Special Projects of National Significance - Cooperative Agreements - Summary of the Project: The University of Massachusetts Lowell, Boston University, JSI Research & Training Institute, Inc. and the University of Nevada Reno, with their interdisciplinary Advisory Council, are pleased to submit a proposal to serve as the Evaluation Provider (EP) for Health Resources & Services Administration’s HIV/AIDS Bureau, (HRSA HAB), Division of Policy and Data’s Street Medicine Interventions for People with HIV who are Unsheltered (HRSA-25-057). Our team aims to collaborate with HRSA and the funded Capacity Building Provider (CBP) and demonstrations sites in the implementation, evaluation and dissemination of strategies for street medicine interventions for people with HIV who are unsheltered. We will work with the CBP and demonstration sites to build and assess sustainable, culturally relevant low-barrier access to client-centered HIV and behavioral health care that reduces stigma and coordinates services to address the structural and social determinants of health, and thus, improves health and socio-economic outcomes and quality of life. Members of our team and Advisory Council bring decades of experience and expertise in: 1) providing street medicine, including HIV and behavioral health care to people who are newly diagnosed or previously diagnosed with HIV but not engaged in traditional health care systems, 2) using a community-engaged implementation science and data-driven approaches, and 3) disseminating results and lessons learned to other Ryan White HIV/AIDS Program (RWHAP) recipients and public health organizations and systems that involves persons with lived experience. Collectively, we have worked together for a decade collaborating with over 90 RWHAP-funded organizations on innovative interventions to improve access to care, adherence to treatment, and address psychosocial needs to improve HIV health outcomes for people with HIV, including people who are unsheltered. We will accomplish five main goals: 1) Assess the organizational and local context for team readiness and develop tools for evaluation of the integration of street medicine interventions in collaboration with the demonstration sites, CBP and HRSA; 2) Design, plan, and conduct a methodologically rigorous multi-level, multisystem evaluation of the implementation, service and client outcomes of the demonstration sites’ street medicine interventions; 3) Provide both remote and on-site evaluation training/technical assistance to demonstration sites and monitor fidelity to intervention, modifications and adaptations and policy changes; 4) Plan and conduct regular assessment of implementation strategies, modifications, and adaptations through site visits and semiannual peer learning sessions, and 5) Lead the peer review publications and dissemination of materials to promote street medicine in public and private spaces and disseminate the initiative findings for replication across Ending the HIV Epidemic in the U.S. (EHE) jurisdictions and other RWHAP grantees. We will achieve these goals through collaboration with the CBP, demonstration sites and HRSA. Using the Dynamic Sustainability Framework and Proctor’s Model for Implementation Research, we will conduct a mixed-methods study to examine the fit and ecological context of the sites’ street medicine interventions and their implementation, service and client outcomes for replication to other RWHAP recipients and public health entities. Our evaluation questions include the cost and sustainment of street medicine interventions, their implementation strategies and impact on HIV health outcomes and quality of life for people with HIV who are unsheltered. Our approach is in line with the RWHAP goals for 2030 for people with HIV who are out of care through focused interventions, leveraging partnerships, and community engagement.
