GEO impact: GEO-targeted implementation of a novel mobile pharmacy and clinic healthcare delivery model with community health workers for prevention, care and treatment of HIV and substance use

The National Institute on Drug Abuse awarded Yale University $2,225,580 in project grant funding on April 1, 2026, under CFDA 93.279 (Drug Use and Addiction Research Programs) to develop and implement GEO IMPACT, a geo-targeted learning public health system designed to increase reach and access to HIV prevention, care, and treatment services for people who use drugs in Connecticut through deployment of a mobile pharmacy and clinic model with community health workers.

Yale's work spans three integrated aims: identifying populations living with or at risk for HIV using prevalence modeling and small-area estimation techniques across collaboration with six Connecticut state health agencies and community organizations; aligning identified need with mobile pharmacy and clinic service deployment and evaluating impact at macro (state-level substance use and HIV markers), meso (community service access), and micro (individual participant outcomes) levels; and characterizing local barriers to care through mixed-methods community-engaged research to optimize healthcare delivery. The project runs through February 28, 2031, with place of performance in New Haven, Connecticut.

Yale engages four sub-recipients delivering specialized research support. Wake Forest University provides statistical methodology development and small-area prevalence estimation under Dr. Staci A. Hepler's direction (awarded June 15, 2026). Wake Forest University Health Sciences leads prevalence estimation and mapping efforts under Dr. David M. Kline (June 11, 2026). Virginia Tech conducts geospatial analysis, drive and transit time burden assessment, and survey research on activity-travel patterns and transit time perception among people who use drugs (May 29, 2026). St. Vincent De Paul Place provides community liaison, partnership coordination, and advising on mobile pharmacy and clinic implementation (June 11, 2026).

Abstract

There have been numerous recent outbreaks of HIV among people who use drugs (pwud) creating a "converging public health crisis" that threatens the success of the federal ending the HIV epidemic initiative. No single prevention or treatment approach will end the HIV epidemic among pwud requiring new ways to bring services directly to pwud where they are. This inspired the creation of the first legalized mobile pharmacy and clinic (MPC) health system in the U.S. With community health workers (CHW) working on the ground as one such strategy. However, knowing exactly where to go and how people will uptake services is still a vexing problem. Thus, we propose GEO impact with an overarching goal of: can a learning public health system be developed to increase reach and access to care for pwud and who are living with or at risk for HIV? To reach this high-risk high-reward goal, the strategy is 3 fold: 1) identify the population in need: with a first time-ever collaboration of 6 CT state health agencies, community groups, and researchers, we will identify the pwud population living with or at risk HIV and quantify the magnitude of need for prevention and treatment services using modeling techniques.; 2) align the need with access to services: with ongoing multidirectional data with CT state agencies, community HIV, SUD, and social service partners, and the MPC we will use the data to deploy the MPC to these areas and evaluate its impacts compared with matched communities on outcomes at 3 levels: macro (modeling and existing state markers of substance use and HIV), meso (community services and access to care) and micro (pwud living with or at risk for HIV). A mixed-methods community engaged approach will characterize additional local barriers to optimize healthcare delivery and; 3) use modeling and implementation information to make measurement-based improvement over three phases: within the meta-framework of the implementation research logic model (irlm), we will examine how the modeling information and the MPC intervention are working. Using mixed methods approaches, we will evaluate contextual determinants (barriers and facilitators) that mediate or moderate the achievement of these goals, the implementation strategies designed to achieve them, and if and how these implementation outcomes are being achieved. Akin to a learning health system approach, over three phases, we track how modeling and MPC services are working. With each subsequent phase we make iterative adaptations and improvements. This study combines a unique and broad set of methods and expertise, from the quantitative (spatial statistics, epidemiology and geography) to the clinical and operational (MPC), and implementation science. IT is also multi-sectoral with 6 state agencies that will now collaborate with community and research partners on the health of pwud. GEO-impact is a radical approach that leverages: 1) the latest methods to identify pwud at risk/living with HIV; 2) assertive mobile pharmacy and primary care and community health worker outreach service provision; and 3) a learning public health system to evaluate and improve how these innovative processes impact the lives of pwud at risk and living with HIV.