Yale has received a $3.7-million grant from the U.S. Health Resources & Services Administration, or HRSA, for a new initiative to improve the systems for the treatment of opioid use disorder, HIV and Hepatitis C.

Project MO(H)RE, led by professor of Medicine, Epidemiology and Public Health Frederick Altice, aims to study and integrate opioid-use disorder and HIV treatment services across five states, including West Virginia, Kentucky, New Hampshire, Vermont and Connecticut. The opioid-use disorder component is spearheaded by Lynn Madden, CEO of the APT Foundation, a non-profit that provides treatment for patients with substance use problems. The HIV component of the project is led by Merceditas Villanueva, the director of the HIV/AIDS Program and an associate professor at the Yale School of Medicine. The project will connect experts in the two fields to integrate care services and identify potential treatment opportunities as well as barriers.

“I think one of the things that is really central to this is that it will bring together, what I call a rainbow coalition of stakeholders,” said Altice. “What we’re doing with this project is, we’re looking at what we call a gap analysis. We’re trying to understand who the players are, who’s doing what and how they’re doing it.”

Altice stressed that the initiative is an “implementation science project” and that they are focused on practical applications. The connection between opioid use and HIV transmission is an important one and proves to have high potential for promising treatment results. Villanueva noted that in the regions of the country involved in the project, opioid use disorder is a large part of what predisposes people to contracting diseases like HIV and Hepatitis C.

“These infections are typically transmitted via blood. And so people who are using heroin or fentanyl intravenously with needles and sharing these needles, are at very high risk for either getting Hep C and HIV, or transmitting it to someone else,” noted Minhee Sung MED ’16, postdoctoral fellow at the School of Medicine, who was not involved in Project MO(H)RE.

Unlike previous initiatives, the project looks at different regions of the country and brings stakeholders from a range of expertise together to come up with a common solution. Altice said that their process is iterative and they rapidly cycle through different approaches until they find one that works. If the intervention works well, they can scale it across different regions as part of the study, making it easier to bring a solution from one place to another in the future.

“There’s sort of a global issue going on but the solutions are going to be local,” said Villanueva. “It’s important to get different stakeholder-specific points of view in terms of how they’re dealing with their local epidemic because the epidemic is different in different parts of the country … lessons learned from one community can help another community so I think that that multistate component is a novel aspect of this grant.”

The project also looks into the legal issues related to integrating care. These efforts are overseen, in part, by Jennifer Oliva, associate professor of law at Seton Hall University. Villanueva noted its difficult to fully address this problem without addressing the legal impediments faced by patients and institutions.

The importance of the project has been recognized by other researchers at Yale. In an email to the News, Barry Declan, a clinical psychologist and an associate professor in the Department of Psychiatry, wrote, “The work that Drs. Altice, Madden and colleagues are undertaking is incredibly important. We are in the midst of an opioid crisis. Too many Americans have already died from an opioid overdose. A key public health policy to stymie this crisis is to increase access to medication assisted treatment for opioid use disorder across the U.S. The efforts of these researchers to do precisely that is laudable.”

Beyond addressing different regions of the United States, the project also brings together researchers across the country. These include Alice Thornton, professor of medicine at the University of Kentucky, Daniel Daltry, program chief of the HIV, AIDS and Hepatitis C Program at the Vermont Department of Health and Kimberly Johnson, research associate professor in the Department of Mental Health Law and Policy at the University of South Florida.

“What this grant is going to do is bring stakeholders that have never really been at the same table and really encourage and facilitate them to work together,” said Altice.

According to the state government, Connecticut residents are more likely to die from unintentional drug overdose than a motor vehicle accident.

Maya Geradi | maya.geradi@yale.edu

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