried out with multiple treatment, housing, employment, vocational, criminal justice, & recovery support partners. Both LEAD programs began in the mid-2000s & serve adults (18+) with a possible substance use or co-occurring disorder that come into contact with NHCSO, WPD, or FPD (population of focus). A potential participant can be referred from law enforcement via an arrest diversion (e.g., encounter occurs as part of a criminal incident) or a social referral (e.g., contact in the community with law enforcement). The LEAD programs will provide evidence-based treatment services such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Acceptance Commitment Therapy, Medication for Addiction Treatment, Motivational Interviewing, Seeking Safety, & Matrix Model. In addition, psychiatric services, detox, assertive community treatment teams, recovery housing, employment, financial literacy, & transportation will be provided. CHC will continue to co-facilitate quarterly meetings of the LEAD Coordinating Group (behavioral health partnership workgroup) in both NHC & CC. These groups are comprised of executive representatives from criminal justice (i.e., District Attorney’s Office, law enforcement agencies, judiciary) & behavioral health service providers. These same groups will conduct an early diversion community system mapping exercise designed to identify current initiatives within NHC & CC at each intercept (0-5). A focus for these groups will be to develop & monitor procedures or protocols for coordination with law enforcement, local crisis, & 988 systems on pre-arrest/booking diversion efforts. The LEAD Coordinating Groups will also develop a calendar of training events to be completed in the first 6 months & over the grant period. These trainings will target law enforcement officers, attorneys, judges, civilian first responders, paraprofessionals & other professionals. The proposed project has four goals: 1) divert adults with a mental health disorder or co-occurring disorder from the criminal justice system to community-based mental health, substance use disorder, & other supports prior to arrest & booking in a culturally competent manner; 2) build collaborative partnerships among relevant treatment & recovery support services agencies within NHC & CC; & 3) build community capacity in order to better meet the needs of individuals with mental health & co-occurring disorders that come into contact with law enforcement; & 4) evaluate the project. The proposed project will serve 50 individuals per year across the five-year grant period. Thus, a total of 250 adults will be served with grant funds.

Highland Rivers CSB d.b.a. Highland Rivers Behavioral Health (HRBH), in partnership with the Cobb County Solicitor General, Cobb County Sheriff’s Office, Warrior Alliance and Magistrate Court, will work to create an early diversion program, Project Redirect, designed to better avert adults, children, and youth experiencing mental health crises from jail and/or unnecessary higher levels of inpatient care and/or legal impact in Cobb County Georgia. Cobb County is located just outside the perimeter of Atlanta, GA. Cobb County has a predominantly white population with 51.1% with African Americans making up the second most percentage of the population at 28.8%. It is the 3rd most populated county in Georgia with 771,165 people currently living there . It is estimated that 114,332 individuals living in Cobb have a mental illness, 30,488 of those are considered severe mental illness while 78,955 individuals have a substance use disorder. Although traditional factors for socioeconomic well-being appear better than US averages, when we look at the pockets of poverty that make up 14 % of the population these demographics are much lower. The census tract with the highest poverty rate in the county is 310.01 (34%) in Fair Oaks, an area along South Cobb Drive between Smyrna and Marietta . That tract also has the lowest median household income in the county at just over $29,000. The total population in Cobb County combined that had poverty rate higher than the US average is approximately 115,000 . As the primary Community Behavioral Health Center within its region, Highland Rivers Behavioral Health (HRBH) is part of a public safety net of providers in Georgia, funded to serve the uninsured, underinsured, Medicaid, Medicare and VA benefits population in northwest Georgia who experience substance use and co-occurring substance use and mental health disorders. To reduce the reliance on jail systems, ED’s and higher end crisis services for individuals with MH/ SUD, and COD, Highland Rivers Behavioral Health the Cobb County Solicitor General, Cobb County Sheriff’s Office, Warrior Alliance and Magistrate Court will develop and implement an early diversion program in Cobb County Georgia. This will be completed by establishing a behavioral health partnership workgroup, increasing training for law enforcement and judicial partners, and initiating programmatic elements that connect individuals to resources at the right moment in time. Highland Rivers Behavioral Health intends to serve 50 individuals in year 1, 65 in year 2, 75 in year 3, 74 in year 4 and 85 in year 5 totaling to 350 throughout the project timeframe.

Project Name: Vegas Stronger BHP Early Diversion Program for Adults and Youth Project Summary: Vegas Stronger is a nonprofit organization dedicated to providing comprehensive, evidence-based treatment for mental illness, substance use disorder, co-occurring disorders, and serious emotional disturbance. The project focuses on serving specific populations, including veterans, Spanish-speaking individuals, youth, and those experiencing homelessness or at imminent risk. By implementing proactive and rehabilitative approaches, the Early Diversion Program aims to divert individuals from the criminal justice system, address underlying causes of criminal behavior, reduce recidivism rates, and enhance community safety. Purpose: The purpose of the Early Diversion Program is to offer alternatives to prosecution and incarceration by providing interventions and services, such as counseling, treatment, education, and job training. The program seeks to transform lives positively, foster community integration, and reduce mental health-related crises. Vegas Stronger aims to enhance the overall well-being and mental health outcomes of individuals dealing with mental illness and addiction. Year 1 Goals: 1. Implement a successful Early Diversion Program that diverts at least 50% of eligible youth and adults from the justice system and connects them with community-based mental health services. 2. Increase the diversity and cultural competency of the workforce in the Early Diversion Program by 20% through recruitment strategies, training programs, and fostering an inclusive work environment. 3. Increase community awareness and engagement with the Early Diversion Program through meetings, informational materials, community events, and partnerships with local media outlets. Year 2 Goal: Reduce the rate of psychiatric emergencies and crisis hospitalizations related to mental illness by 20% through comprehensive crisis intervention and prevention services. Year 3 Goal: Increase the social inclusion and community integration of individuals with mental illness by successfully reintegrating 25% of enrolled clients into the community through integration programs. Population and Number to be Served: The project aims to serve 325 individuals over the course of five years, focusing on youth, veterans, Spanish-speakers, and individuals experiencing homelessness or at risk of homelessness.

