Frederick (Rick) Lewis Altice, MD, MA

Frederick L. Altice is a Professor of Medicine (Infectious Diseases) and Epidemiology (Microbial Diseases) at Yale University and a clinical epidemiologist and implementation scientist whose work focuses on improving how care is delivered to populations disproportionately affected by infectious diseases and substance use disorders. His research addresses a central challenge in medicine and global health: how to translate effective, evidence-based interventions into real-world practice in settings where structural barriers, stigma, and fragmented systems of care limit access and outcomes.

Over more than three decades, Dr. Altice has led a sustained program of research at the intersection of HIV, viral hepatitis (HCV, HBV), tuberculosis, and substance use disorders, including opioid, stimulant, alcohol, and nicotine use. His work spans community, clinical, and criminal legal settings and focuses on redesigning health systems to improve access, engagement, and outcomes through implementation science, health service integration, behavioral design, and decision science. His research extends across the United States and internationally, with major programs in Malaysia, Indonesia, Peru, Ukraine, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Azerbaijan, and Tajikistan.

A defining feature of his work is the development and evaluation of integrated, patient-centered models of care that combine infectious diseases treatment, addiction care, mental health services, and social support within coordinated delivery systems. His research spans the full translational continuum, from early intervention development to randomized controlled trials and large-scale implementation and scale-up. Across settings, his work has consistently focused on improving outcomes for populations facing the greatest barriers to care, including people who inject drugs, individuals involved in the criminal legal system, and other marginalized populations.

CURRENT STUDIES

COMPASS

Funding Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)Location: United States (Connecticut)

COMPASS is a large-scale implementation program designed to integrate screening, evaluation, and treatment (SET) for hepatitis C within community-based settings, including syringe services programs and addiction treatment programs. The program is structured to address the full syndemic context in which HCV occurs, including co-occurring HIV, substance use disorders, mental illness, and social determinants of health. A central innovation of COMPASS is the use of same-day HCV RNA testing and immediate initiation of direct-acting antiviral therapy, eliminating delays that typically result in loss to follow-up. The model incorporates behavioral design strategies to improve patient engagement, along with NIATx-based practice facilitation to redesign workflows within participating sites. The program also integrates care coordination, peer support, and telemedicine to ensure continuity of care. COMPASS is designed as a scalable model for integrating infectious diseases treatment into real-world community settings and for improving population-level cure rates.

VIDA (R01 AI177082)

Title: Innovations in Implementing Decentralized HIV Services in PeruFunding Agency: National Institute of Allergy and Infectious Diseases (NIAID)Location: Peru

VIDA is a stepped-wedge, cluster randomized implementation trial aimed at decentralizing HIV care from specialty clinics to primary care settings in urban Peru. The study addresses persistent gaps in access to HIV care by evaluating how best to shift service delivery into more accessible, non-specialty settings.

The study uses a multi-phase implementation approach, beginning with Delphi methods to refine decentralization guidelines, followed by mixed-methods assessments using nominal group technique and socioecological frameworks to identify barriers and facilitators to care. Implementation strategies include NIATx-based process improvement, tele-mentoring through collaborative learning models, and targeted training for non-specialist providers. Outcomes include HIV testing, linkage to care, retention, and viral suppression, as well as measures of implementation fidelity and sustainability.

PRIDE 3

Funding Agency: National Institute on Drug Abuse (NIDA)Location: Ukraine, Moldova, Georgia, Tajikistan, Kyrgyzstan

PRIDE 3 represents the third phase of a long-standing implementation science program focused on HIV prevention and treatment among people who use drugs in criminal legal settings across Eastern Europe and Central Asia. Earlier phases demonstrated the effectiveness of opioid agonist therapy (OAT) in reducing HIV transmission and improving outcomes.

PRIDE 3 focuses on scaling up OAT and HIV prevention services within pretrial detention centers, prisons, and probation systems, with a particular emphasis on continuity of care during transitions from incarceration to the community. The study uses implementation science strategies to address structural barriers, improve provider capacity, and enhance retention in care. It includes multi-level interventions targeting patients, providers, and systems, and evaluates outcomes related to HIV prevention, treatment engagement, and health system performance.

