CENTER FOR SUBSTANCE USE & INFECTIOUS DISEASE CARE INTEGRATION

Overview

The Center for Substance Use & Infectious Disease Care Integration is dedicated to promoting healthy outcomes for people who use substances, with a focus on prevention and treatment of infectious disease and other unintended consequences of substance use.

Mission

We seek to advance scientific knowledge, engage and partner with people and communities affected by substance use, and educate and train scholars. Together, we will develop and implement innovative strategies to promote health outcomes for people with substance use.

Vision

Universally accessible care to prevent and treat infectious disease and other harms of substance use.

Approach

Implementation science: Identifying ways to promote the integration of evidence-based practices into regular medical care to improve health outcomes.

Center Director

Oluwaseun O. Falade-Nwulia, MBBS, MPH

Dr. Falade-Nwulia is an Associate Professor at the Johns Hopkins University School of Medicine in Baltimore, MD. She previously served as Medical Director of the Baltimore City Health Department (BCHD) Ryan White funded HIV Early Intervention Initiative program, designed and implemented the BCHD hepatitis C virus (HCV) testing, linkage to care, and treatment programs. Her research has focused on understanding the distribution and impact of treatments for hepatitis and HIV infections on clinical outcomes and improving access to HCV/HIV and drug use treatment for people who use drugs. Her work has been funded by the National Institutes of Health, the Centers for Disease Control and the Substance Abuse and Mental Health Services administration and has centered on strategies to improve uptake of integrated infectious disease and substance use care. She is an active provider of HIV, hepatitis C and substance use care.

Center Programs Manager

Tracy Agee

Tracy Agee is a Senior Nurse Practitioner at The Johns Hopkins University SOM, Division of Infectious Disease. She has provided care to people with HIV, viral hepatitis C, substance use, and mental health disorders for over 20 years. In addition to ongoing patient care, she is committed to research and program development designed to reduce barriers to care for people with HIV and those who use drugs.

Programs

Support to RESTORE (STR) Learning Collaborative

Support to RESTORE: Leveraging resources, connecting people. Provision of peer recovery support services (RSS) and medical provider Learning Collaboratives to increase access to and engagement in treatment for substance use and alcohol use disorder and deepen the capacity of Maryland’s network of substance use disorder (SUD) treatment providers to most effectively address substance and alcohol use.

The state of Maryland has high rates of overdose deaths, which are preventable through harm reduction and treatment of opioid use disorder (OUD) and other SUDs. Social stigma, limited access to peer recovery services, and provider capacity and shortages limit access to treatment. STR provides peer RSS to people who use drugs in the Baltimore urban region as well as northwest rural Maryland, and hosts Learning Collaboratives for medical professionals with a goal of supporting and increasing the number of providers who integrate substance use disorder care into their clinical practice.

STR peers receive ongoing support and training, and serve a medically complex population with intensive support and navigation for linkage and retention in substance use treatment. They work in the community and also support people leaving hospitalization with life-threatening infections related to injection drug use.

For medical professionals interested in the STR Learning Collaboratives, please email STR’s Senior Research Program Coordinator Maria Latimer: [email protected]

Funding: Substance Abuse and Mental Health Services Administration
Status: Ongoing

RESTORE | REcovery in Specialty care Through medication and OutREach

Provision of and support for low-barrier access to substance use and alcohol use disorder treatment and recovery support services (RSS) at the John G. Bartlett Infectious Diseases Practice at Johns Hopkins Hospital.

RESTORE delivers low threshold SUD medical treatment (including buprenorphine) and RSS in a primary care infectious disease setting. RESTORE’s success in linking, engaging and retaining psychosocially and medically complex patients with severe SUDs lies in intensive peer-delivered RSS, leveraging addictions psychiatry services existing in the Bartlett clinic, dedicated clinician champions for support of Bartlett clinicians and staff in providing evidence-based, non-stigmatizing, low-threshold access to office based opioid and alcohol use disorder treatment.

RESTORE was developed and implemented in response to rising rates of opioid use disorder, overdose deaths, and concomitant increase in viral hepatitis infections and disparate health outcomes for people living with HIV and ongoing substance use. Initially funded by the Substance Abuse and Mental Health Services Administration, it has been sustained and is an ongoing service of the Johns Hopkins Bartlett Specialty Practice.

Funding (originally): Substance Abuse and Mental Health Service Administration
Status: ongoing

Interested in quick information about this program and how to find out if you are eligible? Please click here.

ACCESS Telehealth

Escalation in opioid use in rural Maryland has led to marked increases in overdose morbidity, mortality, and hepatitis C infection. Key barriers to effective HIV/HCV and OUD response in rural Maryland include limited transportation options in rural regions of our state, a limited number of infectious disease and substance use care providers, and scant integration of addiction and infectious disease treatment and services.

