Compass - comprehensive approach to syndemic screening and same-day treatment

The Department of Health and Human Services Substance Abuse and Mental Health Services Administration awarded Yale University $5.381 million on September 30, 2025, under the Substance Abuse and Mental Health Services Projects of Regional and National Significance program (CFDA 93.243) to implement COMPASS, a statewide hub-and-spoke model for hepatitis C elimination and syndemic screening and treatment in Connecticut.

COMPASS deploys same-day HCV testing, telehealth-enabled treatment, and peer-supported care integrated with screening and services for HIV, substance use disorder, and mental illness across five highest-burden cities: New Haven, Waterbury, Bridgeport, Hartford, and New London. The program aims to treat and cure at least 125 people annually and reach over 2,400 vulnerable individuals—including people who inject drugs, individuals experiencing homelessness, recently incarcerated individuals, and racially marginalized populations—over the three-year performance period ending September 29, 2027. Work is performed in New Haven, Connecticut, with community-embedded outreach workers placed in trusted community-based organizations including syringe service programs, shelters, and transitional housing sites to conduct point-of-care HCV testing, assessment, and enrollment.

Sub-recipients include Connecticut Harm Reduction Alliance Inc., the City of Waterbury Department of Health, Alliance for Living Inc., and Liberation Programs Inc. Each sub-recipient site conducts HCV RNA testing, assists participants in starting and completing HCV treatment, engages clients in wrap-around services, and participates in training and quality improvement learning collaboratives. Combined sub-award goals include conducting 640 HCV RNA tests, assisting 112 participants in starting HCV treatment, and assisting 100 participants in completing treatment across all sites.

Abstract

Compass will implement a statewide, community-embedded hub-and-spoke model to eliminate HCV in connecticut's highest-burden regions. Leveraging same-day testing, telehealth-enabled treatment, and peer-supported care, the program integrates screening and services for HCV, HIV, SUD, and mental illness. We aim to treat and cure greater than or equal to 125 people annually, reaching over 2,400 vulnerable individuals across five cities with the highest syndemic burden over 3 years. The compass initiative proposes a groundbreaking statewide strategy to pilot test an HCV micro-elimination strategy and address intersecting epidemics of substance use disorder (SUD), serious mental illness (SMI), HIV, and homelessness in connecticut, a state paradoxically marked by the second highest per capita income yet home to five of the poorest cities for their size in the nation. These five cities-new haven, waterbury, bridgeport, hartford, and new london-not only rank among the ten most impoverished but also account for more than 75% of the state's, greater than 18,300 untreated HCV cases. All are deeply impacted by homelessness and unstable housing and overdose fatalities, with connecticut's drug-related death rate (38.3/100,000) among the highest in the nation. Population to be served: compass will engage at least 2,400 unduplicated individuals and cure 375 people with HCV infection over three years, including people who inject drugs (pwid), individuals experiencing homelessness, recently incarcerated individuals, uninsured/underinsured adults, and racially marginalized populations disproportionately burdened by syndemic conditions. Strategies and interventions: anchored in a novel hub-and-spoke design, compass embeds trained outreach workers (OWS) in trusted community-based organizations (cbos), including syringe service programs, shelters, and transitional housing sites. OWS conduct point-of-care (POC) HCV RNA testing along with a validated syndemic screening instrument to identify syndemic conditions like HIV, SUD, SMI and homelessness. For those testing positive for HCV RNA, they are immediately linked to a centralized telehealth hub staffed by clinicians who deliver same-day bundled services: screening for HIV (POC testing), SMI (PHQ-2, madrs, GAD-7), and suds (alcohol and opioids). Pangenotypic daas are initiated on the same day for those testing positive for HCV. They may also be evaluated and treated for opioid or alcohol use disorder, SMI or other conditions. A rich array of community partners are available for supplemental support. In addition to same-day testing and treatment for HCV, HIV, mental health, and substance use disorders, compass clients will have seamless access to a full range of wraparound services. These include housing navigation, food assistance, insurance enrollment, access to medicaid and ryan white providers, linkage to primary care, psychiatric referrals via telehealth, and harm reduction resources such as naloxone, sterile supplies, and overdose prevention counseling. Outreach workers and peers will support clients in navigating these services, ensuring that care is trauma-informed, culturally responsive, and sustained over time. Outreach workers also serve as patient navigators and support engagement and linkage to housing, insurance, and psychosocial services. Clients will also have the option to engage with peers. All client-level data are captured in redcap, queried from the epic EMR, and integrated into CT's E2PREVENT and harm reduction databases. Goals and measurable objectives: each year, compass will initiate and complete HCV treatment in greater than or equal to 125 people with greater than or equal to 90% cure rates, while also increasing access and retention in SUD and mental health care. The program's bundled care model will be refined into a replicable toolkit, shared through apha, inhsu, and federal briefings to promote broader scale-up.