About

Frederick (Rick) Lewis Altice, MD, MA, is a physician-scientist and Professor of Medicine (Infectious Diseases) and of Epidemiology and Public Health at Yale University. He serves as the Director of the Yale Center for Clinical and Community Research and is an internationally recognized leader in implementation science, health service integration, global health, and health equity. His career is focused on translating evidence-based interventions into real-world practice for populations disproportionately affected by infectious diseases and substance use disorders. Dr. Altice remains an active clinician in infectious diseases and addiction medicine, ensuring his research is informed by patient care realities. His work centers on implementation science at the intersection of HIV, hepatitis C, tuberculosis, and opioid use disorder, especially among populations facing structural vulnerabilities such as people who inject drugs, men who have sex with men, transgender women, female sex workers, and individuals involved in the criminal legal system. He addresses disparities in access to prevention and treatment, including HIV prevention (PrEP), antiretroviral therapy, hepatitis C and tuberculosis treatment, and medications for opioid use disorder. Dr. Altice is known for his leadership in integrating health services traditionally delivered in silos, developing models that combine infectious diseases treatment, addiction care, mental health services, primary care, and social support into coordinated, patient-centered systems across clinical and community settings. His research spans epidemiology, intervention development, decision science, and implementation science, applying frameworks like EPIS, PRISM, RE-AIM, iPARiHS, and CFIR to guide the systematic scale-up of interventions while emphasizing sustainability and health system integration. A key focus of his work is addressing stigma as a barrier to care, utilizing behavioral design and decision science principles to reduce stigma at multiple levels and reshape care delivery to be more accessible and aligned with patient preferences. He has also led the development of digital health and mHealth interventions, including mobile applications, clinical decision support tools, and AI-enabled platforms, to support real-time decision-making, improve engagement, and extend care beyond traditional settings. With over two decades of global implementation science and health systems research, Dr. Altice has led or collaborated on projects funded by major agencies like NIH, CDC, SAMHSA, and HRSA, partnering with international organizations such as WHO, UNAIDS, USAID, PEPFAR, and UNODC. He directs international training programs and collaborations in Malaysia, Peru, Georgia, and Ukraine, contributing to global capacity building in implementation science, health service integration, and stigma-informed care. His leadership is characterized by a commitment to bridging the gap between evidence and practice through integrated, patient-centered models of care, with a focus on reducing disparities and improving outcomes for vulnerable populations.

Research topics

• Medicine
• Internal medicine
• Virology
• Political Science
• Emergency medicine
• Nursing
• Psychology
• Immunology
• Intensive care medicine

Selected publications

• Using Nominal Group Technique With Human-Centered Design to Inform Preimplementation Planning for Combined Rapid-Start Initiation of Antiretroviral and Opioid Agonist Therapies in People Who Inject Drugs With HIV in Ukraine

  Journal of the Association of Nurses in AIDS Care · 2026-04-27

  articleSenior author

  ABSTRACT: International guidelines recommend rapid-start antiretroviral therapy (RS-ART) for people with HIV. Guidance for implementing RS-ART among people who inject drugs (PWID), a population often denied equitable treatment due to stigma and rights violations, remains limited. Using human-centered design, barriers and facilitators to combined RS-ART and opioid agonist therapy initiation in Ukraine were explored, where HIV is concentrated among PWID with opioid use disorder. Using nominal group technique, a human-centered design method involving client input, five focus groups (6-12 participants each and 42 participants total) with PWID with HIV in four Ukrainian cities most affected by HIV were conducted. Responses were rank-ordered and grouped using NVivo along the socioecological model. The most common barriers were organizational, including nonintegration of ART and opioid agonist therapy services (45%), followed by individual (22%), such as fear of withdrawal symptoms, policy/regulatory (20%), including the national addiction registry, and relationship (13%) barriers, including pervasive stigma. Solutions focused on equity, promoting behavioral design interventions like choice architecture, nudging, and message framing.