Working in collaboration with the Maryland Department of Health Center for Harm Reduction services and local health department/Syringe Service Programs, providers from the Johns Hopkins Infectious Disease Division provide expert care for hepatitis C and opioid use disorder care via telemedicine to patients at these local health departments or syringe service programs.

Appointments for care can be scheduled by calling 443-812-8148.

Funding: Maryland Department of Health ACCESS Telehealth

Research

SPRUCE | SSPs and Peers in RUral areas ConnEcting

This project aims to integrate HIV self-testing into rural sterile syringe programs (SSPs) through social networks. People who inject drugs (PWID) face multilevel barriers to accessing HIV-related services resulting from stigma, low knowledge/awareness of services, and prioritization of immediate basic needs (e.g., food, housing, addiction) over remote health concerns. In rural areas, these barriers are exacerbated by service scarcity. SSPs, a cornerstone of HIV prevention among PWID, are trusted by this population. Telemedicine provides a sustainable method to deliver services where they are scarce. Social network-based interventions have proven effective in disseminating health information and HIV risk reduction among PWID.

SPRUCE is a hybrid implementation-effectiveness trial using a community-engaged approach to adapt a network intervention focused on advancing progress of PWID along the HIV/hepatitis C/OUD care continuum to a rural context. SSP clients will be trained on prevention, treatment options, and self-testing of HIV, with the guidance to disseminate this information to their social networks. Intervention effectiveness will be determined by comparison with an equal-attention control condition, using a rigorous randomized trial design. Mixed methods will be used to characterize the implementation process and outcomes.

Funding: NIH/ NIDA R01 DA058387
ClinicalTrials.gov: NCT06103370
Status: Initial project planning phase

Interested in quick information about this study and how to find out if you are eligible? Please click here.

PROSPER | PROviding Support for People through collaborativE caRe

This project aims to further the National Ending the HIV Epidemic goals via peer-supported collaborative care for substance use and mental health disorder and HIV care integration.

Despite effectiveness of antiretrovirals for HIV treatment, people living with HIV who also have mental health or substance use disorders suffer disparities in rates of HIV suppression and retention in HIV care. Collaborative care is a well-established, evidence-based model for integrating mental health disorder care into primary care settings.

PROSPER is a Hybrid Type 1 implementation-effectiveness trial of an adapted collaborative care model with peer coaches as care managers. The program aims to increase integration of screening and treatment for mental health and substance use disorder care into HIV care settings. In PROSPER, peer coaches receive rigorous training and supervision in a structured, flexible intervention. Those who agree to participate and are randomized to intervention engage with a peer coach who is part of a collaborative care team including a consulting psychiatrist and the patient’s own HIV primary care provider. Those randomized to usual care have access to existing Bartlett Clinic resources, including therapists, psychiatrists and in-clinic low-barrier SUD treatment and support. Mixed methods will be used to characterize the implementation process and outcomes.

Funding: NIH: NIH/ NIDA R01DA052297
ClinicalTrials.gov: NCT04601064
Status: Ongoing

Interested in quick information about this study and how to find out if you are eligible? Please click here.

Rapid HCV

A multicenter, open-label, phase IV randomized controlled trial, led by Johns Hopkins and implemented in Baltimore, Toronto (University of Toronto), San Francisco (UCSF), and Alabama (UAB) evaluating an approach to delivering hepatitis C (HCV) treatment in accredited opioid treatment programs (OTPs).

People who receive opioid agonist treatment in OTPs, such as methadone or buprenorphine, have disproportionately high rates of HCV. Oral direct-acting antivirals can cure >= 95% of HCV, but do not reach all who are infected.

RAPID HCV a hybrid implementation-effectiveness trial evaluating the effectiveness of immediate access to on-site HCV evaluation and treatment, enhanced by peer mentor support at the OTP, compared to standard of care of referral for off-site HCV treatment. Mixed methods will be used to characterize the implementation process and outcomes

Funding: Investigator initiated trial funded by AbbVie
ClinicalTrial.gov: NCT04677153
Status: Enrollment complete

Past Grants & Projects

MPeer4Life

This study was a collaborative effort between investigators in the Johns Hopkins School of Medicine, Applied Physics Lab, and Bloomberg School of Public Health to develop and conduct usability testing for a peer led, mHealth-supported, narrative-based intervention to enhance linkage and engagement in opioid agonist treatment (OAT) for people with opioid use disorder.

mPeer4Life developed and assessed the feasibility, acceptability and usability of an innovative peer-led patient navigation intervention based in narrative storytelling and supported by mHealth reinforcement. It focused on linkage to and engagement in OAT for those in an emergency department setting to the outpatient setting.

Funding: Johns Hopkins Discovery Award
Status: Complete