Coastal Horizons a provider of mental health and substance use prevention, recovery and treatment services in Southeastern North Carolina, will increase access to services for individuals with substance use disorders and/or co-occurring substance use and mental health conditions who are at risk for or with HIV and increase testing for those at risk for Hepatitis B or C within the catchment area of New Hanover, Brunswick, Pender, Bladen and Columbus Counties. The project is known as Coastal Horizons Center Minority AIDS Initiative for High-Risk Populations. The project will serve 640 adults over five years. Serving 80 in YR1, 140 in YR2, 140 in YR3, 140 in YR4 and 140 in YR5. Goals and objectives are as follows: Reduce the prevalence of substance use, HIV, and viral hepatitis within catchment area by increasing access to evidence-based SUD programs and screening for infectious diseases. Obj1 Enhance accessibility of screening through incorporating Peer Support Specialists into mobile clinics to conduct rapid testing for HIV and HCV at a minimum of three days per week, on average throughout the life of the project. Obj2 Increase evidence-based SUD/COD treatment and recovery support services to individuals with or at risk for HIV, including screening/assessment, outpatient services, intensive outpatient services, and the use of FDA approved medication for treatment of SUDs and/or COD to 640 participants. Improve access to screening and linkage to services for individuals with or considered high-risk for HIV or Hepatitis B or C who are diagnosed with a substance use or co-occurring SUD and mental health condition. Obj1 100% of project participants will be screened for HIV, HBV, HCV, and SUD. Obj2 Link 100% of participants testing positive for HIV to medical care and case management services within 30 days. Obj3. Retain 100% of project participants who screened positive for HIV in medical care. Obj4. Establish 50% average engagement rate for project participants in Harm Reduction Services through assessing quarterly rapid testing rates. Obj5. Increase community knowledge and awareness about the importance of SUD, HIV, and Hepatitis B and C screening through targeted educational campaigns/awareness programs. Increase engagement of high-risk populations (at risk or living with HIV with SUD) in recovery support services Obj1 By 6/30/24, 60% of project participants will be engaged in peer support services, and 80% by 06/30/26, and 90% by 09/29/28.Obj2 Increase effective communication and collaboration between SAIOP facilitators and Peer Support Specialists (PSS) to promote continued engagement of project participants in recovery support services as evidence by completing a successful warm hand off to peer support services after project participants compete a three month SAIOP program as exhibited by a 50% average engagement rate in PSS. Establish a continuous quality improvement program to assess performance based on individual-level outcomes, perception of care and quality of care. Obj1 Maintain an 80% reassessment rate for project participants in completing 6-month GPRA interviews post intake Obj.2 Conduct key informant interviews/surveys to assess inclusivity and client satisfaction of service delivery to provide ongoing insight to quality improvement efforts. Obj3 Monitor and evaluate ongoing program effectiveness: Based upon key informant interviews/survey patient satisfaction scores. Increase sustainability of project initiatives beyond grant funding. Obj1 Increase the number of eligible billable units by Peer Support Specialists Obj2 Advocate for funding at the local, state, and federal level utilizing data to support program needs and advocate for funding/reimbursement rates. Obj3 Utilize internal advisory board to obtain recommendations to guide development of a sustainability plan Obj.4 In year four, identify two funding opportunities/sources or establish MOAs with new community partners to support sustainability.

QCHC's proposed program will increase engagement in care for a total of 90 racial and ethnic medically underserved individuals with SUD and/or co-occurring SUD and mental health conditions (COD) who are at risk for or living with HIV. QCHC will implement 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. With this program, QCHC aims to reduce the prevalence of SUD, HIV and viral hepatitis while increasing access and linkage to HIV treatment for the population of focus. QCHC will engage the following strategies that are central to our organization's implementation of HIV and SUD related programming including a status-neutral approach that focuses on meeting people where they are through a "whole" person approach to care and putting the needs of the person ahead of their HIV status. QCHC's status neutral service provision is possible through our evidence-based one-stop shop service delivery model that weaves together resources from across public health domains. Building on this approach, QCHC has invested in our staff and health care community to provide comprehensive, client-centered services that emphasize Gender-affirming care, healthcare empowerment, motivational interviewing, harm reduction, peer support, telehealth, trauma-informed care, intimate partner violence, and meaningful involvement of people living with HIV.

The Eskenazi Health Center Substance Use Treatment in Primary Care project seeks to increase engagement in care for racial and ethnic medically underserved individuals with substance use disorders (SUD) who are at risk for or living with HIV. The project is a partnership between Eskenazi Health Center and Marion County Public Health Department (MCPHD) Safe Syringe Access and Services (Safe Syringe) program that will focus on racial and ethnic minorities in Marion County, Indiana. Eskenazi Health Center will partner with MCPHD Safe Syringe to provide SUD treatment and recovery support services to individuals with or at risk for HIV. Patients will be screened for SUD, and they will also be offered point-of-care HIV testing. Patients that screen positive for opioid use will receive case management, linkage to care, MOUD and PrEP, if appropriate. SAMHSA funds will also be used to establish a Connections Café that will serve as a safe, nonjudgmental space for people who inject drugs to socialize and access services in a noncoercive way. The Connections Café will offer socialization opportunities for PWID with their Peers and individuals in recovery through games, movie nights, and group activities. The Connections Cafe will also offer weekly sessions such as art therapy, technical skills training, healthy living with HCV, grief counseling, and more. Goals and objectives for the proposed project include the following: 1. Create a coordinated, comprehensive program to address substance use disorder and the associated high risk behaviors within Eskenazi Health Primary Care. 2. Provide evidence-based SUD/COD treatment and recovery support services and HIV testing to 200 unduplicated individuals each year. 3. Link patients at high risk for HIV and HCV relative to substance use to appropriate treatment and/or harm reduction services. 4. Improve access to SUD treatment within a healthcare system capable of wraparound services relative to individual healthcare needs. 5. Introduce quarterly continuing education opportunities relative to stigma, harm reduction, motivational interviewing, etc. to primary care providers. 6. Offer weekly educational sessions for cognitive-behavioral therapy, trauma therapy, and other mental/behavioral health needs through Connections Café. 7. Improve health equity for marginalized populations affected by SUD, infectious diseases, and other risky behaviors. 8. Offer technical skills training and legal aid assistance to people engaged with the Connections Café. 9. Offer MAT financial assistance to uninsured patients desiring SUD treatment beginning in January 2024. Eskenazi Health Center and MCPHD already have robust programs in place for people who are at risk for HIV. Patients at risk for HIV or those living with HIV receive case management and linkage to care services. Eskenazi Health Center and MCPHD also continue to grow services for people with substance use disorders. Clients can receive treatment and harm reduction services at any of the EHC sites or via the MCPHD Safe Syringe program. The combination of experience and services will allow successful implementation of the proposed project.

The Broward House (BH) Clear Paths to Ending the HIV Epidemic Program will provide low-barrier therapeutic support services to support recovery from substance use disorders (SUDs) and co-occurring mental health challenges (CODs) to any member of a racial/ethnic medically underserved minority group living with or at risk of HIV in Broward County. With 35 years of experience working with the population and as the only HIV-specific substance use treatment program in the state, the agency has unique insight into the intersectionality of HIV, substance use, and mental health challenges and the complex barriers to accessing care and achieving and maintaining health and stability. Agency experience has shown that traditional treatment providers cannot provide the same safe and affirming environment needed for persons living with HIV (PLWH) to feel comfortable, be vulnerable, open up, and discuss the things necessary to recover truly. For this same reason, treatment is provided with on-site housing and intensive wrap-around supports, and for a more extended period, averaging five months, to ensure clients have a moment to stabilize their health, overcome addiction, build healthy skills, and access resources to support long-term success after they leave. Still, according to participant feedback, transitioning from the highly structured environment in treatment to more independent living is especially difficult. Therefore, the agency plans to utilize Clear Paths as a bridging program, helping clients maintain health, viral suppression, and recovery success. The goals of the Clear Paths initiative align with the Healthy People 2030 AHS, MHMD, SDOH, and IID categories, the President’s National HIV/AIDS Strategy 2022–2025 (NHAS), and the Ending the HIV Epidemic (EHE) Strategic Plan to reduce the spread of HIV. They include providing on-site HIV/STI/Hepatitis testing, risk assessment, and education to 100 clients annually with expedient linkages to medical care and Ryan White case management services for individuals testing positive for HIV and PrEP/PEP for individuals testing negative with increased risk factors. Moreover, the agency will provide integrated co-occurring behavioral health treatment, housing navigation, and case management services to these clients, totaling 500 over the 5-year project period. In addition, the agency will recruit 10% of Clear Paths clients each year as Peer Advocates and interview them to develop Role Model stories which they will distribute amongst their social networks to facilitate hope and recruit new participants into the program, leveraging the value of lived experience and universality to reach systems-fatigued individuals inaccessible through traditional channels. In this same spirit, Care Counselors will deliver services with the least possible barriers, holding sessions in their office, over the phone, virtually, and out in the field, meeting participants anywhere they feel comfortable–at residences, shelters, campsites, parks, coffee shops, and other agencies. This less traditional, more holistic care model, with multiple touchpoints and a combination of personal and systems-level interventions, is the best way to build trust and ensure individuals make lasting improvements. Since 1988, BH has served individuals in Broward County who are vulnerable to and living with HIV. Services include assisted living and transitional housing, medical and nonmedical case management, mental and behavioral health counseling, substance use treatment, peer support, advocacy, a community food pantry, HIV/STI prevention, outreach, and testing. Overall, it is the county's largest housing and Ryan White case management provider to PLWH. Therefore, the agency has the experience, infrastructure, and constituency, including relationships with priority underserved populations, to implement this program immediately and effectively, complementing existing services and adding a new dimension to care.