IMPACT

Funding Agency: National Institute on Drug Abuse (NIDA)Location: Ukraine

IMPACT is a Type II hybrid effectiveness-implementation trial designed to integrate methadone treatment with HIV and tuberculosis care within primary care settings. Using a stepped-wedge cluster randomized design, the study compares outcomes between traditional specialty addiction treatment models and integrated primary care models.

The intervention includes tele-mentoring using collaborative learning models, pay-for-performance incentives, and structured implementation support. Outcomes include clinical effectiveness, quality of care, retention in treatment, and cost-effectiveness. The study is designed to inform national scale-up of integrated care models.

BIRCH (R01 DA054703)

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States (West Virginia)

BIRCH is a multi-site implementation trial that integrates HIV treatment and prevention, HCV care, and medications for opioid use disorder into rural primary care clinics. The study uses the RE-AIM framework and NIATx-based facilitation to evaluate strategies for scaling up integrated care in resource-limited settings. The intervention includes audit and feedback, clinical dashboards, tele-mentoring, and guided implementation support. The study evaluates both clinical outcomes and implementation outcomes, including adoption, fidelity, and sustainability.

Expanding Medication-Assisted Therapies for HIV Prevention in Central Asia (R01 DA054851)

Funding Agency: National Institute on Drug Abuse (NIDA)Location: Kazakhstan, Kyrgyzstan, Tajikistan

ExMAT is a large-scale implementation science study aimed at expanding opioid agonist therapy across more than 200 sites in Central Asia. Using the EPIS framework, the study combines rapid mixed-methods assessments with NIATx-based implementation strategies to address barriers to scale-up.

The study evaluates mechanisms of implementation, including leadership engagement, group collaboration, and economic incentives, and examines how these factors influence uptake and sustainability of OAT programs.

Reducing Stigma in People Who Inject Drugs with HIV Using a Rapid Start Antiretroviral Therapy Intervention(R01 TW012674)

Funding Agency: Fogarty International Center (NIH)Location: United States and international settings

This study focuses on reducing stigma as a major barrier to HIV care among people who inject drugs and individuals in criminal legal settings. Using behavioral design principles, the study develops and tests interventions that reshape clinical interactions, improve patient engagement, and facilitate rapid initiation of HIV treatment.

The project includes guideline development, pilot testing of rapid-start ART models, and the use of framing and nudging strategies to improve uptake of care. The study integrates implementation science methods to evaluate scalability and impact.

Identifying Challenges and Opportunities for PrEP Uptake Among Women at Elevated HIV Risk in Georgia(D43TW012492-02S1)

Funding Agency: Fogarty International Center (NIH)

Location: Georgia

Despite the availability of pre-exposure prophylaxis (PrEP), uptake among women at elevated risk of HIV in Georgia remains low, in part due to structural barriers such as reliance on centralized AIDS centers. This study builds on a broader effort to establish an HIV implementation science training program in the Caucasus by examining how PrEP can be delivered in ways that are more accessible and acceptable to women. The study focuses on women at elevated risk, including partners of people who inject drugs, women who inject drugs, sex workers, and transgender women in Tbilisi and Batumi (N=540). Using a mixed-methods approach, it combines focus groups employing nominal group technique (n=40) with a choice-based conjoint survey (n=500) to identify barriers and quantify preferences for PrEP delivery, including location, eligibility, and adherence support. Findings will inform the design of a more patient-centered, scalable PrEP delivery model to improve uptake and reduce HIV risk among vulnerable women in Georgia.

Digital Health and AI Interventions

Funding Agency: NIH (NIAID, NIDA, Fogarty International Center)Location: Malaysia, United States

These studies develop and evaluate mobile health applications, AI-enabled chatbots, and electronic health record-integrated decision support tools to improve HIV prevention, testing, and treatment. Interventions target MSM and other key populations and include online-to-offline care models, adaptive interventions, and integration of mental health and substance use services.

These platforms are designed to extend care beyond traditional clinical encounters, support real-time decision-making, and enable scalable implementation of evidence-based interventions.

