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Frederick Altice, MD

Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Clinical and Community Research; Director, HIV in Prisons Program; Director, Community Health Care Van; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA)

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Frederick Altice, MD

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Research Summary

My focus of research has broadly been on the interface between infectious diseases and substance use disorders, with additional interests in research in community, criminal justice and clinical care settings. As a clinical epidemiologist, health services and intervention researcher, has created novel programs for the treatment of HIV, HCV, and tuberculosis in vulnerable populations, including injection drug users and prison inmates. Specifically, has been an international leader in research related to adherence to antiretroviral therapy, particularly among HIV+ drug users, and has made considerable inroads into novel approaches using directly administered antiretroviral therapy and other structural interventions to facilitate adherence both nationally and internationally.

I am currently leading a number of studies that bridge the gap between the correctional and community setting, specifically on the use of directly observed antiretroviral therapy and medication-assisted therapy for the treatment of substance use disorders. Current research includes methadone and buprenorphine as primary and secondary HIV prevention, directly administered antiretroviral therapy, peer-driven interventions, secondary prevention among drug users and prisoners, medication-assisted therapies for the treatment of substance use disorders using methadone, buprenorphine and naltrexone. International research projects are currently underway in Malaysia, Indonesia, Ukraine, Russia and Argentina.

Implementation science is a key element of the current research, specifically how and why evidence-based interventions (e.g, HIV treatment, PrEP, HIV Prevention, HCV treatment, opioid agonist therapies) are introduced and scaled to need. Such studies are underway in a number of settings.

Specialized Terms: Interface between infectious diseases and substance abuse; HIV, HCV, and tuberculosis treatment in vulnerable populations (including injection drug users and prison inmates); Antiretroviral therapy; extended release naltrexone, buprenorphine and methadone treatment in management of co-morbid conditions; Healthcare integration; Adherence interventions; Behavioral interventions; Implementation Science; Decision Science; mHealth strategies

Extensive Research Description

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.
  2. 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
  3. 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.
  4. 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.
  5. 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).
  6. 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).
  7. 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.
  8. 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)
  9. 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.
  11. 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.
  12. 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.

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
  2. HIV, Buprenorphine, and the Criminal Justice System. Placebo, RCT of buprenorphine among HIV+, opioid dependent pretrial detainees in DC. Funding: NIDA. Principal Investigator: Altice
  3. 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.
  4. 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
  5. 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).
  6. 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).
  7. 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
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.

Coauthors

Research Interests

Acquired Immunodeficiency Syndrome; Behavioral Medicine; Community Medicine; Decision Making; Epidemiology; Hepatitis, Viral, Human; Mobile Health Units; Social Medicine; Global Health; HIV Infections; Cognitive Behavioral Therapy; AIDS-Related Opportunistic Infections; Health Status Disparities; Healthcare Disparities; Infectious Disease Medicine; Community-Based Participatory Research; Chemicals and Drugs; Health Care; Implementation Science

Public Health Interests

Behavioral Health; Clinical Trials; Community Health; Disease Transmission; Epidemiology Methods; Global Health; Health Care Management; Health Economics; HIV/AIDS; Infectious Diseases; Mental Health; Modeling; Poverty and Economic Security; Community Engagement; Sexually-Transmitted Infections; Substance Use, Addiction; Health Equity, Disparities, Social Determinants and Justice; Implementation Science; Health Systems Reform

Selected Publications