COVID-19 News: Homebound: Pandemic Takes Project STAY to Youth Where They Are

For more than 30 years, Project STAY has provided confidential, wrap-around services for youth affected—or infected—by HIV and other sexually transmitted infections. Each year thousands of young people connect with Project STAY through New York City high schools, colleges, workforce development agencies, organizations serving justice-involved youth, and programs providing supportive care for LGBT youth.

“The main focus of our work is to address high rates of HIV and STIs throughout New York City and particularly in northern Manhattan,” says Alwyn Cohall, MD, director of Project STAY and professor of pediatrics at VP&S and the Mailman School of Public Health. He also directs the Harlem Health Promotion Center, which runs Project STAY in partnership with the Mailman School of Public Health, NewYork-Presbyterian Hospital, the New York State Department of Health, and the New York City Department of Health and Mental Hygiene.

The team’s outreach work is year round but reaches its peak in early spring in what the team has taken to calling “March Madness” for the frenetic pace of screening events that happen during that month. In March 2020, however, as schools and businesses throughout metro New York shuttered to flatten the curve of COVID-19 cases, those services ground to a halt. “We had to put the brakes on because we couldn’t go out in the field, and our community partners stopped delivering services,” says Dr. Cohall, who says even the Project STAY medical clinic at NewYork-Presbyterian saw visits plummet as New Yorkers hunkered down at home.

“But we had a situation where young people were at high risk for sexually transmitted diseases, HIV, and unintended pregnancies because they continued to have sex, and—because of COVID-19 and its impact on their families and social networks—they were also having increased mental health issues,” says Dr. Cohall.

Most of the team’s volunteer health educators are pre-medical, nursing, MPH, and social work students at Columbia who are trained by Project STAY leadership to provide sexual health education, risk assessment, screening, and information about the Project STAY clinic at NYP. As those volunteers traveled across the country to shelter in place with their families, Renee Cohall, LCSW-R, the program’s director of outreach, started overhauling the team’s work flow and, in partnership with colleagues at NYP’s Comprehensive Health Program and the NYC Department of Health and Mental Hygiene, began figuring out how to provide at-home HIV and STI screening. 

The health educators became case managers with a caseload of clients. They conducted individualized intakes with clients over the phone, helping clients assess the psychosocial supports they would need before learning their HIV status. “Because we were no longer tied to certain hours that we could communicate with clients in the community, the staff really opened up their hours,” says Ms. Cohall. “If a client needed to connect at 10 p.m. or over the weekend, we could do that. Some of our clients were essential workers, so they still had commutes and shifts during the day that limited their ability to take personal, confidential calls.” 

On May 1, 2020, Project STAY mailed its first at-home HIV test. Like a home pregnancy test, the screening provides rapid results. Health educators not only developed a how-to guide in English and Spanish to accompany the test, says Ms. Cohall, they also answered questions about how to collect the requisite swabs and even stayed on the phone with clients during the tense 20-minute wait if the client wanted them to. In June 2020, Project STAY added at-home STI testing in partnership with NewYork-Presbyterian Hospital. “The home testing filled a tremendous void,” says Dr. Cohall, when the majority of New York City’s sexual health clinics were closed. 

For one client, a Long Island resident, Project STAY facilitated access to a prescription for an STI diagnosed before the pandemic. The young man’s pharmacy had converted to drive-through only, but the youth didn’t have access to a car and the pharmacy prohibited pickups by pedestrians. Dr. Cohall and a health educator persuaded a pharmacist to make an exception and let the youth in the door just long enough to hand him his meds. Another health educator helped a client who had multiple housemates strategize about how to get the privacy he needed to collect samples and await results. “It can be empowering for patients because they control the testing process,” says Dr. Cohall of the at-home approach. “There’s literature to suggest that patient swabs are just as reliable as those taken by providers.”

In addition to sexual health, other issues were identified. “As we started reaching out, we found much more in the way of need,” notes Ms. Cohall. The health educators identified a client whose father died from COVID; he subsequently became very depressed and began using substances to cope with his loss. The team successfully linked him to mental health services.

Similar to HIV and STIs, COVID has disproportionately affected communities of color. To address the need to enhance COVID screening, the Cohalls in June 2020 were part of a team that collaborated with community partners (Alliance for Positive Change and Argus Community) along with colleagues from the New York State Psychiatric Institute (Dr. Kate Elkington) and the NYP Comprehensive Health Program (Dr. Peter Gordon) to strategize how to collectively leverage what had been learned over three decades of HIV/STI outreach to improve COVID education and testing. That led to a grant, RADx (Rapid Acceleration of Diagnostics), from the NIH. “We’re using the medical center as a home base, which combined with our extensive network of partners, has tremendous potential to provide screening, support, and appropriate services to vulnerable populations,” says Dr. Cohall. “The added value of these community partnerships is the development of trust and respect, critical ingredients necessary to promote vaccine awareness and utilization.”

In addition to establishing strong community connections, says Ms. Cohall, Project STAY is enhancing the public health workforce by creating opportunities for Columbia students from various disciplines—medicine, nursing, public health, and social work—to learn firsthand about the impact of social determinants on the health of community residents. “These experiences will profoundly shape their future practice and interactions with patients.”