Special Health Resources for Texas, Inc. (SHR) seeks funding to bridge the behavioral health gap present in East Texas preventing racial/ethnic minorities from having equal access to evidence-based, trauma-informed, and recovery-oriented substance abuse treatment. Project Supporting Treatment & Recovery from Opioid Withdrawals (STROW) proposes to increase access to high-quality, comprehensive, and coordinated services to 350 individuals of racial/ethnic minority background with a substance use disorder or co-occurring substance use and mental health disorder and who are living with or at risk for HIV and hepatitis infection. The Project STROW treatment model will be based on a combination of evidence-based practices in coordination with recovery support services and medical care. SHR proposes a combination of EBPs recommended by SAMHSA or the CDC which have been shown to produce positive outcomes in the population of focus. These interventions are: Seeking Safety, Cognitive Behavioral Therapy, Foundations of HIV Testing and Navigation, and Personalized Cognitive Counseling. The proposed treatment model will be implemented under the umbrella of trauma-informed care and include hope, person-driven, safety, trustworthiness, transparency, and collaboration as its main components. Further advancing health equity, Project STROW will make services available via telehealth or in person, based on each client's preference. The following are the proposed measurable goals: 1) To establish a high-quality, evidence-based, treatment model to deliver, coordinated treatment to ethnic/racial minority adults with SUD/COD, living or at risk for HIV/Hepatitis infection. 2) Increase access to and engagement in SUC/COD, trauma-informed, recovery-oriented, high-quality, coordinated treatment for ethnic/minority adults with SUD/COD at risk or living with HIV/Hep. 3) Increase the number of racial/ethnic minority adults with SUD/COD living with or at risk for HIV/Hepatitis who receive HIV/AIDS and hepatitis services/treatment and prevention services. 4) To evaluate, analyze, and report on project processes and outcomes as measured by the collection of GPRA, dosage, and other local data. To fulfill the purpose of the grant, SHR will assign/hire experienced staff that includes a Project Director, Project Coordinator, two Licensed Chemical Dependency Counselors, one Licensed Professional Counselor, a Case Manager, a Peer Recovery Specialist, and an Evaluator.

La Clínica del Pueblo's MAI: High-Risk Populations project specifically targets the low-income, limited English-proficient Latinx community residing in Washington, DC, and Prince George's County, MD, facing substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD). It focuses on individuals who self-identify as men who have sex with men (MSM) and transgender women (TG) aged 18 and above who are either HIV-positive or at high risk of contracting HIV. The project aims to increase engagement in care for 200 members of the focus population throughout the grant period by providing access to high-quality, culturally, and linguistically competent, evidence-based substance abuse treatment, HIV and viral hepatitis testing and treatment, and access to PEP/PrEP. This purpose directly responds to SAMHSA's overarching purpose for the MAI: High-Risk Populations program. La Clínica's project aims to continue and expand upon the achievements of our current TCE-HIV High-Risk Populations project, which has received funding under SAMHSA TI-17-011 and is set to conclude on 09/30/2023. It will build on the existing program based on the Matrix Model and Trauma Recovery and Empowerment Model (TREM) evidence-based interventions, which were tailored for the focus population and integrated into our substance use programming with the support of SAMHSA TI-17-011 funding. It includes case management, mental health evaluation and treatment, HIV/viral hepatitis testing, education, and linkage to care as integral program components. To achieve its purpose, the project will meet the following goals and objectives: Goal 1: Increase the focus population's participation in care by providing access to high-quality, culturally and linguistically competent, evidence-based substance abuse treatment. 1.1: Conduct at least 75 outreach contacts with Latinx on the relationship between trauma and substance abuse and the availability of La Clínica's treatment and education program through a social and traditional media campaign and community education events; 1.2: Provide 200 unduplicated members of the focus population with outpatient and intensive outpatient substance abuse treatment services, and when needed refer individuals to La Clínica's medical services for FDA-approved medication treatment. Goal 2: Provide access to members of the focus population participating in La Clínica's substance abuse treatment to HIV/viral hepatitis prevention, care, and treatment services. 2.1: Provide HIV education, testing, risk reduction counseling, and treatment as needed; 2.2: Provide viral hepatitis education, testing, risk reduction counseling, and treatment; 2.3: Navigate substance abuse treatment clients with identified HIV and/or viral Hepatitis to La Clínica's medical services for confirmatory testing and follow-up care; 2.4: Provide education, case management, and referral to PrEP and PEP services as needed. Goal 3: Evaluate the program's success in providing effective, culturally, and linguistically appropriate treatment options for the focus population. 3.1: Collect data and report performance on key performance measures under the SAMHSA SPARS system; 3.2: Conduct annual local performance assessments to determine the success of the program model in meeting substance abuse treatment needs; 3.3: Conduct an annual event to disseminate best practices and lessons learned among key stakeholders to promote and inform the development of system improvements intended to expand SUD/COD, HIV, and viral hepatitis prevention and care, focused on the DC Metro region Latinx community's needs.

