Pharmacies are nationally emerging as frontline public health practicing spaces due to their ubiquity, accessibility to medication and screening, and rapid scalability. Independent pharmacies, in particular, have successfully expanded services with greater ease due to the absence of corporate restrictions, including delivery of harm reduction services. Today, linkage to and retention in buprenorphine treatment and HIV prevention and care remains suboptimal in many underserved, HIV burdened communities. The goal of this application is to further expand public health pharmacy practice by exploring on-demand harm reduction services delivered by pharmacy staff in two communities facing persistent shortages in healthcare and local community-based services (i.e., Harlem and South Bronx in New York City). Building upon two decades of community pharmacy-based intervention research via Pharm-Link Studies (2001-2021), and due to recent innovations including telemedicine-based buprenorphine treatment, our team leveraged the NYC Health+Hospitals Virtual Buprenorphine Clinic (VBC) to investigate Pharm-Link/VBC+ which entails in-pharmacy delivery of opioid use disorder (OUD) services (i.e., low-threshold access to telemedicine-based buprenorphine treatment initiation, naloxone dispensation/overdose prevention counseling) linked with HIV services access (i.e., HIV testing/ counseling, PrEP/PEP dispensation, HIV treatment re/initiation) for community/hospital EHR-recruited persons who use opioids (PWUO). Pharm-Link/VBC+ will include public health-oriented pharmacy staff trained in harm reduction and patient navigation, focused on linking individuals to resources such as food, housing, support groups, legal aid, and public assistance. These efforts will be supported through partnerships between pharmacies and community-based service organizations. In brief, the specific aims for this developmental R34 proposal are to: (Aim 1) Develop Pharm-Link/VBC+ using in-depth interviews among 3 stakeholder groups (n=10 per group): frontline providers (pharmacists/ technicians/ clerks, buprenorphine prescribers, HIV providers, community-based organization providers), administrators (pharmacy administrators, health department officials), and PWUO with OUD treatment history; (Aim 2) Assess feasibility and usability of implementing Pharm-Link/VBC+ using (a) semi-structured surveys (baseline, 6-, and 12-weeks) among PWUO (n=30) across 3 sequential waves (n=10 per 12-week wave); and (b) administrative data collected from the study pharmacies and NYC Health+Hospitals EHR; and (Aim 3) Finalize Pharm-Link/VBC+ for R01 scale-up using focus groups (n=3; 6-8/group) among same 3 stakeholder groups, utilizing findings from Aim 2; and conducted and analyzed sequentially such that each group informs the next. These Aims will be accomplished through existing partnerships with two independent pharmacies with demonstrated research capacity from our prior work. Bolstering multi-sectoral approac...