St. Louis, MO
The SPOT, a comprehensive clinic hosted by the Washington University School of Medicine in St. Louis, Missouri offers HIV care, sexual health care, mental health services, and psychiatry services in one location and delivered by a multidisciplinary team, to youth and young adults ages 13–24. Located within a residential area, The SPOT provides a wide range of services, allowing youth and young adults to discreetly access HIV-related services and care. The SPOT also has drop-in health and social services, minimizing barriers to care. Since opening its doors in 2008, The SPOT has served over 20,000 youth and young adults in the St. Louis area. From 2021–2022, viral suppression and retention in care rates among The SPOT clients increased from 82% to 88% and from 86% to 89%, respectively.
Youth and young adults carry a disproportionate share of new HIV cases in the St. Louis area. People ages 15–24 also account for nearly half of all new STI cases in the United States.1 In 2020, 3.5 percent of St. Louis County residents aged 20–24 years were diagnosed with chlamydia, and 1.7 percent were diagnosed with gonorrhea.2 The SPOT not only addresses the medical needs of the area’s youth, but also provides a safe space for youth to access services not readily available to them otherwise, including mental health services and psychiatry services.
Positive youth development is the underlying philosophy that guides The SPOT, encouraging youth and young adults to develop to their full potential. It promotes positive outcomes in all aspects of life, not just those related to HIV care (e.g., getting a new job, applying for college or vocational school, etc.). The philosophy also prioritizes giving youth and young adults a voice in the services they receive and promotes the clinic’s long-term involvement in their lives. While The SPOT specifically serves youth ages 13–24, team members help transition clients to adult programs when the time comes, and maintain relationships with former clients.
The SPOT, located within a residential neighborhood in St. Louis, offers multiple services in addition to HIV care, including support services, sexual health care, and mental health services. By offering a wide range of services at one location, The SPOT reduces HIV-related stigma associated with receiving care in a traditional HIV clinic and encourages sustained engagement in care for youth and young adults whose needs are likely to change as they age.
The SPOT offers drop-in support services and HIV/STI testing to clients without requiring an appointment. Drop-in services allow clients to seek care on their terms, which is essential for a population with conflicting priorities, such as youth. The clinic offers free sexual health services, mental health counseling, and psychiatry services, removing another barrier that often prevents youth and young adults from accessing services.
Adult HIV services may be less supportive than youth programs. Thus, The SPOT focuses on preparing clients for life beyond youth services and ensuring they have the necessary skills and knowledge to be able to navigate their care on their own. This includes encouraging clients to pursue and apply for resources and services outside of The SPOT. The SPOT begins to prepare clients for this transition years before adulthood, allowing for a smoother transition into more independent care.
The SPOT offers free STI/HIV testing and has a Rapid Antiretroviral Therapy (ART) program for those who test positive for HIV. After a positive test, clients are connected to HIV medical care and ART medication as soon as possible.
The SPOT compared viral suppression and retention in care rates for clients in 2021 to clients in 2022. The SPOT also calculated the percent of clients with a new diagnosis of HIV who were linked to care and reached viral suppression within 60 days of diagnosis. Overall, clients accessing services at The SPOT experienced an increase in viral suppression and retention in care rates. For clients with a new HIV diagnosis, 100% were linked to care and 90% reached viral suppression within 60 days of their initiation of ART.
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Source: Hudson-Lewis L. The SPOT Presentation. Ryan White HIV/AIDS Program, Part D Virtual Symposium.
“The environment was much more comfortable than a regular doctor’s office and I did not feel judged.”
Youth-friendly environment. The SPOT was designed for youth and young adults, and the environment reflects the unique needs of this population. The SPOT worked with staff to create a youth-friendly environment, and staff members were trained on multiple topics such as positive youth development, trauma-informed care, HIV care and prevention best practices, cultural sensitivity, and mental health first aid. These efforts ensure that the clinic is a safe space that promotes youth empowerment, fosters interaction between staff and clients, and engages youth from all walks of life.
Involvement of youth in decision making. The SPOT clients are given a voice in how and what services are provided to them, empowering them to take ownership of their care. Clients are regularly engaged in program development, as well as provided opportunities to develop their own leadership skills by leading activities at The SPOT. The clinic is also developing a youth advisory board to formalize the process for getting youth input to inform development and improvement of The SPOT’s programs and services.
Staffing. The SPOT employs several key staff members including: a medical director, nurse, mental health specialist, case manager, community health worker, pharmacist, clinical quality and evaluation manager, and receptionist. The medical director, pharmacist, clinical quality and evaluation manager, and receptionist are employed at .10 FTE. The nurse, mental health specialist, and case manager are employed at .25 FTE. The community health worker is employed at .20 FTE.
The SPOT opened in 2008 and continues to operate today. It is funded by Ryan White HIV/AIDS Program (RWHAP) Part D, the Substance Abuse and Mental Health Services Administration (SAMHSA), state funders, and a variety of local and community stakeholders, including Barnes-Jewish College (BJC) HealthCare, St. Louis Mental Health Board, St. Louis Children’s Hospital Foundation, St. Louis County Children’s Services Fund, and the City of St. Louis Department of Health.
- Maintaining youth voice. The SPOT staff members tend to hold multiple responsibilities, meaning that client engagement is often addressed in a patchwork fashion. To better support youth voice in decision making, The SPOT would like to employ a position dedicated to coordinating with clients about clinic activities and programming.
- Long-term funding. The intervention was originally established as a RWHAP Part D-funded initiative, but has grown through funding from multiple sources. Maintaining diverse funding streams is important for ensuring The SPOT can continue to serve the youth and young adults of St. Louis.
- Data and evaluation staff. Hiring a data or evaluation staff member earlier on in the process would have allowed The SPOT to analyze and interpret outcomes sooner, leading to earlier and ongoing quality improvements informed by data.
- Need for a high level of education/training for employees. The SPOT is designed to be responsive to the needs of the youth and young adult community. Making sure new staff are onboarded properly with relevant training is essential for the success of the program. It also secures new staff buy-in on The SPOT’s mission and core philosophy.
- Youth capacity building. Youth and young adults need to be empowered to manage their care in order to successfully transition to adult care when needed.