Frederick Lewis Altice, MD, MA

Frederick L. Altice is a professor of medicine, epidemiology and public health. He is a clinical epidemiologist and intervention researcher at Yale University School of Medicine. Dr. Altice's primary research examines the relationship between infectious diseases and substance use disorders. His work has also focused on the criminal justice system, examining linkages between the community and correctional settings. Specific topics include; substance use disorders including opioids, stimulants and alcohol use disorders on HIV treatment outcomes and healthcare integration strategies. He has been a pioneer in the creation and evaluation of innovative strategies to engage HIV-infected drug users in care as well as develop strategies to facilitate adherence to antiretroviral medications. He is developing and creating methods to assess health services integration as a means to promote improved health outcomes, especially for HIV, viral hepatitis, tuberculosis, mental illness and substance use disorders. Additionally, his research seeks to understand the relationship of medication-assisted therapies, such as methadone, buprenorphine and extended-release naltrexone and its role in primary and secondary HIV prevention. His research projects extend internationally in the United States, Malaysia, Peru, Ukraine, Russia, Kazakhstan, Azerbaijan and Argentina.

Dr. Altice received his M.D. at Emory University. He is the Academic Icon Professor of Medicine at the University of Malaya in Kuala Lumpur where he conducts research in collaboration with colleagues at the Centre of Excellence on Research in AIDS and the Centre of Addiction Studies. He has been the principal investigator of several projects for the National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Agency, the Health Services Resource Agency's Special Projects of National Significance and Center for Substance Abuse Treatment.

