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Program Name

Care Coordination Program

Year Opened


Contracted Census



The program focuses on treatment and medication adherence with people who are newly diagnosed with HIV/AIDS or have been lost to care for over a six months. Staff work with individuals on a weekly, monthly and quarterly basis to ensure people are living healthier lives. Some of the results our work and other benefits include decreased HIV viral loads by 7%, housing placements, enrollment in public assistance benefits and entitlements, collaborating with several clinics, hospitals and ensuring clients receive pertinent information about the illness and approaches to better health.

Recent Work

The program is in partnership with several medical centers to target individuals in need of these services. The program has also been collaborating with Med-Alliance Medical Health Services by assisting with services for People Living with HIV/AIDS. By extending a Memorandum Of Understanding relationship with Balm of Gilead medical clinic, the program is prepared to service clients who attend this clinic. We continue to provide pantry for average of 50 clients a month.

Future Goals

The program is planning to partner with more Bronx-based agencies like Lincoln Hospital, provide food pantry services for up to 200 clients a month, strengthen the relationship with Montefiore Medical Center, and assist clients by fulfilling their needs by referring them for vocational training, job placement and ongoing behavioral health issues.