Malaysian Implementation Science Training (MIST) Program (D43 TW011324)

Title: Malaysian Implementation Science Training ProgramFunding Agency: Fogarty International Center (NIH)Location: Malaysia and Indonesia

MIST is a long-standing and recently renewed international training program designed to build implementation science capacity in Southeast Asia. The program trains faculty scholars, PhD candidates, and real-world implementers through a comprehensive model that includes degree programs, certificate training, mentored research, and intensive implementation science boot camps.

The renewed program expands training to Indonesia and emphasizes leadership development, biostatistics, and advanced implementation science methods. Trainees engage in hands-on research projects and collaborative learning activities, with a focus on HIV and other public health priorities. MIST is designed to build sustainable, locally led research capacity and to support the development of independent investigators.

Georgian Implementation Fellowship Training (GIFT) Program (D43 TW011324)

Title: Georgia Implementation Fellowship Training ProgramFunding Agency: Fogarty International Center (NIH)Location: Georgia

GIFT is an international training program designed to build capacity in implementation science and biostatistics in Eastern Europe. The program trains faculty and PhD-level investigators through a hybrid model that combines in-country training with mentored research collaborations at Yale.

The program includes formal coursework, mentored research projects, and short-term training opportunities for implementers and policymakers. GIFT focuses on addressing gaps in HIV prevention and treatment and emphasizes the development of sustainable, locally led research programs.

RECENTLY COMPLETED

Alcohol Pharmacotherapies Among Released Prisoners

Funding Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA)Location: United States

This randomized, placebo-controlled trial evaluated the effectiveness of extended-release naltrexone for HIV-positive individuals with alcohol use disorder transitioning from incarceration to the community. The study addressed a critical period of vulnerability characterized by high rates of relapse, poor adherence to HIV treatment, and increased risk of adverse outcomes. The intervention aimed to reduce alcohol consumption, improve engagement in HIV care, and enhance viral suppression. Findings from this study contributed to understanding the role of pharmacotherapy in improving continuity of care and health outcomes among individuals with co-occurring HIV and alcohol use disorder during community re-entry.

HIV, Buprenorphine, and the Criminal Legal System

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States (Washington, DC)

This randomized controlled trial evaluated the initiation of buprenorphine among HIV-positive, opioid-dependent individuals in pretrial detention. The study examined whether initiating medications for opioid use disorder prior to release improved post-release treatment engagement, reduced opioid use, and enhanced HIV treatment outcomes. The trial provided critical evidence supporting the feasibility and effectiveness of initiating addiction treatment within criminal legal settings and highlighted the importance of continuity of care during transitions to the community.

Naltrexone for Opioid-Dependent Released HIV+ Populations

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States (multi-site)

This multisite, randomized, placebo-controlled trial evaluated extended-release naltrexone for HIV-positive individuals with opioid use disorder transitioning from incarceration to the community. The study assessed the impact of pharmacotherapy on relapse prevention, retention in HIV care, and viral suppression. By focusing on a high-risk population during a critical transition period, the study provided important insights into strategies to reduce opioid use and improve HIV-related outcomes.

Project Harapan I & II

Funding Agency: National Institute on Drug Abuse (NIDA)Location: Malaysia

This 2x2 randomized controlled trial evaluated the combined and independent effects of methadone maintenance therapy and a behavioral intervention (Holistic Health Recovery Program) among HIV-positive prisoners with opioid use disorder. The study examined outcomes related to HIV treatment adherence, substance use, and post-release engagement in care. Project Harapan I was among the first studies to rigorously evaluate integrated HIV and addiction treatment interventions within prison settings in Southeast Asia. Part 2 included screening for TB in prisons using novel methodologies along with a trial of daily isoniazid for 6 months vs a 12 week short course of rifapentine/isoniazid for TB preventive therapy.

Exploring the Within-Prison Risk Environment and HIV Transmission

Funding Agency: National Institute on Drug Abuse (NIDA)Location: Kyrgyzstan

This mixed-methods study examined the structural and behavioral factors contributing to HIV transmission within prison settings and during transitions to the community. Using qualitative interviews and surveys among opioid-dependent individuals with and without HIV, the study characterized risk environments and informed the development of targeted prevention and treatment interventions. Findings contributed to a broader understanding of how incarceration influences HIV risk and care engagement.