Whitney M. Young, Jr. Health Center’s proposed project will adopt a trauma-informed, recovery-oriented approach to address the complex needs of Black, Hispanic/Latino, and other underserved communities in the Albany Capital District who have SUD, mental health, and/or co-occurring disorders (COD), and are living with, or at risk for, HIV/AIDS, Hepatitis C (HCV), and other STIs. Based on identified service gaps in the local community, we propose to focus on several key priority areas that are aligned with regional needs and the required activities stated in this SAMHSA Funding Opportunity Announcement: (1) provide culturally-informed, evidence-based, Substance Use Disorder (SUD) and Co-occurring Disorder (COD) treatment, including screening/assessment, outpatient services, and medication-assisted treatment (MAT), for individuals with or at risk for HIV; (2) provide on-site HIV and Hepatitis testing services, with facilitated on-site confirmatory testing and linkage to care for those who test positive; additionally, provide on-site screening for Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis services, with facilitated on-site linkage to care; (3) expand Case Management and Peer Support Services to facilitate referral, linkage, and retention in care for those with preliminary positive and/or confirmatory HIV test results; (4) expand outreach services to link individuals to HIV/HCV testing, SUD, mental health, and COD treatment, and HIV and hepatitis primary care and prevention services. The goals of this program will be realized through the implementation of several Evidence-Based Practices, including an overarching Trauma-Informed Care approach, Medication Assisted Treatment (MAT), Strengths Based Case Management, PrEP, Motivational Interviewing, and ARTAS. The proposed project will involve a close collaborative effort across Whitney M. Young, Jr. Health Center’s multiple access and treatment sites, as well as community outreach via our mobile van, resulting in linking our target population with a coordinated system of evidence-based intervention, intensive case management, continuing care monitoring, and program evaluation. The proposed project will ultimately enhance and expand local capacity in the greater Albany area to identify, treat, and manage the complexity of co-occurring substance abuse, mental health, and HIV/HCV-related conditions.

Summary - Jordan Community Residential Center, in partnership with the Cleveland Clinic’s Infectious Disease Department proposes to increase engagement in services for African American women with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for or at living with HIV/AIDS. A total of 40 African American women will be served per year with a total of 200 receiving services over the grant period. Project Name – Minority HIV/AIDS Project Demographic Characteristics - A representative participant in this project is an English speaking, female, and African American. Ages will range from 18 to 65 with the average age being 35. Women presenting with a dependence on opioids will be from a variety of socioeconomic levels with a majority being indigent and uninsured. Most will be unemployed or employed part-time many may only have a high school diploma or GED. Often these women will be or have been involved with other public systems such as child welfare, public assistance and behavioral health systems. Although most list marital status as single, many of these defendants are likely to be parents and are challenged to meet parental responsibilities. They may be “doubling up” with family members to avoid homelessness. It is anticipated that most of the population will be court-involved and have histories of human trafficking and sexual exploitation. Strategies and Interventions - The goal of this proposed project is to increase engagement in services for African American women with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for or at living with HIV/AIDS. Objective #1: Upon notice of award, the project director will convene a Project Management Team to design, implement, monitor, evaluate and sustain the Minority HIV/AIDS Project. Objective #2: By December 30, 2023, train all project staff and Project Management Team representatives on the prevention and treatment of infectious diseases including HIV, viral hepatitis B and C. Objective 3: By January 30, 2024, begin service delivery by screening for the presence of high-risk sexual behavior, substance use, mental and co-occurring disorders using evidence-based screening instruments. Objective #4: By January 30, 2024, begin enrolling participants in a continuum of evidence-based and trauma-informed substance use disorder treatment, recovery housing and other recovery support services (40 participants per year). Objective #5: By January 30, 2024 begin providing on-site HIV rapid preliminary antibody (and confirmation testing) and viral hepatitis B and C testing, follow-up and medical care to 40 project participants and their partners. Objective 6: By January 30, 2024, offer HIV prevention education and referral for Pre-Exposure Prophylaxis (PrEP) to project participants’ who test negative for HIV infection and Post-Exposure Prophylaxis (PEP) services for individuals who are increased risk of exposure. Objective #7: By January 30, 2024, Collect and report GPRA, HBV and HCV and other program-related data for the purposes of grant compliance and continuous quality improvement. Objective #8: By July 1, 2024, form a Culturally and Linguistically Appropriate Services in Health and Healthcare (CLAS) – Behavioral Health workgroup and strategic plan with assignments, responsibilities and timelines to improve the provision of all individuals regardless of race, ethnicity, language, socioeconomic status and other cultural characteristic. Number of Unduplicated Individuals to be Served with Grant Funds Year 01 - 40 Year 02 - 40 Year 03 - 40 Year 04 - 40 Year 05 - 40 Total - 200

EMPOWER seeks to reduce the racial disparity in SUD treatment engagement and retention by increasing access and linkage to HIV and HCV testing and treatment. Participants, 290 Black men and women with SUD/COD who are at risk for or living with HIV, will receive culturally tailored, patient-focused and evidence-based interventions designed to promote engagement and retention in medications for opioid use disorder (MOUD) treatment. The goal of EMPOWER (Expanding Medical Prevention and Outreach While Enhancing Recovery and Retention) program is to increase SUD treatment engagement and retention and related care among medically underserved Black individuals with Opioid and other SUD and co-occurring disorders (COD) who are at risk for or living with HIV. The project will serve English-speaking adult Black men and women with: Opioid/other SUDs; COD; with predominantly low socioeconomic status; any sexual orientation or gender identity; and at risk for or living with HIV; a group that is less likely to enter and remain in treatment and less likely to receive MOUD than their White counterparts. The project will enroll participants at a stepped target annual rate (40 in year 1, 70 in years 2, 3, and 4, and 40 in year 5). EMPOWER builds upon the solid foundation of REACH, a large outpatient SUD treatment program in central Baltimore City, providing MOUD (e.g., buprenorphine, methadone, naltrexone) and a range of services to a diverse population of about 700 patients. Almost three-fourths of REACH patients are Black, and it is estimated that 20% are positive for HIV and 60% are positive for HCV. EMPOWER will focus on early treatment engagement and retention at REACH (months 1-6) where despite a menu of treatment options, stark racial disparities have been identified, with more Black men and women discontinuing treatment early, before HIV/HCV screening and mortality (including overdose deaths) and improve physical and mental health, particularly for the population of focus. Trained multidisciplinary EMPOWER staff with lived experience and representing the populations of focus will use a coordinated team approach to provide culturally tailored, patient-focused, and evidence-based interventions designed to promote engagement and retention of Blacks in SUD treatment. Individual plans of care will focus on building rapport within the therapeutic relationship to strengthen patient motivation and self-efficacy, while providing direct access to medical and psychosocial services needed to achieve each participant's SUD- and HIV/HCV-related treatment objectives. EMPOWER goals include: a) increase SUD treatment engagement (month 1) and retention (months 2-6) for Black men and women; b) increase awareness of and testing for HIV and HCV; c) provide HIV and viral hepatitis rick-reduction education; d) increase access to and engagement in comprehensive care including linkage to HIV and HCV treatment; e) improve health outcomes for program participants; and f) evaluate the effectiveness and impact of the EMPOWER program. The EMPOWER program will work closely with the Baltimore City Health Department and the Johns Hopkins John G. Bartlett Specialty Practice as key referral sites for patients diagnosed with HIV and not linked to specialty or primary care. If successful, EMPOWER will reduce health disparities for program participants, with lower mortality rates and improvements in physical and mental health and quality of life.

