Special Projects of National Significance - Demonstration/Implementation Sites - St. John’s Community Health (SJCH) proposes to establish a Demonstration Site project to enhance our existing street medicine and other critical interventions in unsheltered environments in low-income South LA neighborhoods for PLHW aged 18+ who are newly diagnosed, out of care or not consistently engaged in care, and are unstably housed and living unsheltered. The demographics of the target population for this Street Medicine HIV project are based on our current patient base. Most clients (65%) will be aged 31-54, 21% aged 55+, and 14% young adults 18-30. Breakdown by sex is 86% male and 14% female. Our project will serve all races and ethnicities. However, SJCH’s current patient base for HIV care which also reflects the neighborhood as a whole, the ethnic/racial breakdown of the target population will be primarily Latino (50%) and Black (43%), with Whites representing 3%, Asians/Pacific Islanders 2%, and American Indians/Alaskan Natives and others representing approximately 2% total of those served. All of the targeted population will be living in poverty, below 100% of the Federal Poverty Level (FPL). Approximately 75% of target population will have a history of involvement with the criminal justice system. We will provide trauma-informed, patient-centered, whole-person medical, behavioral health, and other services to 40 members of the target population annually. The goals of SJCH’s Street Medicine HIV (SMH) program are to: 1. Improve the health of unsheltered PLWH in South LA by achieving sustained viral suppression and reducing the community's HIV viral reservoir—lowering the risk of further transmission—through the development, launch, and sustained implementation of street medicine interventions. 2. Improve physical and mental health, and socioeconomic outcomes among target population. 3. Expand and formalize cross-sector partnerships with housing and social service providers to enhance service coordination, streamline referrals, and improve health outcomes. 4. Strengthen collaborations with government and community-based partners to enhance program impact. 5. Utilize Implementation Science to disseminate effective PLWH street medicine interventions. Current and prospective patients of our Street Medicine Program face severe and persistent unmet health needs made even more consequent by extreme poverty and social isolation. The mortality rate of unsheltered people in LA is 4.5 times higher than the general population, driven by extremely high rates of overdose, coronary heart disease, homicide, suicide, and COVID-9. It is critical to note that HIV medical specialty care, rapid HIV screening, and the availability of biomedical prevention must be made available as an essential part of a whole-person model of care. PLWH have other pressing health and social needs; and treating and preventing HIV is most successful with impoverished communities where there is support to address housing, food security, behavioral health, acute medical issues, and comorbid chronic conditions. Services provided include: community outreach and engagement; primary and preventive health care including HIV treatment, hepatitis C treatment, comorbidities care, and medically assisted treatment for substance use disorders; HIV screening and linkage to care; vaccinations; laboratory; medication dispensing and management; case management, health education, and patient navigation; substance use/mental health counseling, treatment and recovery support; and peer support and advocacy. Additionally, using an Implementation Science model, SJCH will actively contribute to the joint workplan, communications, and evaluation strategies in collaboration with the Capacity Building Provider and Evaluation Provider. This partnership will ensure high-quality program implementation, facilitate real-time learning, and drive the dissemination of evidence-based street medicine practices, ultimately advancing HIV care for unsheltered PLWH in South LA and beyond.
