LAUSR

Background In 2018, new HIV diagnoses among heterosexual persons who inject drugs (PWID) in King County, WA increased over 300%, from 7 to 30 cases. A cluster of 15 related cases were identified among persons living unhoused in a 3-mile radius in north Seattle, including 10 women who used drugs and exchanged sex. Here we describe a mobile outreach clinic designed to serve women in this community. Methods The SHE (Safe. Healthy. Empowered.) Clinic mobile unit began in July 2018. SHE provides weekly walk-in medical care and harm reduction services, including low-barrier buprenorphine-naloxone, contraceptives, sexually transmitted infection (STI) testing and treatment, and HIV pre-exposure prophylaxis (PrEP). The mobile clinic parks in front of a support center for women living with various combinations of homelessness, opioid addiction, and exchange sex. A retrospective chart review of the initial clinic visits of the first 50 women describes this high-risk population. Results None of the SHE Clinic patients had been screened for STI in the 3 months prior to clinic enrollment. Combined STI prevalence was high (44.5%); 48% of tested women had Trichomonas vaginalis (11/23), 18% had Chlamydia trachomatis (5/28) and 18% Neisseria gonorrhoeae (5/27). Only 29% of women reported condom use with all sex. No women reported planning for pregnancy; however, only 31% were using contraceptives and 10% (4/39) had new diagnosis of pregnancy. Forty-two patients tested for HIV, and 17 (44.7%) HIV-negative women initiated PrEP at their initial visit. Four women (8.5%) were HIV-positive, all were referred for treatment and are receiving some HIV care in the SHE clinic. Conclusion A mobile clinic affiliated with a well-established community-based organization has successfully provided limited primary medical care – including HIV testing, treatment and PrEP - to a homeless population of women who inject drugs and exchange sex in the epicenter of an HIV outbreak. Disclosure No significant relationships.