Housing Works, Inc. (HW) proposes to enhance its Health Outreach, Utilization and Support Enhancement (HOUSE) Project, to continue to reach and engage Black and Hispanic/Latinx men who have sex with men (MSM) and transgender (TG) women living in East New York, Brooklyn (ENY) and Central Brooklyn who have a substance use disorder (SUD) and/or co-occurring substance use and mental health disorder (COD) and are at risk for or are living with HIV and/or hepatitis C (HCV). The project will engage members of the House & Ball community in New York City (NYC), with whom HW has developed a relationship over the last several years. This community is made up primarily of Black and Hispanic/Latinx MSM and TG women of color. The population is disproportionally impacted by HIV/AIDS and has high rates of substance use and mental health disorders due to stigma, discrimination, and poverty.
The HOUSE program will be implemented at HW's ENY Health Center, a designated federally-qualified health center (FQHC) operated by HW's healthcare subsidiary, Housing Works Community Healthcare (HWCH). HW will expand its successful street and virtual outreach model to engage Black and Hispanic/Latinx MSM and TG women in an integrated suite of HIV, viral hepatitis, and COD screening and assessment, linkage to primary care, mental health and SUD treatment (including Medication Assisted Treatment), and comprehensive status neutral HIV prevention (including PrEP and PEP) and other essential support services (i.e., housing, employment, legal services). Funding will also be used to expand the suite of evidence-based programs (EBPs) offered through HOUSE. HW will continue to implement the Personalized Cognitive Counseling (PCC), The Haven (Seeking Safety), Transgender Women Involved in Strategies for Transformation (TWIST) EBPs, and plans to add SAMHSA's Anger Management EBP for HOUSE participants and Trauma-informed Care training for all program staff.
Outreach and engagement for the program will be driven primarily by HW's Youth and Prevention Services (YPS) unit, whose staff is reflective of the clients served (included YMSM and TG women of color). Outreach will be conducted through in-person and virtual events, as well as social media and app-based advertisement.
HW initiates a formal intake and assessment process with all recruited clients. In addition to SAMHSA's GPRA Intake Interview, along with the 6-month Follow Up and Discharge Interviews, HW uses evidence-based screenings for mental health (PHQ-2), substance use (DAST-10), social determinants of health (PRAPARE), and post-traumatic stress disorder (PTSD-5). Clients who screen positive for substance use, mental health disorders, and/or PTSD will be referred to appropriate treatment as well as the aforementioned EBPs. During intake, staff will also work with clients to identify barriers to healthcare and support needs, with this information informing their individual care plans.
Program staff will provide rapid HIV and HCV screening to clients. Those engaged in testing receive pre- and post-test counseling and have immediate access to services on-site at HWCH, including HIV care, PrEP services, behavioral health, and telehealth access to other providers if necessary. HWCH will offer same-day PrEP/PEP provision and will provide prescription starter packs for clients with limited/no insurance coverage.
The HOUSE program will serve 240 individuals per year over the five-year program period. All (100%) clients will receive a tailored care plan and appropriate referrals to care and support services; and 100% of those testing positive for HIV or HCV will be linked to care and 90% of those testing HIV-negative will be referred from PrEP services. By the end of the program, HW anticipates that 75% of enrolled clients will complete a behavioral health referral and that there will be a 10% reduction in both substance use and symptoms of depression and anxiety among enrolled clients.