7. PROJECT SUMMARY / ABSTRACT Given the complex socio-structural barriers that PWID face, models of care need to shift from disease-centric models to status-neutral person-centric approaches that address non-HIV issues in addition to HIV services. Yet, few such models exist to date and of those that do exist, there has been little to no evaluation of their impact – including indirect effects on other risk groups and/or geographies. India is home to ~800,000 PWID, with HIV prevalence >20% in many cities. HIV incidence among PWID in New Delhi is 21.3 per 100 PY and less than 10 percent of PWID living with HIV are virologically suppressed. Additionally, a significant proportion of PWID in New Delhi report same-sex or opposite-sex partnerships and the majority report migrating to Delhi for work. Understanding these connections could help identify direct and indirect impacts this intense epidemic (and mitigation efforts) have on PWID in New Delhi and other populations and/or geographies or vice-versa. A status-neutral, person-centric clinic (the Blue Shed as referred to by the community) is being established at the venue that appears to be driving HIV transmission in New Delhi (opening March 2023). Our team is uniquely situated to evaluate the direct impact of this spatially-targeted person-centric intervention (Blue Shed) in a setting with one of the highest HIV incidence rates globally and indirect impacts across PWID networks and other groups. Our Specific Aims are to: Aim 1: Evaluate the impact of a spatially targeted status-neutral person-centric intervention on HIV incidence, viral suppression, and mortality among PWID in New Delhi, India; Aim 1a: Investigate the diffusion of a status-neutral person-centric intervention over networks and spaces; Aim 2: Quantify the overlap of HIV epidemics between PWID in New Delhi and other populations in New Delhi, as well as PWID across selected Indian cities, to elucidate potential indirect impacts of the Blue Shed intervention; Aim 2a: Examine the overlap between drug use and sexual networks of PWID through sociometric and egocentric network-based behavioral data and phylogenetic analysis; Aim 2b: Assess HIV source-sink dynamics and the geographic extent to which HIV among PWID in New Delhi overflows to PWID in neighboring states of Punjab, Uttar Pradesh, Chhattisgarh, and Manipur; and Aim 3: Model the direct and indirect impacts of a status-neutral person-centric intervention on HIV transmission within and beyond New Delhi alone and with other novel strategies (e.g., LA ART, LA PrEP). We will achieve these aims by 1) continuing follow-up of our sociometric network cohort of ~2500 PWID in Delhi; 2) establishing biometric linkages to the Blue Shed; 3) collecting new GPS data on mobility; 4) recruiting a sample of sexual partners of PWID; 5) leveraging behavioral data and specimens from large serial cross-sectional surveys (from 2013, 2016, 2023) among MSM in New Delhi and PWID in 4 other cities; and 6) whole...