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Program aims to develop creative solutions for opioid, HIV health care

February 24, 2020

Yale has been awarded over $3.7 million to strengthen systems of care for people with opioid disorder and at risk for HIV across five states.

The new initiative, called Project MO(H)RE (Multisite Opioid (& HIV) Response Endeavor), will increase medication-assisted treatments for opioid-use disorder, strengthen networks, and better coordinate care. The project will focus on patients with or at risk for HIV and Hepatitis C (HCV). The award is part of the Health Resources and Services Administration’s “Special Projects of National Significance” program.

The project will be led by Frederick L. Altice, M.D., professor of medicine and public health at Yale, a pioneer in developing and integrating collaborative models of treatment for infectious diseases and substance use disorders. He and his expert team will work across multiple stakeholder groups and disparate geographic regions to design creative solutions to the opioid crisis. Altice is joined by two Yale researchers: Merceditas Villanueva, M.D., associate professor and director of the AIDS Program, and Lynn Madden, CEO of the nonprofit APT Foundation, a nonprofit healthcare organization that specializes in integrated treatment of substance use disorders.

Altice said that “timing for this implementation science project could not be more crucial as the opioid epidemic continues to claim lives with parallel outbreaks of HIV and HCV. This project will help guide multi-level stakeholders within states to focus on scaling up treatment for opioid use disorders, the most effective strategy to reduce overdose and transmission of blood-borne infections.”

Over a period of three years, Yale will coordinate activities with five participating states — Kentucky, West Virginia, Connecticut, Vermont, and New Hampshire — that are either disproportionately impacted by HIV or have recently been designated high-vulnerability regions for outbreaks of HIV and HCV related to opioid use. For example, West Virginia has the highest rate of opioid-related deaths nationally and is now experiencing unprecedented HIV outbreaks in some counties.

Robert Hansen, director of West Virginia’s Office of Drug Control Policy, said: “Building upon our ongoing efforts to address HIV cases resulting from the opioid epidemic is a critical piece of West Virginia’s Substance Use Response Plan. We are excited to have this opportunity to better align our programs to achieve the best possible outcomes.”

Other leaders in Project MO(H)RE include Alice Thornton, M.D., chief of infectious disease at the University of Kentucky, and Daniel Daltry, program chief of the HIV, STD, and Hepatitis C program at the Vermont Department of Health. “This initiative is especially important in Kentucky as the commonwealth has been hit extremely hard by the opioid epidemic,” said Thornton. “We are eager to participate in a project that will better coordinate HIV and opioid treatment services.” He added: “Vermont has made great strides to scale up treatments for opioid-use disorder, yet this project provides new opportunities to better integrate HIV services for those in treatment.”

The team’s first task will be to assess the legal and financial landscapes for increased and improved addiction treatment. They will meet with state and system stakeholders to review the gaps, opportunities, and priorities for scaling up treatment and coordinating services. Subsequently, a team of implementation specialists will facilitate rapid-cycle projects (projects made and tested in three months or less) on addiction treatment scale-up. Project MO(H)RE is modeled on a process developed by the Institute for Healthcare Improvement that helps organizations achieve “breakthrough” improvements in quality medical treatment.

Additional team members include Kimberly Johnson from University of South Florida, who will guide the epidemiological and regulatory gap analysis, and Jennifer Oliva from Seton Hall University, who will oversee the legal components of the project. Altice and his team will lead efforts carried out across the country. “States are thrilled to bring together public health and behavioral health constituencies and key stakeholders, who are not often at the same table, to work together to solve common and related challenges,” he said.

Submitted by Julie Parry on February 26, 2020