The New England and Appalachia regions have been immersed in addressing the opioid crisis for years, but by no means have found all the answers to maximizing crisis response. A multi-state initiative funded by the Health Resources and Services Administration (HRSA) will fuel strategies for scaling up treatment to combat both opioid use disorder (OUD) and HIV.
Project MO(H)RE, which stands for Multisite Opioid (and HIV) Response Endeavor, will target existing gaps in addressing both illnesses in an integrated fashion, from the presence of separate funding streams to the lack of integrated screening and treatment in many traditional care settings.
“One of the key things that will be happening is to bring together behavioral health providers and HIV and public health providers,” Frederick L. Altice, MD, professor of medicine and public health at Yale University and project leader, tells Addiction Professional.
Participating states are Connecticut, Vermont and New Hampshire from the New England region and Kentucky and West Virginia from the Appalachian region. The New England region generally has been a leader in evidence-based OUD treatment, but Altice says that in states such as Connecticut, rural communities still face a significant gap in access to care compared with urban centers.
In Kentucky and West Virginia, overall HIV prevalence is fairly low, but the area is highly vulnerable to serious outbreaks, says Altice. Moreover, he adds, those states have been slower to adopt agonist medication treatment for OUD or syringe services programs to combat the spread of blood-borne infections.
Yale has received more than $3.7 million for this systems-of-care initiative, which also involves a team that includes leaders such as Alice Thornton, MD, chief of infectious disease at the University of Kentucky, and Daniel Daltry, program chief of the HIV. STD and Hepatitis C program at the Vermont Department of Health.
Seeking breakthrough improvements
Project MO(H)RE is modeled after the Institute for Healthcare Improvement's quality improvement process, which uses collaborative learning strategies that have been adopted by the Network for the Improvement of Addiction Treatment (NIATx). Altice explains that upon completion of gap analyses in year one of the project, each state will be assigned a coach to help leaders implement rapid-cycle projects (three months or less in duration) to scale up treatment in years two and three. Each state will decide how to structure the collaborative that works to implement these service enhancements.
Scaling up evidence-based medication treatment for OUD in a meaningful way will top the list of priorities, Altice projects. He adds that it will be important for OUD medication treatment providers to conduct more routine screening for HIV, and for HIV and primary care settings to do a better job of delivering medication-assisted treatment. The efforts of federally qualified health centers (FQHCs) could be a key asset in this initiative, Altice says.
Initial efforts in the initiative are focusing on identifying financial and legal gaps that can impede the provision of high-quality treatment. For example, Altice says in his recent travels to West Virginia, some discussion centered on barriers such as a state moratorium on new opioid treatment programs (OTPs), as well as certification requirements for buprenorphine prescribers that add another regulatory layer to the existing federal requirements around the agonist medication.