Iowa Tribe of Oklahoma ETHIC II - The Iowa Tribe of Oklahoma (ITO) is initiating growth to better serve citizens and community of the ITO and the Perkins Family Clinic (PFC) in the Ending the HIV/AIDS Epidemic: A Plan for America (EHE) and the Indigenous HIV/AIDS Strategy (indigi-HAS) pillars and focus areas. The PCF has increased the presence and programing in the community in the areas of Syphilis/HIV/Hepatitis/STIs by promoting sexual health awareness at Tribal specific and non-Tribal community events. With the expansion project of the PFC, services will be expanding and prime the ability to apply quality improvement efforts in the areas of syndemic methodology for diagnosis, treatment, and prevention of Syphilis/HIV/Hepatitis/STIs. The response pillar of the EHE and indigi-HAS has been an area that ITO has partnered with area agencies such as the Oklahoma Area Tribal Epidemiology Center (OKTEC), planning for field testing. Testing for Syphilis/HIV/Hepatitis C outside of the clinic walls and in a mobile unit, will help remove barriers for better access to services for the community. Within the PFC, the ITO will be able to support universal testing for Hepatitis C, HIV, and Syphilis for the recommended once in a lifetime screen. Care Continuum evaluation within a quality improvement plan will support brining PrEP for HIV prevention on to formulary, especially in the wake of ending the Ready, Set, PrEP program. The ITO will work to train at least one provider in syndemic care methods, that will include primary care access to PrEP, Hep C treatment, and HIV treatment; through the support of area agencies such as the Indian Country ECHO, AETC, and OKTEC. Local social support for current activities have led to the patients being comfortable seeking their PrEP care and other syndemic related care at PFC, and ITO seeks to increase this capacity, efficacy, and patient support/satisfaction for Tribal citizens and the community.