HIV/HCV/Syphilis & Polysubstance Use Disorder for Homelessness
Good evening. My name is Clay Porter, and today I am presenting STREETRx at Valley Health Care, which stands for Syndemic Treatment, Rapid Engagement, and Equitable Transitions.
This proposed program addresses the intersection of homelessness, polysubstance use disorder, overdose risk, HIV, hepatitis C, and syphilis among unhoused individuals in Columbus, Georgia. The central argument of this project is that these conditions should not be treated as separate public health problems. Instead, they operate as a syndemic, meaning they interact with and intensify one another within a context of housing instability, poverty, fragmented care, and structural inequity.
The purpose of STREETRx is to create a low-barrier, co-located MAT and syndemic screening model within Valley Health Care’s existing clinical and outreach infrastructure. Rather than relying on traditional referral systems that require transportation, identification, appointments, and over SE-stability, this program brings services directly to individuals where they are already seeking care.
The problem this project addresses is both clinical and structural. Unhoused individuals experience high rates of premature mortality due to overdose, untreated chronic disease, infectious disease, violence, and exposure. For individuals using substances, especially in the context of fentanyl and polysubstance use, the risk of overdose is compounded by HIV, hepatitis C, and other sexually transmitted infections. At the same time, fragmented systems often separate addiction treatment, infectious disease care, behavioral health, and housing services. This fragmentation creates delays, missed opportunities, and preventable deaths.
The mission of STREETRx is to close the treatment-access gap for people experiencing homelessness in Muscogee County by embedding rapid MAT linkage, including medications such as buprenorphine and extended-release naltrexone or Vivitrol, within HIV, HCV, and STI prevention services.
The program is guided by three theoretical frameworks. First, the Social Ecological Model helps explain risk across individual, interpersonal, community, and structural levels. Second, the Structural Determinants of Health framework shows how homelessness, poverty, criminalization, and healthcare access barriers produce unequal outcomes. Third, Syndemic Theory explains how substance use, HIV, hepatitis C, and syphilis interact and worsen health outcomes together. These frameworks justify a stabilization-first approach that addresses immediate clinical needs while also responding to broader structural barriers.
Operationally, the model follows a simple logic: engage, screen, treat, navigate, and stabilize. Outreach teams and peer navigators would engage individuals through shelters, encampments, day centers, and Valley Health Care’s clinic. Clients would receive opt-out rapid testing for HIV, hepatitis C, and syphilis, along with brief assessment for polysubstance use, overdose history, and withdrawal status. When appropriate, same-day MAT initiation would be offered, along with naloxone, harm reduction supplies, counseling, and care navigation.
A key feature of this model is that navigation happens in real time. Each client would be connected with a care navigator who coordinates HIV care, rapid ART initiation if needed, HCV confirmatory testing and treatment referral, syphilis treatment, behavioral health services, MAT follow-up, and housing linkage. This reduces the likelihood that individuals are lost between referrals.
The program’s SMART objectives make the model measurable. Within six months, the goal is to screen at least 85% of enrolled clients for HIV, hepatitis C, and syphilis. Within three months of implementation, at least 70% of eligible clients should begin MAT at the first visit. Within twelve months, at least 90% of clients newly diagnosed with HIV should be linked to care within seven days, and at least 75% should initiate ART within fourteen days. Additional objectives include naloxone distribution, MAT retention, HCV treatment initiation, housing linkage, and reductions in overdose events.
This program depends on strong partnerships. Valley Health Care would serve as the lead clinical partner. The Georgia Department of Public Health would support testing, surveillance, and linkage systems. Homeless service agencies such as Open Door Community House and SafeHouse Ministries would serve as access points and outreach partners. Piedmont Columbus Regional could support emergency department referral pathways after overdose events. The Muscogee County Sheriff’s Office could support diversion and pre-release MAT linkage. Peer navigators and individuals with lived experience would be essential to trust-building and retention.
The proposed budget prioritizes personnel, clinical supplies, mobile outreach, housing support, and data evaluation. Most funding would support providers, nurses, outreach staff, peer navigators, a program manager, and a data analyst. Additional costs would include rapid tests, MAT medications, naloxone, mobile outreach operations, transportation, ID recovery, housing supports, and data dashboards.
The expected impact is significant. For Valley Health Care, the program expands integrated MAT and infectious disease care, strengthens outreach capacity, improves retention, and increases competitiveness for future funding. For public health, it reduces overdose risk, improves HIV and HCV outcomes, increases viral suppression, and addresses disparities among unhoused individuals. For my leadership development, this project demonstrates doctoral-level competency in systems thinking, program design, partnership development, and equity-centered evaluation.
The evaluation plan would use both implementation and outcome measures. Key indicators include screening completion, MAT initiation, MAT retention at 90 days and six months, HIV linkage, viral suppression, HCV treatment initiation, naloxone distribution, overdose events, and housing placement. A more advanced evaluation could use a quasi-experimental matched cohort design, propensity score weighting, Cox proportional hazards models, and equity-stratified interaction terms to assess whether the intervention improves retention, reduces overdose, and narrows disparities.
In reflection, this project’s major accomplishment is the design of a practical, low-barrier, co-located care model that integrates addiction treatment, infectious disease screening, harm reduction, and housing navigation. The major challenge is implementation complexity. Coordinating across clinical systems, homeless services, public health agencies, and criminal justice partners requires strong communication, shared goals, and sustainable funding.
In conclusion, STREETRx at Valley Health Care offers a stabilization-first response to overdose, homelessness, and syndemic disease. By embedding MAT, HIV/HCV/STI screening, harm reduction, and care navigation into one coordinated model, this program shifts care away from fragmented referrals and toward integrated public health practice. Ultimately, the program advances health equity by meeting people where they are, reducing preventable mortality, and strengthening the local public health system in Columbus, Georgia.
340b *money can be made*
StreetRx can generate sustainable revenue for nonprofit health organizations when it is integrated with the 340B Drug Pricing Program—but the mechanism isn’t about profit in a traditional sense; it’s about program income that can be reinvested into care.
Under 340B, nonprofits purchase medications at steeply discounted rates and are reimbursed at standard payer rates (e.g., Medicaid or managed care). When StreetRx facilitates rapid prescribing and dispensing—especially for high-cost medications like MOUD or HIV/HCV treatments—the difference between acquisition cost and reimbursement becomes 340B savings (margin). That margin is legally retained by the nonprofit and can be used to expand services.
StreetRx strengthens this model by:
Increasing patient volume through outreach to unhoused and high-risk populations
Accelerating linkage to billable services (same-day starts, walk-in care)
Improving medication adherence, which sustains reimbursement over time
Capturing encounters that would otherwise be lost to fragmented systems
In practice, nonprofits can reinvest this revenue into harm reduction (syringe services, testing), outreach staff, peer navigators, mobile units, and integrated HIV/HCV/MOUD care. So while StreetRx itself isn’t a profit engine, it acts as a front-end access model that drives 340B revenue generation, converting structural access gaps into financially sustainable, equity-focused care delivery.
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