Bailey House, Inc.’s (BH) TranquiliT program will engage Transgender (TG) Persons of Color (POC) ages 18 and older with a substance use disorder (SUD) and/or a co-occurring disorder (COD) including a serious mental illness (SMI), HIV, and hepatitis C (HCV) that work, congregate, or live in the Central and East Harlem and Midtown neighborhoods of Manhattan and the Hunts Point/Mount Haven, Highbridge/Morrisania, Crotona – Tremont, and Fordham-Bronx Park neighborhoods of the South Bronx. The economic conditions in Central and East Harlem and the South Bronx are among the poorest in all of NYC—52% of residents live below 200% of the Federal Poverty Level and over half (55%) experience rent budget where 30% or more of their income is spent on rent. While economic conditions in Midtown Manhattan are better, the area serves as a transportation hub in NYC with many subway lines, Bus Terminal, and Penn Station. Given the number of individuals who flow through the area, Midtown is a hub for sex work, unsheltered individuals, and individuals who inject drugs. BH uses its experience and relationships within these communities to reach and engage those who might not otherwise seek services. LGBT individuals experience SUD and COD at higher rates than the general population. A recent study found that SUD diagnoses were significantly elevated among TG adults relative to their cisgender counterparts. A meta-analysis of mental health among TG individuals found consistent levels of depressive symptoms, suicidality, interpersonal trauma exposure, SUD, anxiety, and general distress. LGBT people may be discouraged from seeking SUD treatment because of negative experiences in coming out to providers, anticipating negative reactions, or having heard about others’ bad experiences. Further, the priority population is disproportionately impacted by the HIV and HCV epidemics. TG individuals of all experience are priority populations in the NYC Ending the HIV Epidemic Plan. In 2021, 62 TG people were newly diagnosed with HIV in NYC, of which 92% were TG women and 87% identified as Black or Latinx/Hispanic. A greater proportion of newly diagnosed TG individuals were under 30 years old at age of diagnoses compared to their non-TG counterparts. Rates of viral suppression (77%) and sustained viral suppression (60%) among HIV-positive TG individuals in medical care were significantly lower than their non-TG counterparts, indicating a need to support medication adherence. In 2021, only one-quarter (26%) of individuals with a positive viral diagnostic HCV test initiated treatment. TranquiliT will provide services utilizing an evidence-based, harm reduction, culturally sensitive, and health equity approach to increase access to and engagement in harm reduction and HIV prevention services and primary and behavioral health care among the priority population in the service area. Informed by its experience, BH will expand its successful street and virtual outreach model and person-centered approach to engage TG POC in comprehensive, integrated suite of harm reduction services including syringe exchange, HIV/HCV screening, and trauma-informed screening and link them to primary care, mental health and substance use treatment, and comprehensive status neutral HIV prevention and other essential support services. BH will also implement the Transgender Women Involved in Strategies for Transformation (TWIST) and Seeking Safety evidence-based programs, implement a virtual safe space, and support the Youth & Prevention Services Advisory Board to guide services across the department, including this program. Over the five-year period, HW will engage 525 individuals: 75 in Year 1, 100 in Years 2 and 3, and 150 in Years 4 and 5 through outreach and HIV/HCV screening. By the end of the program, there will be a 10% reduction in substance use and symptoms of depression and anxiety, and at least 90% of clients with HIV will be virally suppressed at their last appointment.

The Lighthouse Project is designed to link homeless youth and young adults who identify as Lesbian, Gay, Bisexual, Transgender and Questioning and their Straight Allies (LGBTQ+) to a trauma-informed system of care that includes linkages to permanent supportive housing and primary health care, case management services, substance abuse and mental health treatment and a wide array of recovery support services. The University of Arizona-Southwest Institute for Research on Women (SIROW), SAAF and El Rio Health will partner to serve LGBTQ+-identified, youth and young adults, in Southern Arizona, from diverse racial/ethnic backgrounds, with a specific focus on those between the ages of 18 and 35 who are chronically homeless. The goals of this project are (1) Increase the number of LGBTQ+ youth and young adults experiencing homelessness who are aware of available local services and the associated enrollment requirements and expectations, (2) Increase the number of youth and young adults, specifically those who are LGBTQ+, experiencing homelessness engaging in mental health and supportive service provision, (3) Increase the number of youth and young adults, specifically those who are LGBTQ+, experiencing homelessness obtaining and maintaining stable housing, (4) Improve equity in the quality of care in the current local system of providers who serve homeless LGBTQ+ young adults, including behavioral health treatment providers, primary health care providers and consumer-led organizations and (5) Goal 5: Increase the use of Lighthouse II SPARS data to inform project activities and to make needed adjustments and to inform the broader community about successful strategies and those that could be improved for LGBTQ+ youth experiencing homelessness. To best meet the needs of the 300 participants over 5 years, we will employ two Evidenced Based Practices (EBPs) in addition to other services. Wellness Recovery Action Plan (WRAP) is designed to help people with mental health disorders cope with symptoms and advance toward wellness and Motivational Interviewing will be employed during outreach and case management sessions to encourage participants to make positive changes in their lives with regard to substance use, mental health, physical health, stability and self-sufficiency. The Lighthouse Project participants will also have the opportunity to participate in the SIROW Sexual Health Education-Queer HIV prevention education curriculum, LGBTQ-affirming substance abuse and mental health services, vocational programs, financial education, and personal empowerment programs.

MAI- High-Risk Populations in Baltimore City responds to the impact of health disparities, substance use, and risk for infection with HIV and HCV among illicit opiate-using racial and ethnic minority individuals living in Baltimore City by providing accessible HIV/HCV testing and prevention, mental health screenings, social determinants of health screening, Hepatitis A&B immunization, risk reduction counseling linked with the co-located medical care program, the Health and Recovery Practice (HARP), at the University of Maryland Drug Treatment Center's substance use treatment programs. The University of Maryland Drug Treatment Center is a community-based organization affiliated with the University of Maryland School of Medicine in Baltimore, Maryland. The University of Maryland Drug Treatment Center provides comprehensive substance abuse treatment to 700 adults living in Baltimore City. The clinic has approximately 300 new intakes per year—about 60% of clients in the clinic self-identify as racial and ethnic minorities. The principal aims of this project are to strengthen patient engagement in the HARP clinic and the integrated mental health and substance abuse services for ethnic and racial minorities at high risk for HIV/AIDS and HCV seeking substance use treatment through a contingency management program (CM). This project will (1) determine if participants who utilize CM will increase engagement with the following medical care services: Infectious disease including preventative HIV care and HIV treatment, substance use, and mental health treatment and care, (2) evaluate the feasibility of the CM intervention for both patients and staff members. Project staff will receive training to deliver evidence-based practices (EBP). We will offer harm reduction services and a syringe program for participants to reduce blood-borne infectious diseases such as HIV and Hepatitis C. The community health workers will provide patient navigation (PN), an EBP that improves health outcomes among substance use treatment and HIV care. Due to the high prevalence of co-occurring mental health disorders and trauma and its effect on medical care engagement, psychotherapy services will enhance the CM program by offering dialectical behavioral therapy (DBT) skills and acceptance and commitment therapy (ACT) interventions. ACT is a transdiagnostic third-wave cognitive behavioral therapy that is effective for many disorders, including substance abuse, depression, and anxiety and has emerging evidence for treating PTSD. We believe that the combination of contingency management, harm reduction services, patient navigation, DBT, ACT, and MI will motivate and encourage patients to access medical care services at DTC and/or external referral sources, particularly preventative HIV care and HIV/HCV care and treatment, and will address the social determinants of health (SDoH) associated with poor medical engagement (i.e., substance use, trauma, high-risk behaviors). We plan to enroll 475 racial and ethnic minority individuals in the MAI program over five years (about 95 participants per year) to achieve our aims. The desired outcomes of this combination of interventions are to increase screening for high-risk behavior and connect individuals to clinical and ancillary services, increase utilization of HIV and HCV testing and immunization for Hepatitis A & B; screen for the SDoH impacting health care access and engagement; decreased mental health and trauma-related symptoms; improved retention in mental health, substance abuse treatment, infectious disease, and primary care services; and for those living with HIV/AIDS increased engagement and retention in HIV medical care.