ART Adherence and Secondary Prevention of HIV (R01 HD075630)

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States

This randomized controlled trial evaluated the effectiveness and cost-effectiveness of contingency management alone versus contingency management combined with direct video observation to improve antiretroviral therapy adherence among individuals with HIV and substance use disorders. The study demonstrated the potential for scalable behavioral interventions to improve adherence and reduce onward HIV transmission.

EnhanceLink (Special Projects of National Significance)

Funding Agency: Health Resources and Services Administration (HRSA)Location: United States (multi-site)

EnhanceLink developed and evaluated integrated models of care for individuals transitioning from jail to the community. The program combined substance use treatment, contingency management, and HIV care, with buprenorphine serving as a central component of treatment. The study demonstrated the feasibility of integrating addiction treatment with HIV care in transitional settings and informed national models for re-entry care.

Choices

Funding Agency: Substance Abuse and Mental Health Services Administration (SAMHSA)Location: United States

The Choices program expanded upon earlier work to develop mobile buprenorphine induction and stabilization models, targeting individuals transitioning from incarceration who were living with or at risk for HIV. The program integrated medications for opioid use disorder with HIV prevention and treatment services and emphasized outreach and engagement strategies to improve continuity of care.

AHORA-L

Title: HIV Testing and Treatment to Prevent Onward HIV Transmission Among High-Risk MSMFunding Agency: National Institutes of Health (NIH)Location: Peru

This randomized controlled trial evaluated HIV treatment outcomes among men who have sex with men with alcohol use disorders who were newly initiating antiretroviral therapy. The study assessed viral suppression, adherence, and behavioral outcomes over 12 months, with a focus on reducing onward HIV transmission. The trial contributed to understanding the interaction between substance use and HIV treatment outcomes in key populations.

Modeling HIV/HCV Transition Dynamics of Injection Networks

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States

This study used network-based modeling of over 500 people who inject drugs and their extended injection networks to examine HIV and HCV transmission dynamics. The study identified optimal strategies for treatment as prevention, including the integration of opioid agonist therapy and harm reduction services, and provided insights into how interventions can be targeted within networks to maximize impact.

mHEALTH (SPNS)

Title: Medical Home Engagement and Aligning Lifestyles and Transition from HomelessnessFunding Agency: Health Resources and Services Administration (HRSA)Location: United States

This project developed and evaluated a novel care model for individuals with HIV experiencing homelessness and mental illness. Using mobile health technologies, the intervention aimed to improve engagement in care, adherence to treatment, and stability during transitions from homelessness. The study demonstrated the potential for mHealth tools to support complex, high-risk populations.

Project SMART

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States

This pilot feasibility study evaluated automated text messaging interventions, with and without nurse-based counseling, to improve antiretroviral therapy adherence among individuals with HIV and cocaine use disorders. The study provided early evidence supporting the use of digital interventions to improve adherence in populations with co-occurring substance use.

Multisite Opioid and HIV Response Endeavor (MOhRE)

Funding Agency: Health Resources and Services Administration (HRSA, SPNS)Location: United States (Kentucky, West Virginia, Vermont, Connecticut, New Hampshire)

MOhRE was a large-scale implementation science initiative addressing the opioid epidemic in rural settings. The study used NIATx-guided process improvement to scale up medications for opioid use disorder and integrate these services with HIV prevention and treatment. The project emphasized systems-level change and demonstrated the feasibility of integrating services in resource-limited rural settings.

Secondary HIV Prevention and Adherence Among Drug Users (R01 DA032290)

Funding Agency: National Institute on Drug Abuse (NIDA)Location: United States

This randomized comparative effectiveness trial evaluated an adapted behavioral intervention (3H+) versus the original Holistic Health Recovery Program for improving HIV treatment adherence among individuals with substance use disorders. The study included cost-effectiveness analyses and contributed to the development of scalable behavioral interventions for improving HIV outcomes.

CoReCT (Data-to-Care Initiative)

Funding Agency: Centers for Disease Control and Prevention (CDC)Location: United States (Connecticut, Massachusetts, Philadelphia)

CoReCT evaluated a data-to-care strategy to identify individuals with HIV who had fallen out of care and re-engage them using disease intervention specialists. The study adapted the ARTAS intervention and assessed its effectiveness in improving linkage to care, retention, and viral suppression across multiple jurisdictions.