  PublisherDOI

• Evaluation of a “one-stop shop” for integrated harm reduction and primary care for people who inject drugs

  PLoS ONE · 2025-11-21

  articleOpen access

  BACKGROUND: People who inject drugs (PWID) experience high risk for HIV and HCV infection, which can be mitigated by harm reduction strategies, including syringe service programs (SSP). Understanding individuals' patterns of substance use and SSP utilization is important for optimizing harm reduction strategies and disease prevention for PWID. METHODS: We evaluated demographic characteristics and service utilization from the New Haven Syringe Services Program (NHSSP), a low-threshold service delivery site in New Haven, Connecticut that provides fully integrated harm reduction and primary healthcare services to PWID. Site-specific data were extracted from the e2ctprevention database, managed by the Connecticut Department of Public Health, and EvaluationWeb from January 2017 to October 2023. We conducted a descriptive analysis of basic demographic and social characteristics of SSP clients, transaction characteristics, and service utilization. Statistical analyses were conducted using STATA v 16.1 and IBM SPSS Statistics (v 29.0.2.0). RESULTS: Among 1,189 unique individuals utilizing SSP during the observation period, most (65.2%) identified as men and white (73.3%), consistent with SSP clients regionally and nationally. The mean age of clients was 41 years (SD = 9.8); approximately half of participants were unstably housed and 80% were unemployed at intake. From June 2020 to October 2023, there were 7,238 transactions, which increased throughout the COVID-19 pandemic period. During this period, the program dispensed 1,860,621 syringes, in addition to other materials, including overdose education and naloxone distribution (OEND), and provided patient education on safer injecting techniques and wound care. CONCLUSION: In this first comprehensive analysis of a large SSP since its inception and through the COVID-19 pandemic, we described important client characteristics and utilization of an array of syringe services from an integrated SSP. Findings suggest the SSP attracts a high volume of clients, provides on-demand services, and reaches a wide range of clients. Future research is needed to evaluate the impact of the program's home-delivery service and increased outreach efforts. Despite limitations, the program's success demonstrates the SSP can serve as a model for other harm reduction programs nationally.

  PublisherDOI

• Resisting methadone: criminal subculture and methadone implementation in Moldovan prisons

  International Journal of Prison Health · 2025-10-16

  articleSenior author

  PURPOSE: Maintenance treatment with methadone (MMT) is globally recommended as a key strategy for HIV prevention and addiction treatment in prisons, yet implementation remains limited. Moldova offers a rare exception, where MMT has been available in prisons for over two decades, though uptake remains low. This study aims to examine how criminal subcultures, widespread in many Eastern European prisons, shape access to and perceptions of MMT. DESIGN/METHODOLOGY/APPROACH: A total of 35 in-depth qualitative interviews were conducted in two men's prisons near Chišinău with participants of varied social standing and methadone treatment status. Thematic analysis was used to explore how carceral hierarchies and informal governance shape MMT. FINDINGS: Three major themes emerged: implementation efforts for prison-based MMT have largely failed to account for local contexts and the influence of criminal subcultures; MMT disrupts the hierarchical boundaries that structure prison subculture, resulting in the loss of material and social capital for those who initiate treatment; and MMT has become entangled in a power struggle between formal and informal prison authorities, functioning as a tool of influence for the prison administration and reinforcing its undesirable status among people in prison. ORIGINALITY/VALUE: This study is among the first studies, to the best of the authors' knowledge, to capture how criminal subcultures reshape the implementation and meaning of MMT in Eastern European prisons. These findings underscore the need for future implementation efforts to engage with the social, economic and material logics of criminal subculture, enabling MMT programs to emerge that are independent of custodial control.

