PROJECT SUMMARY Biomedical breakthroughs over the past 30 years have dramatically improved treatment and prevention of HIV, hepatitis C virus (HCV), and opioid use disorder (OUD). Yet uptake of these HIV-related evidence-based interventions (EBI) remains distressingly low in populations that could benefit from them the most, notably people who inject drugs (PWID).Three structural limitations of current health delivery practices must be addressed to improve PWID access to HIV-related EBI: 1) the fragmented nature of the US healthcare system that forces PWID to seek care for infectious diseases and OUD from different entities; 2) the prohibitive administrative burdens of social programs such as Medicaid and Ryan White (complex eligibility requirements, burdensome paperwork); and 3) severe stigma toward PWID in healthcare settings that leads to care avoidance and poor retention in care. We propose an intervention that co-locates telehealth in syringe service programs (SSP) to improve uptake and retention of two key EBI, PrEP and MOUD. Because their practices are rooted in harm reduction principles and provide supplies that PWID routinely use, SSPs maintain strong client follow-up and offer many points of entry into care. Telehealth offers a more cost-effective, adaptable, and scalable model than in-person care, and recent service advances have generated a strong knowledge base for remote delivery of HIV-related care. Our intervention will further address administrative burdens by placing case managers on site to ease administrative burden, and by providing our telehealth providers with an evidence based stigma reduction training pioneered by our team. Our work will take place in four SSP sites across Minnesota which is currently experiencing an outbreak of HIV across racially and regionally diverse communities of PWID. Aim 1. Conduct formative research on determinants of HIV and addiction among racially and regionally diverse PWID to inform design of a co-located telehealth program. We will conduct in- depth interviews with N=25 PWID and N=10 advocates from PWID-facing organizations. We will also develop a tailored stigma reduction training for partnering providers using our proven experimental audit approach. Aim 2. Develop an integrative, low-barrier, low-stigma telehealth program for urban and rural PWID informed by Aim 1 findings and input from PWID and providers. Share back of Aim 1 findings will be conducted with 3 advisory boards (rural PWID, urban PWID, providers) to enlist their insights in the design of the stigma reduction training and key features of the telemedicine program. Aim 3. Pilot a telehealth intervention in racially and regionally diverse SSPs to assess feasibility, acceptability, and preliminary impact. Uptake and retention of PrEP and MOUD will be tracked for 6 months in 80 PWID across 4 SSPs (2 rural, 2 urban). Feasibility and acceptability will be informed by process indicators (enrollment, uptake, retention) and exit inter...