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Project Med HEART

From September 2013 to February 2017, 9 study sites across the United States participated in a demonstration project to evaluate models of care that linked HIV-positive homeless individuals with needed services and resources. Each study site created a patient-centered medical home (PCMH) to coordinate housing, social, and health services for each participant. The interventions implemented at each site varied, however, each PCMH included the introduction of a network or peer navigator using intensive case management for social services, housing assistance, and HIV care services.) Data were collected prospectively through interviews and HIV medical chart reviews at baseline, 6 months, and 12 months.

The project aimed to answer:

1. What strategies successfully address housing needs of homeless people living with HIV?

2. What does it take to keep homeless people in HIV care?

3. How can we successfully integrate HIV care, mental health services and substance use treatment for homeless people?

4. What does it take to create a medical home for homeless people living with HIV?

The project was supported by the Health Resource and Service Administration (HRSA) Division of HIV/AIDS Bureau Special Projects of National Significance (SPNS). The Center for Advancing Health Policy and Practice at Boston University School of Public Health and Boston Health Care for the Homeless Program served as the evaluation and technical assistance center for the initiative.

Our Yale team led one of the nine demonstration sites, titled Medical Home Engagement and Aligning Lifestyles and Transition from Homelessness (mHEALTH), in partnership with Connecticut Department of Correction, Liberty Community Services, the New Haven Ryan White Continuum of Care, and the Greater New Haven Coalition to End Homelessness.

Funding Provided by:
Health Resources and Services Administration

Project Period:

External Links:


  • Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Yale Center for Clinical and Community Research, Department of Medicine; Director, HIV in Prisons Program, Infectious Diseases; Director, Community Health Care Van, Intersection of Infectious Diseases and Substance Use Disorders/Addiction Medicine; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine