RESTORE: REcovery in Specialty care Through medication and OutREach
RESTORE delivers low threshold SUD medical treatment (including buprenorphine) and Recovery Support Services (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 Recovery Support Services (RSS) and careful application of the Collaborative Care Model (CCM) leveraging addictions psychiatry and a dedicated clinician champion for support of Bartlett clinicians and staff in providing evidence-based, non-stigmatizing, low-threshold access to OBOT.
RESTORE is a direct response to rising rates of opioid use disorders, overdose deaths and concomitant increase of viral hepatitis and uncontrolled and new HIV infections and comorbid conditions of drug use, and is unique in its application in an infectious disease clinic setting.
Support to RESTORE – Support to RESTORE: Leveraging Resources, Connecting People
With the support of a Substance Abuse and Mental Health Administration grant, the goal of this 5-year grant is to increase access to treatment for opioid use disorder treatment by developing a learning collaborative of community-based providers thus expanding capacity to initiate medications for OUD treatment and training peers to provide psychosocial support, and facilitate linkage to and retention in ongoing SUD treatment in community-based settings.
RAPID HCV – This is an open label multicenter, phase IV randomized controlled trial evaluating two different approaches to delivering Hepatitis C (HCV) treatment for people who use drugs (PWUD) and are enrolled in an outpatient opioid treatment program (OTP). There are disproportionately high rates of HCV amongst PWUD, but due to a number of structural and systemic barriers, extremely low rates of HCV treatment uptake. Aligning with our greater mission to promote healthy outcomes by increasing access to care amongst PWUD, this study aims to demonstrate the effectiveness of an HCV “test and treat” strategy (immediate access to on-site treatment at the OTP) enhanced by peer support, compared to a standard of care referral for off-site HCV treatment. Study participants and peer mentors are being recruited from two local OTPs, where members of our team maintain a daily presence. Study coordinators interact directly with OTP clients, conduct various outreach activities, and engage regularly with the local community.
Peer supported collaborative care -This is a randomized trial designed to assess the effectiveness of incorporating mental health disorder (MHD) and substance use disorder (SUD) care into the HIV care setting. There is a known association between the presence of MHDs and SUDs among people with HIV and lower rates of viral load suppression and retention in HIV care. In an effort to overcome this demonstrated barrier to successful HIV care engagement, we are evaluating the impact of implementing a collaborative care model with integrated MHD/SUD care and peer case management versus the standard of care referral process on HIV outcomes. By facilitating a network of care that includes the HIV provider, consultant psychiatrist, and peer care manager, the collaborative care model capitalizes on the value of using a multidisciplinary approach to provide patient-centered, centralized care. Participants are being recruited daily from the Bartlett clinic at the Johns Hopkins Hospital, where the study team is based.
mPeer4Life – This study aims to improve linkage to outpatient opioid use disorder (OUD) care and increase uptake of medication-assisted treatment (MAT) for Emergency Department (ED) patients by evaluating the acceptability, feasibility, and usability of a peer driven, narrative-centered intervention with mobile app support. This study involves several phases, including development of the mobile-based support app, in-depth interviews and focus groups with patients and providers to enhance development of the intervention, and a randomized controlled trial to compare MAT uptake amongst those receiving the peer-driven, narrative-centered, mobile-supported intervention versus those receiving standard of care referral for MAT linkage. This study is being conducted in the Johns Hopkins ED, where members of the study team actively work with ED providers and staff to recruit participants.
Telehealth ACCESS – Working in collaboration with the Maryland Department of Health Center for Harm Reduction services and Local health department /Syringe Service Programs in St. Mary’s, Washington and Wicomico counties, 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. Appointment for care can be scheduled by calling 443-812-8148.
Center Faculty & Staff
Oluwaseun O Falade-Nwulia, M.B.B.S., M.P.H.-CenterDirector
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 included integration of HCV treatment into varying settings including public health clinic and opioid treatment programs and integration of substance use disorder treatment into HIV care settings. She is an active provider of HIV, hepatitis C and substance use care.
NP Tracy Agee – Project Director
Tracy Agee is a Senior Nurse Practitioner at The Johns Hopkins University School of Medicine in Baltimore MD. She completed her nurse practitioner training at the Johns Hopkins University School of Nursing and graduated with both the Sigma Theta Tau Nu Beta and JHU Alumni Association Leadership awards. She maintains a clinical practice focused on the care of people living with HIV, viral hepatitis, substance use, and mental health disorders. In 2004 she secured Ryan White funding for and set up a satellite clinic of the Johns Hopkins HIV/AIDS practice within an opioid treatment program, and was engaged in early efforts to evaluate feasibility of buprenorphine in the HIV specialty setting., She previously served as Program Coordinator for Sharing The Cure), a successful and sustained effort to train community-based primary care providers in hepatitis C care and cure. She currently serves as Program Director for the Center’s RESTORE, and Support to RESTORE, and is an active collaborator for the Center’s other projects.
Danielle Signer – Senior Program Manager
Danielle Signer is a senior research program manager at the Johns Hopkins University School of Medicine in Baltimore, MD. She received her bachelor of science from Cornell university, and is currently pursuing a master of public health at Johns Hopkins Bloomberg. Danielle has over 10 years of clinical research experience, with a strong background in program development. She has focused primarily on infectious diseases research, acquiring expertise in HIV and hepatitis C (HCV) point of care testing, routine screening, and linkage to care. She has worked extensively on the implementation and integration of HIV/HCV testing practices into clinical care settings, and led the conceptual development of the electronic medical record system integration.