There were an estimated 8,035 people experiencing homelessness in San Francisco in 2019, a 17% increase over 2017. The OPT-IN (Outreach, Prevention, and Treatment Initiation) Project was a four-year, CDC-funded project within the San Francisco Department of Public Health focused on improving HIV- and hepatitis C-related outcomes for people experiencing homelessness. Facente Consulting was hired in 2019 to design and conduct a four-phase assessment to develop innovative prototypes for HIV and hepatitis C-related service delivery for people experiencing homelessness.
In the first assessment phase, Facente Consulting completed a comprehensive literature review to identify evidence-based strategies for delivering HIV and HCV-related services for people experiencing homelessness and people who inject drugs. In the second phase, we led in-depth interviews with San Franciscans who had successfully begun HIV pre-exposure prophylaxis (PrEP), HIV treatment, or hepatitis C treatment while unhoused. We also conducted ethnographic observation and street intercept interviews with attendees of two “encampment health fairs” as part of the second phase. In the third phase, we implemented interviews with service providers focusing on HIV and hepatitis C services for this population, focusing on best practices and potentially promising prototype models for HIV and hepatitis C service delivery. In the fourth and final phase, we tested promising prototype models in a series of market research-style focus groups with people experiencing homelessness, using architectural drawings to enhance the experience.