San Francisco Community Health Center (SFCHC) - a multi-service, community-centered federally qualified health center (FQHC) with robust peer outreach, HIV prevention and treatment, and substance use disorder (SUD) programs - requests five-year funding through the SAMHSA FY 2023 Minority AIDS Initiative: Prevention Navigator Program for Racial/Ethnic Minorities (TI-23-005) to implement TransLink, an innovative, peer-focused initiative designed to significantly reduce the risk of substance use, HIV infection, and STI and viral hepatitis infection among homeless and unstably housed adult transgender women living in San Francisco’s hard-hit Tenderloin neighborhood. SFCHC will hire two new full-time transgender Navigators and three part-time transgender Peer Ambassadors who will reach and connect with high-risk transgender women through our agency’s TransThrive program, which serves nearly 1,000 transgender women each year. Clients enrolling in TransLink will complete an estimated 6-month period of engagement that incorporates a comprehensive client assessment and care plan development process; ongoing intensive navigation services; peer-based social support services; optional participation in weekly Seeking Safety groups; linkage to SUD treatment, individual and group mental health therapy, and socialization and recreational events. All clients will also receive HIV, sexually transmitted infection (STI), and viral hepatitis testing, and will be linked to comprehensive medical 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 TransLink will be to reduce the prevalence of substance use disorders (SUDs), HIV, and viral hepatitis among the adult transgender women of color in San Francisco while increasing awareness, access, and linkage to treatment for persons with SUD and at risk for or living with HIV. Key project process objectives include: a) overseeing a four-month, client-centered needs assessment and strategic planning process during which an ad hoc consumer needs assessment panel is convened; key local needs are identified; outreach, engagement, and retention strategies are developed; evidence-based testing, navigation, and linkage approaches are finalized; data collection and evaluation plans are completed; and a data-driven, comprehensive strategic plan for the project is produced; b) enrolling a minimum of 465 homeless and unstably housed adult transgender women of color in a 6-month assessment, service linkage, and support intervention that includes at least weekly contact with client navigators - including at least one monthly intensive in-person or online progress and support session - along with ongoing contact with Peer Ambassadors; and c) ensuring that all clients enrolled in the program and their partners receive rapid HIV and viral hepatitis testing and PEP and PrEP education at the time of enrollment, followed by integrated HIV, STI, and viral hepatitis testing, confirmatory testing, counseling and education, and linkage to high-quality on-site HIV, STI, viral hepatitis, primary medical care, and PEP and PrEP treatment through the co-located SFCHC medical clinic. Key outcome objectives of TransLink include: a) ensuring that at least 60% of project clients complete the full 6-month substance use and health and wellness navigation and support intervention; b) documenting self-reported reductions in the frequency and severity of substance use 6 for at least 50% of clients who complete the full 6-month navigation and support intervention; c) documenting significantly enhanced mental health status and improved outlook for at least 70% of clients who complete the full 6-month navigation and support intervention; and d) identifying and linking to care within 14 days at least 25 newly diagnosed trans women of color with HIV.
