Special Projects of National Significance - Demonstration/Implementation Sites - Description of Project: Cornell Scott-Hill Health Corporation (CS-HHC) will collaborate with grant-funded organizations (the Evaluation Provider, Capacity Building Provider, and other Demonstration Sites) to develop best practices to adapt, document, evaluate, and disseminate street medicine interventions for unsheltered individuals with HIV. Over four years, CS-HHC will directly serve 96 unsheltered individuals with HIV (18 in Year 1 and 26 a year in Years 2 through 4) by providing integrated HIV treatment, primary care, behavioral health (mental health and substance use disorder [SUD]), and social services to recipients “where they are” to improve their health and quality of life. CS-HHC offers integrated medical (including infectious diseases [ID]), behavioral health, and dental services to 55,000+ people annually—of whom 5,000+ are people experiencing homelessness—in Connecticut’s Greater New Haven area. CS-HHC provides street outreach and integrated treatment services to unsheltered individuals in the region. Needs to Address: CS-HHC’s project will work to improve primary care, ID treatment and prevention, and behavioral health services to unsheltered individuals who have HIV. AIDSVu shows that the Greater New Haven area has particularly high rates of people living with HIV (485 per 100,000 people), but that underestimates the risk in the City of New Haven alone. In the five City of New Haven zip codes (06510, 06511, 06513, 06515, and 06519) where most of our services will occur, the rate of people living with HIV is much higher at 927; 1,233; 885; 934; and 1,179 per 100,000, respectively. These high HIV prevalence rates coincide with an area with many unsheltered individuals, many of whom have HIV (or are at risk for HIV). For example, the City of New Haven estimates that more than 600 individuals in New Haven are unsheltered (camping in parks, under bridges, along roadsides, etc.) with hundreds more “unstably housed”. Proposed Services: CS-HHC will collaborate with other grant-funded organizations to achieve the grant’s goal to adapt, document, evaluate, and disseminate evidence-based street medicine interventions—such as HIV screening, STI treatment and screening, harm reduction, motivational interviewing, case management, SUD and mental health screenings and treatment (as needed)—to unsheltered individuals with HIV. Treatment will occur in the field; at DESK, a drop-in resource center for unsheltered individuals, where we have a care site; and at our main care site (where our ID Department is based). To achieve the grant’s five objectives, CS-HHC will collaborate with other grant-funded organizations to: 1) Build the capacity of its ID and Health Care for the Homeless (HCH) Departments to effectively respond to the health care needs of unsheltered individuals with HIV; 2) Adapt and implement street medicine interventions by ID and HCH staff to better serve unsheltered individuals with HIV; 3) Conduct an effective, informative implementation-science evaluation in coordination with the Evaluation Provider; 4) Develop effective, replicable street-medicine interventions for unsheltered individuals with HIV in coordination with the Capacity Building Provider; 5) Use Centers for Medicare and Medicaid (CMS) place of service codes to accurately reflect the places where services are provided, whether on streets, under bridges, in other public or open spaces, etc. CS-HHC will collaborate with its RWHAP CQM Committee and the Unhoused Activist Community Team (U-ACT) to ensure that people with lived experience with HIV and unsheltered homelessness have input into the project. Population Groups to Serve: The project will serve unsheltered individuals with HIV. Due to the demographic makeup of our community, these individuals will mostly be racial and/or ethnic minorities, individuals with low-incomes, and/or uninsured individuals. *References to unsheltered individuals include individuals who are unstably housed.
