1. Lesson Learned: We found we needed our "Day Treatment Program" to keep clients on-site and available for long portions of the day. This facilitated many program success-elements; indeed, other CBOs and case managers would conduct their interventions at our SPNS site.

How related to achievements: Facilitated delivery of intervention to clients with regularity; locating clients made obviously easier; enhanced nurse-client bonding over time, which in-turn strengthened staff ability to assess client needs/change in needs and develop nursing care that improved client well being; assisted in re-affiliating clients with friends/family.

2. Lesson Learned: Specialized HIV-focused transportation is essential for doubly- and triply-diagnosed, low-SES client populations, for them to access primary health care for their HIV disease – at least in cities having: (a) harsh winters, (b) high incidence of violent crime, and (c) poor-coverage public transportation in low-SES neighborhoods.

How related to achievements: Our strong transportation component made it possible for clients to access their HIV-related health care appointments with high adherence; also, boosted client participation in program interventions; strongly boosted client "comradeship" among each other.

3. Lesson Learned: Doubly- and triply-diagnosed women need a minimal sustainable package of services, long term, to sustain the gains make in treatment.

How related to achievements: With SPNS Branch authorization, we created a multi-tiered program which provided a less-comprehensive (and less expensive) set of services to women with extreme need, long term, to sustain the gains made during the full-service period of program for those clients.

4. Lesson Learned: 70% of dually-diagnosed women (HIV and substance abuse) are also mentally ill.

How related to achievements: We, from the outset, had to re-orient our interventions to the much higher-than-expected incidence of mental illness among our clients.