CURRENT STUDIES

1. Malaysian Center for Implementation Science: This five-year hybrid training program in HIV implementation science is positioned to train the next generation of implementation science in Malaysia. The program will train 4 faculty scholars from University of Malaya who will increasingly assume training and 10 PhD candidates who will earn their PhD in public health. Both faculty and students will complete a Certificate Program in Implementation Science. Each summer, 25-30 real-world implementers will participate in a 2-week implementation science boot camp, where training will involve additional training in human rights. Funding: Fogarty International Center; Principal Investigators: Altice and Kamarulzaman.
1. Prison Interventions and HIV Prevention Collaboration in Ukraine: To develop and test HIV prevention and treatment interventions using implementation research techniques in the criminal justice system and in several other countries in Eastern Europe and Central Asia (Ukraine, Moldova, Armenia, Georgia, Kyrgyzstan). Funding: NIDA. Principal Investigator: Altice
1. Integrating Methadone, HIV and TB treatment into Primary Care Settings in Ukraine: This type II implementation science, step-wedge, cluster, randomized controlled trial using an implementation science strategy compares quality health indicators for patient randomized to treatment with methadone in addiction specialty care settings (control) with methadone in primary care settings with or without pay-for-performance incentives. Implementation will be provided through Project ECHO-like collaborative learning models to provides a collaborative learning environment to make primary care clinicians competent at treatment with methadone, and provide HIV and TB treatment. Cost-effectiveness analyses included.
1. Expanding Medication-Assisted Therapies in Ukraine: This implementation science study uses both quantitative and quantitative surveys of PWID and physicians/nurses followed by coaching using the NIATx treatment improvement model to increase entry and retention on OAT.
1. MEDIUM: This Type II hybrid implementation science study uses a cluster, randomized trial of 36 sites in Ukraine to compare the outcomes on depression outcomes in addiction treatment centers of deploying a SBIRT strategy for patients with opioid use disorder and co-morbid depression. The three arms are standard of care, SBIRT or SBIRT using a pay-for-performance strategy. Both of the SBIRT arms receive facilitation using Project ECHO-like collaborating learning models. Funding: NIDA/NIMH (Altice, MPI).
1. Harapan II: This is a study of HIV/TB infection in prisons in Malaysia to identify the most optimal strategy for screening for TB in this setting, to conduct a RCT of prevention of latent TB infection comparing 26 weeks of daily isoniazid vs 12 weeks of weekly isoniazid/rifapentine, and a RCT of HIV/TB patients with opioid dependence who are transitioning to the community who will be randomized to a preference trial comparing implantable naltrexone vs methadone vs no medication-assisted therapy. Cost-effectiveness and TB prevention modeling will be conducted.
1. BIRCH NIDA R01 DA054703 Title: Integrating Addiction and Infectious Diseases Services into Primary Care in Rural Settings (BIRCH) Using the RE-AIM framework, this research uses the NIATx model to scale-up medications for opioid use disorder, HIV treatment (ART) and prevention (PrEP) and HCV treatment in federally qualified health centers (FQHCs) in rural primary healthcare clinics throughout WV. The study tests multiple facilitation strategies in a stepped wedge design including clinical dashboards (audit and feedback), tele-mentoring (ECHO), guided implementation (NIATx) and educational meetings (one-day training). MPIs: Altice, Madden, Feinberg
1. NIAID R01 AI177082 (Altice, PI) Title: Innovations in Implementing Decentralized HIV Services in PeruDescription: This stepped wedge trial involves using the Delphi method to supplement existing guidelines on how to decentralize HIV care in urban settings, like in Lima, to use the socioeconomic model for assessing barriers and facilitators to decentralized care using NGT and then to use NIATx for process improvement changes to alter service delivery and Project ECHO to support and train non-HIV clinicians to provide HIV care. PI: Altice
1. NIH/FIC R01 TW012674 (Altice, Principal Investigator) Title: Reducing Stigma in People in Prison or Who Inject Drugs Description: This exploratory R01 uses the Delphi method to develop clinical guidelines to develop and pilot test a rapid start ART program in 50 people in prison and 50 PWID to reduce stigma. After guideline development, a behavioral design intervention will be developed to streamline ART prescription with scripted framing and nudging for people with HIV in community and prison settings. The guidelines have been developed, the behavioral design intervention has been developed, including scripting and the pilot study is planned. PI: Altice
1. Using Artificial Intelligence and Machine Learning to Develop a ChatBot: This formative research is to develop an ChatBot that MSM can embed within a social networking app to help guide and promote HIV testing in the Malaysian context where homosexuality is illegal in both Sharia and secular law. It is an improvement over many app-based testing strategies since it does not require major app updates and human resources to maintain it and works within apps that MSM already use frequently. Funding: NIAID; Principal Investigator: Altice.
1. NIDA R34 MH130233 (Shrestha, PI; Altice Co-I)Title: Integrated online-to-offline (O2O) model of care for HIV prevention and treatment among MSMDescription: After developing and pilot-testing a highly successful web-based HIVST platform, low post-test linkage to treatment and prevention services was low. In response to nominal group assessment, we prioritized real-time (online) access to counselors for support and navigation to to HIV and chemsex-related harm reduction services (offline). We created the JomPrEP app, which includew real-time e-counseling (eHIVST) with integrated O2O linkage to HIV prevention and treatment services.
1. Implementation of an AI/ML Informed ChatBot to Promote HIV Testing in MSM: This 5-year study refines a ChatBot informed by artificial intelligence and machine learning to promote HIV testing and screen for and address depression and amphetamine-type substance use in MSM. The app involves a Type 1 implementation science trial using the REAIM framework and will take place in Malaysia. Funding: Fogarty International Center; Principal Investigators: Altice, Ni.
1. Community Drug Checking Services: This project involves addressing challenges in the drug supply, including FTIR testing with supportive messaging to reduce the harms from xylazine and other harmful substances. All clients in the New Haven Syringe Services Program (SSP) have access to these services. This project laid the foundation for creating a library of public health messages related to each drug and adulterant observed during drug checking services. It also introduced crowd-sourcing using a common platform to distribute a photo of the drug tested (packet), date/time and near location of purchase and content, combined with over 1000 public health messages that can be used. This program also created a pilot crowd-sourcing platform to engage people who use drugs and collaborated with the police, community services and the department of health and department of mental health and addiction services. PI: Altice
1. NIDA R21/R33TW011665Title: Development and Testing of a Mobile Application to Enhance HIV Prevention Cascade in Malaysian MSMDescription: We propose to develop and test the efficacy of a clinic-affiliated app (myCareLink) to deliver an integrated HIV prevention intervention that will promote HIV testing and linkage to PrEP and incorporates screening and support for underlying P/SUD in Malaysian MSM. The design of this study will take place in 2 phases. The R21 phase: 1) We will adapt, expand and refine an existing app, which will be integrated within the existing clinical care system using focus groups with MSM and stakeholders to theater test the existing app to develop an interactive prototype, followed by alpha and beta testing with usability and acceptability testing. The R33 phase will involve conducting a Type 1 Hybrid Implementation Science Trial to evaluate the efficacy of myCareLink app vs. treatment as usual (TAU) and multi-level implementation outcomes. PI: Shreshtha, Co-I: Altice
1. ExMAT CA NIDA R01 DA054851 Title: Expanding Medication Assisted Therapies in Central Asia Description: Using the EPIS framework and an interrupted time series design, we are using a guided implementation strategy with NIATx to promote OAT scale-up in 3 Central Asian countries (Kazakhstan, Kyrgyzstan and Tajikistan). Key factors being examined are to understand some of the mechanisms of guided implementation like group collaboration, educational stimulus lectures, group cohesion in collaborative learning, expert mentoring from outside the region, and economic incentives to promote scale-up. Other implementation factors include fidelity to PDSA change cycles using a fidelity checklist. Exploration and preparation activities include rapid mixed methods assessment using nominal group technique (NGT) and item response theory in ranking barriers to OAT scale-up. Staff (online surveys) and MoH leadership (interviews) are assessed twice annually. The study involves 222 sites in 38 oblasts in 3 countries. MPIs: Altice, Madden
1. FIC D43TW011324 Title: Georgian Implementation Science Fogarty Training (GIFT) Program Description: The newly funded GIFT training program will use experts in implementation science and biostatistics from Yale University and introduce a hybrid training program between Yale and Ilya State University (ISU) to initially train 4 ISU faculty in implementation science biostatistics as well as to train 6 PhDs as the next generation of researchers and implementers to have the skills to address the HIV prevention and treatment cascade of care. The training program also provides for multiple short-term training options for real-world implementers and early-stage biostatisticians to gain experience with implementation science and its related biostatistics. The training grant will focus on HIV prevention and vulnerable populations. MPIs: Altice, Esserman and Kirtadze

