Low-Barrier Infectious Disease Specialty Care for Patients Experiencing Homelessness

Problem: Homelessness is prevalent in Maine and throughout the United States. People experiencing homelessness have unique medical needs that require both primary and subspecialist care, but they face barriers to accessing these services. Infectious diseases, including HIV, viral hepatitis, and skin and soft tissue infections, are highly morbid but are preventable and treatable. Thus, access to infectious disease subspecialty care is a high-impact target for improving the health of people experiencing homelessness. Particularly given Maine's HIV outbreak, there is an urgent need to reduce barriers to accessing infectious disease care. Approach: In January 2022, a monthly, half-day infectious disease subspecialty satellite clinic was established at an existing free-standing, low-barrier clinic in Portland, Maine, for people experiencing housing instability. Appointments were scheduled, and walk-in appointments were also available. An infectious disease physician and fellow provided care in collaboration with clinic staff and pharmacy support. Here, we describe the demographics, clinical characteristics, and health outcomes of patients seen in this low-barrier infectious disease clinic. We also compare no-show rates at the clinic and other local infectious disease clinics. Outcomes: Thirty-four patients received infectious disease care at the low-barrier clinic between January 2022 and June 2025. Of these 34 patients, 30 (88%) were experiencing homelessness. All patients (100%) had a history of substance use. The most commonly treated conditions were hepatitis C (17 [50%]) and skin and soft tissue infections (15 [44%]). No-show rates were lower at the low-barrier infectious disease clinic (42%) than at 2 nearby infectious disease practices (70% and 62%). Next Steps: Here we show a proof-of-concept for low-barrier infectious disease care as a feasible approach to caring for people experiencing homelessness. Lower no-show rates suggest potential for greater cost-savings with investment in low-barrier subspecialty care. Further research is needed to better elucidate these secondary benefits and specific drivers.