Integration of HIV high-impact prevention services among injection drug users in the bronx: The development of 'one roof' health prevention model for IDUs

Background: HIV infection continues to result from injection drug use (IDU). Integrating HIV high-impact strategies for IDUs usually presents operational challenges. This paper discusses an HIV prevention service model implemented by a community-based organization in New York that integrates several HIV/AIDS strategies (community outreach, syringe access exchange program, HIV and Hepatitis testing, overdose prevention and peer delivered syringe exchange) and an HIV evidence-based intervention that targets street IDUs (Safety Counts), to reduce HIV infection and provide access and linkage to HIV/HVC care for drug users. Methods: HIV and drug-related strategies were implemented in multiple levels: structural (syringe exchange)funded through local funds and community (outreach), group level (Safety Counts) and individual level (Counseling, Testing and Referral and case management) funded through federal funds at CitiWide Harm Reduction Program, Bronx-NYC. Results: During 2010, community outreach delivered 21,217 encounters. The drop-in center provided services to 2,987 unique participants, including syringe exchange program, HIV and HCV testing, overdose prevention (Narcan) and peer-delivered syringe exchange. Rapid HIV testing reached 500 participants. The Safety Counts intervention was delivered to 100 active drug users who were referred from other agency services and received multiple services (e.g., residential health care, drug treatment, linkage to HIV care, dental care and psychiatric services) that increased the retention rate. Conclusions: An integration of HIV/HCV and HIV behavioral interventions can be attained using the 'one roof' model approach. This model can increase access to health services, linkage to HIV care and drug treatment programs and reduce the risk of HIV/HVC infections.