CS-HHC will serve 475 people with SUD or COD over the 5-year project period (75 in Year 1 and 100 a year in Years 2-5) by providing integrated care (SUD and mental health, primary care, and infectious diseases [ID] services) for those who have or are at risk of HIV. The project will target Black and Hispanic individuals in the Greater New Haven area. Established in 1968, CS-HHC was the first Federally Qualified Health Center in Connecticut. We offer a full range of integrated medical, behavioral health, and dental care to over 50,000 clients annually in Connecticut's Greater New Haven and Lower Naugatuck Valley areas. We serve about 9,000 people with SUD annually. In addition, in CY 2022, we served 333 people with HIV, 814 with Sexually Transmitted Infections (STI), 88 people with Hepatitis B, and 460 with Hepatitis C. We are one of the region's largest behavioral health providers and provide direct in-house ID services. -Project name: Screening and Treatment Offered to Prevent HIV (STOP HIV). -Population to be served: STOP HIV will offer integrated behavioral health treatment and ID screening, testing, education, and treatment services to those who have or are at risk of HIV. AIDSVu (AIDSVu.org) shows that the City of New Haven has particularly high rates of people living with HIV (452 per 100,000 people), but that underestimates the risk in certain areas. In the 06519 zip code, for instance, where our services will be located, the rate of people living with HIV is much higher at 1,345 per 100,000 people. We anticipate that clients will consist largely of racial and/or ethnic minorities (Black and/or Hispanic) as per local prevalence rates, which show New Haven minorities have much higher prevalence rates than Whites--e.g., Black males (7.1 to 1); Black females (13.8 to 1); Hispanic males (5.1 to 1); and Hispanic females (8.5 to 1). -Strategies/Interventions: STOP HIV will offer onsite STI screening and testing (HIV, HCV, and HBV, among others) for clients at our GSP care site (soon to be Recovery and Wellness Center [RWC]), which provides Intensive Outpatient Treatment (IOP) and Partial Hospitalization Program (PHP) services, and at our South Central Rehabilitation Center (SCRC), which provides methadone maintenance and detox. Clients who test positive or are at risk for HIV will receive linkages to our ID Department, which provides STI services such as education, HIV treatment and care, viral hepatitis treatment services (A, B, or C), and PrEP/PEP. The ID interventions will be integrated into the clients' SUD and COD treatment services. For those who are not yet ready for a higher level of service, we will meet them "where they are" and provide them with harm-reduction services at multiple points of access. We also will address clients' social determinants of health (SDOH) through referrals for housing, employment, education, etc. -Goals and objectives: STOP HIV's main goals are to: 1) Hire project staff; 2) Increase STI screening, testing, education, and treatment for clients with SUD or COD who have or are at risk of HIV; 3) Provide clients with access to SUD/COD harm reduction, treatment services, and wraparound recovery-support services that are in line with their level(s) of motivation; and 4) Engage clients in the project consistent with their stage of recovery. Key objectives include: 1) Hiring a program coordinator, clinician, patient navigator, and addiction psychiatrist to implement the project; 2) Providing 475 project clients with HIV/HCV/HBV testing, treatment, and prevention services in the 5-year project period; 3) Providing SUD/COD screenings for 95% of project clients to determine appropriate levels of intervention; and 4) Keeping 80% of project clients engaged at their appropriate levels of recovery at 6 months. -Number of people served: The project will serve 475 clients over the 5-year project period.

The purpose of the HIV/Viral hepatitis Screening, Treatment, and Prevention at the Jefferson Bridge Program is to provide fully integrated SUD/HIV/Viral hepatitis care to racial and ethnic medically underserved adults (18+) in Philadelphia who are experiencing homelessness with co-occurring substance use and mental health disorders (COD) who are at risk for or living with HIV/AIDS, and others with complex care needs facing multiple service gaps. Leveraging Jeffersons extensive infrastructure to reduce the prevalence of substance use disorders, HIV, and viral hepatitis while increasing access and linkage to HIV treatment for people with a SUD that are living with HIV, this program will address complex acute and chronic care needs and provide care coordination with the services of a large medical center. The Bridge Program infrastructure will use MOUD, primary care, motivational interviewing, telehealth, and peer services as the cornerstone to close multiple service gaps in this exceptionally vulnerable population. The project will provide MOUD services to 625 people over five years. (75 people in year 1, 100 in year 2, and 150 in years 3-5). The three main goals of this project include 1) To increase access to and retention within MOUD/SUD treatment for racial and ethnic medically underserved adults experiencing homelessness and/or with complex acute and chronic care needs through an assertive, low-barrier approach; 2) To increase access to and retention in HIV/HCV screening/prevention/treatment for people from underserved racial or ethnic groups who are experiencing homelessness with complex acute and chronic care needs; and 3) To increased access to and retention in primary, behavioral, and specialty infectious disease healthcare for racial and ethnic medically underserved adults focusing on those experiencing homelessness and/or with complex care needs. Core program objectives include 1) offering 100% of program participants being offered screening, prevention, and treatment for HIV and viral Hepatitis and (if needed) immediate referral for confirmatory testing and treatment for themselves and their partners 2) 100% of participants will be offered testing for hepatitis B and C and referred as necessary for treatment 3)100% of HIV-negative participants who meet CDC criteria will be provided with information about PrEP and (if interested) immediate access to a PrEP provider. Innovative telehealth strategies and community partnerships with local methadone, peer services, and housing organizations will support objective achievement. The population of focus will be meaningfully engaged in developing and designing services and ensuring that individuals across all racial/ethnic groups and housing statuses have equal access to and retention in these services.

Minority AIDS Initiative for UPMC Detox Facilities Funder: SAMHSA Due Date: May 22, 2023 PI: Antoine Douaihy, MD Co-Applicants: PERU The University of Pittsburgh Medical Center’s Western Behavioral Health is proposing to implement a program that will potentiate screening for HIV/AIDS among racial and ethnic medically underserved adult (aged 18+) individuals, specifically Black and African American individuals, who access its Addiction Medicine Units (“detoxification” facilities) at Mercy, University of Pittsburgh Medical Center (UPMC) and McKeesport UPMC in Allegheny County, Pennsylvania. Allegheny County has a population of 1,250,578 with a lower median income than PA ($66,659; $67,587) and a lower poverty rate than PA (11.5%; 12.1%). Of the total population, 77.5% are non-Hispanic White, 13.5% are B/AA, 2.4% are Hispanic, 4.0% are Asian, 0.02% are American Indian, and < 0.01% are Native Hawaiian and Pacific Islander. Based on national estimates, 10% of residents identify as LGBTQIA2S+ and 7.7% speak a language other than English, pointing to a diverse demographic. This program will implement evidence-based screening and evaluation processes within these Addiction Medicine Units, linkage with Peer Navigators within these facilities for those who screen positive to facilitate the individual’s access to biomedical testing, treatment, and ongoing support. The program will also include ongoing training and support for the Addiction Medicine Units and testing/support facilities on how to best engage and retain racial and ethnic medically underserved individuals with substance use disorders and co-occurring mental health disorders who are testing negative and positive for HIV. Finally, the program will include a comprehensive quasi-real time evaluation component that will guide program implementation and evaluate its impact upon individual health and well-being. The program aims to serve ten individuals who test positive for HIV (two individuals each year) and 80 individuals (16 individuals each year) who are at risk for contracting HIV.

