Centerstone's wellness on wheels (C-WOW) will take a syndemic approach to providing portable clinical care focused on integrating low barrier substance use disorder (SUD) treatment; HIV and other…

Centerstone's wellness on wheels (C-WOW) will take a syndemic approach to providing portable clinical care focused on integrating low barrier substance use disorder (SUD) treatment; HIV and other infectious diseases/conditions testing and treatment; mental health care; and harm reduction services for an unduplicated total of 300 individuals experiencing unsheltered homelessness in rural desoto and non-rural manatee counties, florida, across the 3-year project period (Y1: 60; Y2: 110; Y3: 130). Demographics and clinical characteristics of focus population individuals will mirror those of the unsheltered population in florida's continua of care (COCS) 500 and 517 serving catchment area counties, with 49% male, 51% female, 75% white, 24% black, and 37% hispanic individuals. Based on the FL-500/517 COCS, C-WOW's subpopulations are expected to include 242 racial/ ethnic minorities; 67 sexual/gender minorities; and 28 veterans. Rates of health/behavioral conditions among focus populations are higher than catchment area individuals: HIV (0.5% VS. 0.3%, respectively), hepatitis C (22% VS. 0.04%), chlamydia (7% VS. 0.4%), and serious mental illness (14% VS. 6%). CO-occurring HIV and mental illness are expected among 50% of the focus population, and nearly 12% will experience SUD. Opioid misuse contributes to HIV prevalence, with nearly 17% of those who are HIV positive having had injected drugs. C-WOW's evidence-based strategies/interventions include the SAN francisco department of public health's homeless health outreach and mobile engagement (HHOME) program, samhsa's tip 59: improving cultural competence, and samhsa's harm reduction framework to guide overall activities; on-site intensive case management, motivational interviewing, and soar; facility-based community-friendly healthy recovery program; and other facility-based interventions at centerstone available to C-WOW participants per their goals/ needs (e.g., medication assisted treatment, hazelden's CO-occurring disorders program, whole health action management, dimensions). C-WOW's goals include: 1) implement a pilot project for underserved populations experiencing unsheltered homelessness through the provision of portable clinical care, focused on the integration of behavioral health and HIV treatment and prevention services; 2) develop/implement system capacity building activities to enhance and sustain project services; 3) increase on-site point of care for the focus population; 4) decrease barriers to care for the focus population; and 4) develop/disseminate a documented service model/pilot program for replication/adoption. C-WOW's measurable participant-related objectives include conducting screenings/assessments and/or testing for HIV, hepatitis, sexually transmitted infections (STIS), mpox, tuberculosis, SUD/COD, and other mental health conditions; developing individual treatment and service plans; and providing case management, care coordination, linkage to services for 300 individuals. For 100% of participants per their needs/goals, C-WOW will provide on-site low-barrier SUD treatments, including FDA-approved medications, primary care health services, and infectious disease services; linkages to housing resources; and transportation to infectious disease treatment/vaccination and to prep/PEP, SUD/COD/mental health treatment, primary care treatment services, mpox, and recovery support services. C-WOW will increase access to trauma-informed, culturally responsive, integrated mental healthcare services among 80% and to harm reduction education, supplies, and other related services among 100% of participants. Additional objectives include training 50 centerstone/project staff and other providers in SUD/CO-occurring disorders identification, culturally-/linguistically-appropriate care, harm reduction, HIV/infectious disease treatment/prevention, etc. And establishing an advisory council comprising 20% focus population/individuals with lived experience.