As Boston’s largest homeless service provider since 1985, Boston Health Care for the Homeless Program (BHCHP) has transformed HIV care by delivering lifesaving treatment directly to homeless individuals living with or at risk for HIV. BHCP’s most recent study, “HIV Program Response to Boston HIV Cluster: Data Trends 2019–2023,” details the astounding progress the organization has made in recent years, the Boston Globe reports.

Led by Jennifer Brody, MD, MPH, director of HIV services at BHCHP, the study findings show the effectiveness of community outreach in reducing HIV transmission and increasing viral suppression. The program forgoes traditional doctor’s appointments and clinic visits and prioritizes nurses who work directly in communities handing out antiretroviral medications to those with HIV.

Dedicated nurses provide care in various unconventional settings, including on street corners, under bridges and down back alleys as well as at community meal programs, overnight drop-in centers, emergency departments and more.

“Many of our patients have experienced unimaginable levels of trauma in their lives, and trust is difficult for them,” said Beckie Tachick, RN, a BHCHP street team director, in a Facebook post. “It takes time and dedication to create that trust with our patients. I feel so lucky to be able to build relationships with our patients that allow space to share tears and big belly laughs.”

The program launched at the height of the COVID-19 pandemic, when HIV diagnoses among homeless drug users in Boston spiked from about two a month to more than two dozen cases, according to the Boston Globe.

BHCHP nurses not only provide HIV treatment to people on the streets, but they also draw blood to determine individuals’ HIV status and act from there. Outreach teams then follow up to ensure they continue taking their medication.

“We knew that if someone gets a diagnosis and is not immediately connected to a provider, then despair can set in,” Brody told the Boston Globe. “And sometimes people in that despair will withdraw and will not come back into care. They may disappear.”

The study tracked the number of new HIV diagnoses linked to care at BHCHP since 2019. Findings showed that the number of diagnoses peaked in 2021 with about 60 new cases and has been declining steadily since. By the end of 2023, there were fewer than 10 new HIV diagnoses.

What’s more, as of August 2023, the viral suppression rate for people living with HIV who were receiving outreach-based adherence support was 90%.

“[The results] blew me away,” Brody said. “It really speaks to the benefits of a low-barrier approach to providing medications and treatment outside the walls of a clinic in parallel with harm reduction.”

The program expanded its reach to include additional areas in Massachusetts with high homeless populations, including people living in encampments known as Mass. and Cass at the intersection of Melnea Cass Boulevard and Massachusetts Avenue, an area dubbed “the epicenter of the region’s opioid addiction crisis.”

However, Mass. and Cass was recently dismantled, the Globe notes, making it more challenging for health care workers to reach those individuals.

Teams at BHCHP continue to support individuals in Boston through its direct-to-the-streets approach to medical care, which has reduced HIV transmission through viral suppression, allowing people to live healthy lives without transmitting the virus to their sexual partners.