RECENTLY COMPLETED

1. Alcohol Pharmacotherapies Among Released Prisoners: Randomized, placebo-controlled trial of depot-naltrexone for HIV+ prisoners with alcohol dependence who are transitioning to the community. Funding: NIAAA. Principal Investigators: Altice and Springer

1. HIV, Buprenorphine, and the Criminal Justice System. Placebo, RCT of buprenorphine among HIV+, opioid dependent pretrial detainees in DC. Funding: NIDA. Principal Investigator: Altice

1. Naltrexone for Opioid Dependent Released HIV+ Criminal Justice Populations: Multisite, randomized, placebo-controlled trial of depot NTX among HIV+, opioid dependent released prisoners. Funding: NIDA. Principal Investigators: Altice and Springer.

1. Project Harapan I: 2x2 Randomized controlled trial of methadone maintenance and Holistic Health Recovery Project among HIV+ prisoners with opioid dependence in Malaysia. Funding: NIDA. Principal Investigator: Altice

1. Exploring the Within Prison Risk Environment and HIV Transmission in Kyrgyzstan: This study will use qualitative surveys of opioid dependent prisoners with and without HIV and examine how the risk environment as prisoners transition to the community. Funding: NIDA.Principal Investigator: Meyer (Altice, Co-I).

1. NIDA R01 HD075630 Title: ART Adherence and Secondary Prevention of HIV. Description: To conduct a RCT using contingency management (CM) verus CM + direct video observation among HIV+ patients with problematic adherence. Funding: NIDA. Co-investigator: Altice (PI: Petry).

1. EnhanceLink: This is a Special Project of National Significance to develop and evaluate evidence-based models for integrating substance abuse treatment and contingency management into a comprehensive jail-release program. The program utilizes buprenorphine treatment as a conduit to care. Funding: HRSA Principal Investigator: Altice

1. Choices: This program builds on our previous SAMHSA work where we developed the first mobile buprenorphine induction and stabilization program in the country. In this project, we target our buprenorphine expansion for released prisoners with or at risk for HIV/AIDS. We also integrate other evidence-based interventions as part of the expansion and enhancement of services.

1. AHORA-L: Title: HIV Testing and Treatment to prevent onward HIV Transmission among high-risk MSM in Peru. This RCT compares HIV treatment outcomes (viral suppression and ART adherence) in newly diagnosed HIV+ MSM with alcohol use disorders and newly initiating ART over 12 months. (PI: Duerr, Co-I: Altice - Protocol Chair: Altice.

1. Modeling HIV/HCV Transition Dynamics of Injection Networks of PWID. This study uses data from over 500 PWID and their 2500 individuals in their injection network. Modeling will include identification of the most effective strategy to use treatment as prevention with or without various HIV prevention (OAT / NSP) strategies. Funding: NIDA.Principal Investigator: Altice.

1. mHealth: Special Project of National Significance: mHEALTH: Medical Home Engagement and Aligning Lifestyles and Transition from Homelessness Description: To create a new innovative model of managing complex HIV+ patients with mental illness and homelessness. Funding: HRSA; Principal Investigator: Altice.

1. Project SMART: This is a pilot feasibility study comparing a control condition (medication monitoring) versus automated text reminders and automated text reminders plus nurse-based counseling in HIV+ patients with cocaine use disorders with the outcome being ART adherence. Funding: NIDA.Principal Investigator: Altice.

1. Multisite Opioid and HIV Response Endeavor (MOhRE): This Special Project of National Significance (SPNS) is an implementation science study collaboration between Yale University and five states profoundly impacted by the opioid epidemic (Kentucky, West Virginia, Vermont, Connecticut, New Hampshire) and where there is a focus on rural responses to the epidemic. After completing a gap and legal analysis, Project MOhRE uses the NIATx treatment improvement model to scale-up treatment using medications for opioid use disorder and to integrate these services with HIV treatment and prevention. Funding: HRSA (Altice, PI).

1. NIDA R01 DA032290 (Copenhaver, PI; Altice, Co-I) Title: Secondary HIV Prevention and Adherence Among Drug Users. Description: RCT comparative effectiveness trial to test the efficacy and cost-effectiveness of an adapted, brief, version of an evidence-based intervention (EBI) called Holistic Health for HIV (3H+) vs. the original EBI -- Holistic Health Recovery Program for HIV+ drug users (HHRP+). Funding: NIDA.Principal Investigator: Altice.

1. CoReCT: The two key elements of this study is to create a data to care (D2C) strategy to identify people with HIV who are recently out of HIV care and randomize them to a disease intervention specialist (DIS) that is adapted from the ARTAS intervention vs standard of care. This multisite study involves Connecticut, Massachusetts and Philadelphia. Funding: CDC (Altice, MPI with Villanueva)