Indigenous Peoples Task Force

Founded in 1987, Indigenous Peoples Task Force (IPTF) is an AIDS service organization providing culturally informed prevention and care services for Indigenous communities in Minneapolis and surrounding reservations. IPTF’s harm reduction programming began in 2018 to expand wrap-around services to existing participants and provide an entry point for people not engaged in care. Guided by cultural and organizational values that focus on healing relationships between people and with the natural world, IPTF addresses medical needs and social determinants of health through infectious disease prevention and testing, case management and housing navigation for people living with HIV (PLWH), and cultural programming to share traditional knowledge and connections. One of IPTF’s goals was to develop case management and patient navigation services for people who use drugs (PWUD) to complement existing programming for PLWH and more comprehensively respond to participants’ evolving health needs. This included expanding staff capacity for participant engagement and follow-up, tracking service availability during the COVID-19 pandemic, and creative partnerships with external providers.

IPTF was active in a number of organizational networks and local partnerships coming into the project and was proactive in building relationships to better respond to participants’ needs. During the pandemic and throughout the project, IPTF increased coordination with other state and local harm reduction programs on promising strategies, resource availability, and emergent issues. Funding from the patient navigation project was critical in providing dedicated staff time to pursue and maintain these relationships, referral networks, and feedback mechanisms.

IPTF worked with local housing and homeless service organizations to navigate emergency shelter and quarantine resources and organize responses to raids on encampments and community displacement. Increasing focus on housing services for PWUD included stakeholder outreach (to promote services like MOUD navigation and benefits enrollment to external partners) and navigation to housing for SSP participants. Of 155 total patient navigation participants, 24 (15%) received housing referrals.

To facilitate responsive and low-threshold care for participants, IPTF, in partnership with the University of Minnesota Community-University Health Care Center (CUHCC), implemented a “fast-track” MAT program through the patient navigation project. The navigator worked with clinic staff to conduct field-based intake and check-in appointments, leveraging pandemic-related policies that allowed for telehealth induction and prescribing of buprenorphine. Participants who received buprenorphine prescriptions through the program were interested both in reducing or stopping street opioid use and in having an alternative opioid supply during the pandemic, which caused disruptions in drug supply quality and availability. Approximately 65 of IPTF’s 155 patient navigation participants (42%) received navigation to MOUD through the clinic partnership and fast-track program.

In addition to challenges related to COVID-19, the May 2020 murder of George Floyd in Minneapolis fueled public outcries, community grief, and distrust of law enforcement and other public services. Like many other places, economic instability and social distancing measures (which limited shelter space and/or caused people to avoid congregate settings) increased houselessness and the presence of encampments in the city, which were often met with backlash and police raids. Displacement from raids disrupted service provision and made it more difficult to connect and follow up with program participants. Engagement and outreach were further affected by severe winter weather, which leads people to move seasonally between temporary indoor housing or shelters and outdoor encampments. To better maintain communication, including while social distancing measures were in effect and their offices were closed, IPTF began using a dedicated phone line for sharing information about available services and conducting intakes and referrals. Participants were able to call or text and found the phone line especially helpful for receiving emergency assistance, including connections to housing and HCV and HIV treatment.

During the project period, IPTF enrolled 155 individuals in patient navigation, which can be seen in the table below. Of those participants, the most common navigations were to MOUD (65 individuals) and HIV and HCV testing and treatment (70 individuals). IPTF facilitated access to wound care, sexual health services including PrEP for HIV prevention, and provided navigation for a variety of social and administrative services—including housing, identification and vital records, and benefits like health insurance, nutrition assistance, and unemployment assistance.

Indigenous Peoples Task Force Patient Navigation Encounters (March 2020 – February 2022)

Total Patient Navigation Enrollment – 155

In August 2020, IPTF developed a relationship with a 34-year-old American Indian man while he was staying at a hotel organized by the city of Minneapolis to provide quarantine space for unhoused people and PWUD. The hotel program allowed IPTF and other providers to do on-site outreach. The patient navigator discussed the participant’s needs with him and they agreed to test for HIV and HCV—the HCV test was negative, and the HIV test was positive; the navigator provided appropriate counseling. On his next visit, the patient navigator provided information on HIV care and strategies to prevent transmission to others, including safer sex education, condom distribution, and safer injection guidance and supplies. The navigator also supplied a naloxone kit and training on responding to opioid overdose.

In a subsequent conversation, the participant disclosed that he had already been aware of his HIV status before being tested by IPTF. The navigator discussed the importance of getting back into care, to which the participant was receptive. The navigator then worked with a medical case manager at IPTF to make an appointment for the participant to resume HIV treatment. The participant enrolled in IPTF’s medical case management program to support medication adherence, continuing medical appointments, and engagement with wrap-around services.

IPTF’s presence at the hotel to promote SSP and navigation services created an opportunity to reengage someone living with HIV in care. The navigator’s outreach offered a low-threshold way to share information about IPTF and available services, which may have made the participant more receptive to the idea of resuming treatment there in later conversations. It also demonstrates the benefits of facilitating collaboration and co-locating SSPs with complementary health services.

Participating in the patient navigation project directly contributed to IPTF and CUHCC’s low-threshold MOUD collaboration and streamlined entrance for IPTF participants to hotels being used for quarantine and shelter during the COVID-19 pandemic. IPTF has a strong reputation in their community and word of mouth was instrumental in encouraging awareness of and engagement with their programming, especially MOUD access. IPTF were able to incorporate patient navigation approaches into other areas of internal service provision. Expanded partnerships and participation in provider networks allowed IPTF to adopt best-practice approaches and share their experiences—as the project ended, the Minnesota Department of Human Services was looking into opportunities to fund patient navigation for PWUD through SSPs statewide after learning of IPTF’s work.