The Special Treatment and Research (STAR) Program of State University of New York (SUNY) Downstate Health Sciences University (DHSU) proposes to conduct the STAR Priority Populations Project, which will be implemented at STAR's flagship clinic site (STAR Health Center) (SHC) at SUNY-DHSU's University Hospital at Downstate in Brooklyn, NY. The SHC is STAR's trauma-informed, co-located outpatient primary care and behavioral health (BH) program for adults ages 18 and older. The populations to be served include Black and Latinx adults (18 and older) with substance use disorder (SUD) and or co-occurring SUD and mental health (MH) conditions (COD) who are at risk for or living with HIV. SUNY-DHSU serves a dense urban service area populated by low income, predominantly Black and Latinx immigrant populations. This area is underserved with respect to primary care and MH care, and HIV rates are disproportionately high. Barriers to care include poverty, homelessness, unemployment, and lack of education and health insurance. Brooklyn ranks first in NYC for new HIV diagnoses and concurrent HIV and AIDS diagnoses. Nearly one quarter of Brooklyn's cumulative AIDS cases among women are directly attributable to injection drug use (IDU) (27% among males); many more heterosexual and MSM cases are indirectly attributable to substance use. Proposed interventions include evidence-based SUD/COD treatment and recovery support services to HIV positive and at risk individuals, including screening and assessment, outpatient services, and the use of FDA approved medication for the treatment of SUD and or COD; on-site preliminary and confirmatory HIV testing; PEP and PrEP; provision for all clients and their partners who use drugs and or sexual partners of HIV rapid preliminary antibody testing at enrollment, including rapid fourth generation HIV diagnostic testing; education, case management, and follow up care and treatment for all clients who have a preliminary positive HIV and confirmatory HIV test result; education, case management, and PrEP and PEP services for individuals who screen negative for HIV but are at increased risk of exposure to HIV; screening and assessing individuals with or at risk for HIV for the presence of COD and use the information obtained to develop appropriate treatment approaches; evidence-based mental and SUD treatment and practices that are trauma-informed and recovery oriented; viral HBV and HCV testing on site and developing continuous outreach with consumer input. Goals are to identify adults with a SUD and or COD living with or at risk for HIV and or hepatitis; implement evidence-based interventions; provide HIV and hepatitis screening and hepatitis vaccinations; and engage and retain those testing positive for HIV and or hepatitis and or SUD or COD in primary care and BH services at the SHC. Objectives include providing in reach and outreach to identify eligible clients; HIV and hepatitis prevention services and linkage to care; case management to coordinate all aspects of care, including MH, primary care, HIV and hepatitis treatment; and other supportive services (e.g., housing, benefits) for 100% of newly-identified positives; implementing CBT for all eligible clients. Nos. to be served: 80 persons in each project year for a total of 400 persons over 5 years.

Santa Fe Recovery Center (SFRC) will develop and implement a Minority AIDS Initiative -High Risk Populations Project at two implementation sites in northern New Mexico to address the critical need for engagement-focused treatment among Native Americans and other underserved minority populations at high risk for HIV/AIDS. The populations of focus are the minority individuals of all genders in northern NM who not only are at risk for (or are living with) HIV/AIDS but also meet DSM-5 criteria for substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD), as determined by a licensed health professional. SFRC will implement and manage the Minority AIDS Initiative from its Santa Fe and Gallup, NM facilities. NM Dept of Health has identified service gaps pertaining to a Minority AIDS Initiative: limited access to PrEP and PEP; limited-to-no access to comprehensive case management and face-to-face case management; and limited access to culturally specific prevention interventions. The NMDOH HIV Prevention Program currently only contracts with five external organizations, down from a peak of 14 partners roughly 10 years ago. Only one ethnic-specific provider is left in this network. This has reduced the number of culturally specific prevention interventions available, particularly for young gay/bisexual men and transgender women of color. SFRC has designed a comprehensive program to deliver engagement-focused services to a high risk population using a team-based care model. The Minority AIDS Initiative will serve 600 unduplicated individuals annually as a well-designed program enhancement to mitigate the impacts of the HIV epidemic and address targeted populations’ health disparities due to the catchment area’s deficient resources and service gaps. Goal 1: Increase knowledge of status for minority individuals in the targeted geographic region. Goal 2: Increase engagement in care for the region’s minority individuals with SUD/COD at risk for HIV or who are HIV positive. SFRC's MAI Program Coordinator (100% LOE) will manage the day-to-day strategies and activities including community engagement campaigns and targeted case management for HIV prevention, for SUD/COD treatment, and for referrals to three HIV/HCV treatment facilities for treatment and follow up: Gallup Indian Medical Center, UNM Truman Health Services, and CHRISTUS St. Vincent Regional Medical Center.

Migrant Health Center Western Region, Inc. (MHC) is a Community Based, 330 (g) (e) (h), non-profit, 501(c) 3, MHC is Federally Qualified Health Center and Patient Centered Medical Home primary and preventive healthcare facility with a vast array of clinical and support service staff member, distributed across its 13 service sites located throughout the western regions of Puerto Rico (PR). MHC provides primary, preventive, and specialty care, as well as support services that include HIV, Hepatitis and SUD prevention/treatment, group therapy, transportation, case management, health education, general medicine, pediatrics, family medicine, psychological, psychiatric services, oral health, OB/GYN, MAT, PrEP, optometry, radiology, pharmacy, laboratory, vaccination, nutrition, and more. MHC is requesting $500,000 per year for 5 years to give continuity to the CARIB Project. MHC have identified the population of underserved Latino young men who have sex with men (YMSM) ages 15-34, and other high-risk populations such as men who have sex with men (MSM) ages 35 and older, gay, bisexual, and transgender 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. The proposed catchment area is the Western Region of PR, which is composed of 17 Municipalities. According to the U.S. Census Bureau approximately 530,103 individuals reside in the proposed area, of which 98.8% are Latino, 95% speak Spanish as their primary language, and 40.5% live under federal poverty level. MHC will provide community outreach, case management, substance abuse counseling, SUD/COD screening, treatment and recovery support services, patient navigation, psychological and psychiatric services, HIV and HCV testing, linkage to medical care, linkage to prevention services and PrEP, support groups, and Hepatitis vaccination, among others. The interventions to be utilized include Trauma Informed Care, SBIRT, Personalized Cognitive Counseling, ARTAS, Cognitive Behavioral Therapy, Motivational Interviewing, and Dialectic Behavioral Therapy, among others. Throughout the lifetime of the project MHC is proposing to serve 1,200 persons (FY1 – 240, FY2 – 240, FY3 – 240, FY4 – 240, and FY5 – 240). The project goals are1) Increase access to HIV testing and risk reduction services for individuals who are at risk and increase access to treatment for those living with HIV to antiretroviral therapy (ART), and linkage to care, reducing HIV risk and prevalence. 2) Increase the number of individuals who are at risk for HIV with SUD/COD who access evidence-based screening/assessment, SUD/COD treatment and recovery support services. 3) Increase the number of individuals with SUD/COD who live with HIV who are on ART and linked to HIV care, reducing the impact of behavioral health problems, reducing HIV risk and incidence, reducing trauma related conditions, and increasing access to retention in treatment for individuals with co-existing behavioral health, HIV and Hepatitis condition among the target population. The established objectives are: 1) Conduct a community need assessment; 2) Establish at least 10 MOAs annually; 3) Annually link at least 20 individuals with SUD/COD to treatment and/or recovery services; 4) Annually at least 100 program participants will be linked to psychological or psychiatric services, as needed; 5) Annually at least 50 clients will receive case management and substance abuse counseling services; 6) Annually at least 400 HIV test and 300 Hepatitis (C or B) will be performed; 7) Annually 100% of individuals at risk for HIV receiving program services will be screened for HIV, SUD and for the presence of CODs; 8) 100% of HIV/Hepatitis positive results will be referred/linked to treatment; 9) Annually at least 200 members of the target population will be referred to prevention and essential support services, including PrEP; and 9) Annually at least 50 viral Hepatitis (B or C)

