Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS

The Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment is accepting applications for fiscal year (FY) 2012 Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High-Risk for HIV/AIDS grants. The purpose of this program is to facilitate the development and expansion of culturally competent and effective community-based treatment systems for substance use and co-occurring substance use and mental disorders within racial and ethnic minority communities in States with the highest HIV prevalence rates (at or above 270 per 100,000). The expected outcomes for the program include reducing the impact of behavioral health problems, reducing HIV risk and incidence, and increasing access to treatment for individuals with co-existing behavioral health, HIV, and Hepatitis conditions. This program will ensure that individuals who are at high risk for or have a substance use or co-occurring substance use and mental disorder and who are most at-risk for or are living with HIV/AIDS have access to and receive appropriate behavioral health services. Grant funds must be used to serve people diagnosed with a substance use disorder as their primary condition. This grant program is part of the Congressional Minority AIDS Initiative, which was developed to improve HIV-related health outcomes for racial and ethnic minority communities disproportionately affected by HIV/AIDS and to reduce HIV-related health disparities. The program also supports the goals of the National HIV/AIDS Strategy. Three key findings from National Institute on Drug Abuse (NIDA) Research Report indicate that the interactions of drug abuse and HIV/AIDS extend far beyond injection drug use. First, drug abuse impairs judgment and good decision making, leaving people more prone to engage in HIV risk behaviors, including risky sexual behavior and non-adherence to HIV treatment. Second, drug abuse adversely affects health and may exacerbate disease progression. Third, and most important, because of these linkages, we must recognize that drug abuse treatment is HIV prevention, https://www.drugabuse.gov/sites/default/files/rrhiv.pdf. According to combined data from 2005 to 2009 National Survey on Drug Use and Health (NSDUH) about one in six individuals with HIV/AIDS had used an illicit drug intravenously in their lifetime (16.60 percent); nearly two thirds had used an illicit drug but not intravenously (64.44 percent), and 18.96 percent had never used an illicit drug; and one in four of those living with HIV reported use of alcohol or drugs at a level that warranted treatment, http://www.samhsa.gov/data/2k10/HIV-AIDS/HIV-AIDS.htm. The National HIV/AIDS Strategy (NHAS) clearly articulates the need for resources to be strategically concentrated in areas with high rates of HIV infection, and the need for targeting specific population subgroups at higher risk, such as young minority men who have sex with men. Key goals of the NHAS include: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities (p. vii, National HIV AIDS Strategy, Office of National AIDS Policy, the White House, Washington, DC, 2010). In support of the NHAS, the goals of the Minority AIDS Initiative and SAMHSA's mission to reduce the impact of substance abuse and mental illness on America's communities, applicants eligible to apply for this grant opportunity are limited to domestic public and private nonprofit, community-based organizations (CBOs) and Federally recognized Tribes and tribal organizations, in States and Territories with HIV prevalence rates of 270/100,000 or higher.1 The following 22 States and Territories meet this criterion: District of Columbia, New York, U.S. Virgin Islands, Florida, Puerto Rico, Maryland, New Jersey, Georgia, Louisiana, Delaware, South Carolina, Connecticut, California, Mississippi, Nevada, Texas, Virginia, North Carolina, Illinois, Pennsylvania, Tennessee, and Alabama. Note: Federally recognized Tribes may be partially or entirely located in one of the 22 identified States and Territories. Federally recognized Tribes that are not located in one of these 22 States and Territories, but can demonstrate an HIV prevalence rate of 270/100,000 or higher (using local tribal epidemiologic data) are also eligible to apply. To determine eligibility, provide local tribal prevalence data in Attachment 7. Using data from the local health department, all applicants must provide evidence of the need for the provision of substance use and/or co-occurring substance use and mental disorders treatment in their community, that the population(s) of focus are highly impacted by HIV/AIDS, and that they will primarily serve racial and ethnic minority populations, in Section A of the Project Narrative. This program will also align with goals of the HHS Action Plan for the Prevention, Care & Treatment of Viral Hepatitis2 related to addressing the need for reducing viral hepatitis related to drug use behavior. HIV-infected persons, MSM, and intravenous drug users (IDUs) are disproportionately affected by viral hepatitis and related adverse health conditions. Grantees will be required to integrate efforts to prevent new viral hepatitis infections, identify hepatitis infected persons, and to provide better linkages and referrals to care and treatment. Grantees should try to identify persons infected with viral hepatitis early in the course of their disease. All clients who are considered to be at risk for viral hepatitis (B and C) as specified by CDC recommendations for hepatitis B (CDC, 2008)3 and hepatitis C (CDC, 1998)4 should be tested for hepatitis (B and C). All clients testing positive for viral hepatitis (B or C) should be referred for treatment. SAMHSA is particularly interested in providing services to focus on young MSM. According to recent CDC data5, young MSM are particularly affected by HIV, representing one quarter of all new HIV infections. You are not required to focus on young MSM. However, if young MSM is your sole population of focus, you will be able to earn up to 5 points in Section B of the Project Narrative. In this section, applicants who propose to provide services to young MSM are asked to describe their experience and effectiveness in serving this population. (See Section V-I of the RFA, Priority Population-Young MSM). Applicants must propose to provide substance use and/or co-occurring substance use and mental disorders treatment and recovery support services to racial and ethnic minorities in one or more of the following populations at high risk for HIV or living with HIV: Young men who have sex with men (MSM) (ages 18-29); Adult heterosexual women and men; and Men who have sex with men (MSM) (ages 30 and older). In addition to providing substance use and/or co-occurring substance use and mental disorders treatment and recovery support services, HIV/AIDS testing and case management services, grantees are expected to enhance infrastructure and capacity to improve the community's response to HIV/AIDS by increasing access to care and services for racial and ethnic minorities at high risk for or living with HIV/AIDS. Expected outcomes for individuals with substance use and/or co-occurring substance use and mental disorders include: reduced HIV transmission; increased number of people receiving treatment for substance use and/or co-occurring substance use and mental disorders; increased number of people who, post-treatment, receive recovery support services; increased number of people who know their HIV status; and increased number of HIV positive people who are case-managed and referred to primary HIV care for antiretroviral therapy (ART) and other services necessary for optimizing health outcomes; increased number of people screened for viral hepatitis (B and C); increased number of people who know their hepatitis status; and increased number of people positive for viral hepatitis (B and C) who are referred to primary care. The TCE-Substance Abuse Treatment for High-Risk Populations program addresses a number of SAMHSA's Strategic Initiatives including Prevention of Substance Abuse and Mental Health Illness, Recovery Support, and Health Reform. The TCE-HIV program is one of SAMHSA's services grant programs. SAMHSA intends that its services grants result in the delivery of services as soon as possible after the award. Service delivery should begin by the 4th month of the project at the latest. The TCE-HIV grants are authorized under Section 509 of the Public Health Service Act. This announcement addresses Healthy People 2020 Substance Abuse Topic Area HP 2020-SA.