The purpose of this proposal, Treatment engagement for SUD and co-occurring mental health disorders to medically underserved racial/ethnic individuals at risk for or living with HIV in the Charleston Tri-County Area: REACH clinic is to enhance the capacity of the EMPOWERR Program in the Charleston-North Charleston metropolitan area of South Carolina (a state labeled as an EHE priority jurisdiction) to provide comprehensive culturally-informed, integrated, evidence-based substance use disorder (SUD) treatment and related mental health and HIV services for racial/ethnic minority adults with co-occurring SUD and traumatic stress in a Ryan White clinic to meet currently unmet treatment needs in this catchment area. The Charleston- North Charleston area has consistently been in the top 10 metropolitan areas in the Southeast for new HIV infections, with racial/ethnic minority men and women making up the largest number of new infections. SC also has high rates of interpersonal violence (e.g., traumatic stress highly co-occurring with SUD) and substance misuse. The services proposed through this grant will include screening, assessment, outpatient evidence-based treatment, case management (inclusive of linkage services and recovery support), and outreach strategies targeting continuous engagement of underserved racial/ethnic minorities in SUD/HIV/COD related services. The proposed activities in this application, which fully align with the required activities outlined in FOA T1-23-008, address this “risk triad” (SUD, traumatic stress, and HIV)—through expansion of EMPOWERR services to establish the REACH clinic: Resiliency, Engagement, and Access for Co-Occurring HIV/SUD/PTSD populations. Specifically, this grant will provide the necessary resources for the EMPOWERR Program, in conjunction with our Ryan White clinic partner, to address critical service gaps in the EHE priority jurisdiction Charleston- North Charleston area, including but not limited to: 1) Implementation of SBIRT [Screening, Brief Intervention (motivational enhancement), and Referral to Treatment (for evidence-based SUD and co-occurring traumatic stress services)] to people living with HIV presenting to local HIV clinic; 2) Implement COD screening; 3) Provide evidence-based treatment for co-occurring SUD (SBIRT, Motivational Enhancement Therapy + Cognitive Behavioral Therapy/MET + CBT, including MOUD as needed) and traumatic stress (Cognitive Processing Therapy/CPT) for adults living with HIV or at risk for living with HIV through clinic-based and telehealth services; 4) Provide HIV testing through rapid preliminary antibody HIV testing to the population of focus, linkage to care as needed, and/or referrals to PrEP services for those with HIV negative results; 5) Establish Patient Engagement Groups (PEGs) to incorporate strategies for engagement and community education needs; 6) Provide recovery and support services; 7) Administer education sessions, outreach strategies, and linkage services for Hepatitis testing, PEP services for HIV exposure, and education on PrEP and related services. Outcomes will be closely and regularly monitored, including: SUD and HIV-related behavioral outcomes reported on the CSAT GPRA Client Outcome Measures for Discretionary Programs; number of individuals tested for HIV/VH and referred for services, number of participants receiving SBIRT and other identified evidence-based interventions for SUD and traumatic stress (e.g., MET/CBT, CPT), number of individuals receiving case management services through REACH (e.g., linkage to PrEP, PEP). By the end of the five-year period, 500 will receive evidence-based assessments and/or interventions (100 annually). The overarching goal of the project is to reduce SUD and traumatic stress through increased service engagement among racial/ethnic minority PLWH, in the Charleston-North Charleston area via co-located mental health services in a trusted Ryan White clinic.

Individuals with substance use disorders (SUDs) in the Columbus, Ohio region, especially racial/ethnic minorities, experience disparities in the prevalence of co-occurring mental health disorders (CODs), Human Immunodeficiency Virus (HIV), and Hepatitis C Virus (HCV). Despite increased prevalence for these conditions among racial/ethnic minorities, service gaps remain across the substance use care continuum from initial screening through engagement and retention in appropriate treatment. Project ASPIRE-OSU (Accelerating Substance use and Psychiatric screening among Individuals at-risk or HIV-infected and facilitated Referral via the Emergency Department) at The Ohio State University (OSU) will address health disparities related to the syndemic involving substance use, mental health disorders, and HIV infection. The central premise of Project ASPIRE-OSU is that individuals with SUDs, particularly racial/ethnic minorities, are not reliably screened and linked to needed SUD treatment. Project ASPIRE-OSU will leverage sites of the two high-volume, urban emergency departments (ED) of the OSU Wexner Medical Center (OSUWMC) in conjunction with OSUWMC infectious diseases and comprehensive substance use treatment services to: 1) Implement screening for SUD/COD among patients identified as at-risk for HIV or with HIV infection, most of whom are racial/ethnic minorities; 2) Utilize a multicomponent, comprehensive linkage service with an innovative combination of early, intensive, and sustained efforts to link and retain these patients to culturally-tailored SUD/COD treatment, HIV and viral hepatitis treatment and prevention, and other services as needed. Secondarily, we will leverage the ED Project ASPIRE-OSU program component to recognize patients presenting for emergency care who have not been linked or have fallen out of HIV or substance use treatment. Objectives for Project ASPIRE at OSU include measures to assess each of the project’s primary and secondary goals (e.g., number of patients screened for SUD/COD, linked to SUD treatment, retained in SUD treatment). We project 120 people will be served years 2 through 4 after 90 served in year 1 and 60 served in year 5. By the end of the project, a total of 500 individuals will be served. Of the 500 enrolled, we project >375 (75%) will be racial and ethnic minority individuals who are also medically underserved. Project ASPIRE at OSU utilizes an approach informed by SAMHSA’s Screening, Brief Intervention, and Referral to Treatment (SBIRT) evidence-based practice and will significantly impact the ability to screen and provide an intensive, sustained linkage-to-care intervention to address the needs of predominantly minority populations with substance use and co-occurring mental health disorders who are at high risk for HIV or HIV positive in the Columbus, Ohio region.