  PublisherDOI

• Preferences for mHealth Features to Support Engagement in the HIV Pre-Exposure Prophylaxis Cascade Among Men Who Have Sex With Men in Peru: Cross-Sectional Online Survey (Preprint)

  JMIR Public Health and Surveillance · 2025-09-29

  articleOpen access
  PublisherDOI

• Screening and diagnostic strategies for active pulmonary tuberculosis among people in prison in Malaysia: a prospective diagnostic study

  The Lancet Regional Health - Western Pacific · 2025-11-01

  articleOpen access

  Background: The World Health Organization (WHO) recommends tuberculosis (TB) screening in prisons but data on specific strategies are lacking. Methods: Men sequentially entering Kajang Prison, Malaysia's largest prison, underwent standardized WHO symptom screening (SS), chest X-ray (CXR), and c-reactive protein (CRP ≥5 mg/L) screening tests while acid-fast bacilli (AFB) smears and Xpert were diagnostic tests. The reference standard was culture. We defined three screening strategies and compared their sensitivity, specificity, positive predictive value, negative predictive value, receiver operator curves, and area under the curve (AUC). Findings: We enrolled 588 people in prison, mean age 43 (range: 21-68) years, 60 (10.2%) with HIV, 493 (83.8%) with opioid use disorder, and 265 (45.1%) with HCV. Among these, 34 (5.8%) were diagnosed with culture-positive active pulmonary TB (PTB). For screening, the sensitivity of SS, CRP ≥5 mg/L, and CXR demonstrating PTB was 38.2% (95% CI 22.2-56.4), 47.1% (95% CI 29.8-64.9), and 91.2% (95% CI 76.3-98.1). Among people without HIV, "SS-CXR" had the highest AUC (74.7% [95% CI 68.6-80.7]). For people with HIV, however, "SS-CRP" had the highest AUC (85.5% [95% CI 79.4-91.5]). For diagnosis, Xpert had a higher sensitivity (82.4% [95% CI 65.5-93.2] and specificity (95.5% [95% CI 93.4-97.1]) than AFB smear. Compared to "SS-Xpert", both "SS-CXR-Xpert" and "SS-CRP-Xpert" had a significantly higher AUC in people without HIV (84.2% p < 0.0001 and 72.9% p = 0.023, respectively) and people with HIV (87.3% p = 0.022 and 88.2% p = 0.018, respectively). Interpretation: Among people in prison, adding CXR or CRP to symptom screen was more effective than symptom screen alone. In addition to symptom screen, CRP performed better than CXR among people with HIV while CXR was more valuable than CRP among people without HIV. Funding: U.S. National Institute on Drug Abuse.

  PublisherOA PDFDOI

• Pilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®

  AIDS Care · 2025-07-30

  articleOpen accessSenior author

  This study is registered at ClinicalTrials.gov (NCT05597787), with materials submitted in March 2022.

  PublisherOA PDFDOI

• Exploring barriers and facilitators in implementing the Health4All module for HIV stigma reduction in Malaysia healthcare setting, a Delphi study

  BMC Research Notes · 2025-12-29

  articleOpen accessSenior author

  OBJECTIVE: Stigma and discrimination in healthcare settings remain significant barriers to achieving the global goal of ending the AIDS epidemic by 2030. Despite progress, interventions to address these issues are limited in Malaysia, where Health4All module being one of the few implemented in healthcare settings to reduce HIV-related stigma. This study explores the barriers and facilitators to its implementation, aiming to enhance its effectiveness in addressing stigma within these environments. RESULTS: Using the Delphi method, expert opinions from public health and primary care sectors were collected over three iterative rounds to identify and prioritize barriers and facilitators to implementing the Health4All module. Data were obtained via email, with each round refining the previous findings. The implementation was facilitated by strong leadership, adequate funding, clinic champions, established HIV teams, and active staff engagement. Key barriers included workforce shortages, high turnover, recruitment challenges among key populations, language and content limitations, and online training constraints such as technical issues and limited interaction. Despite these challenges, cost-effective online delivery and targeted incentives improved uptake, emphasizing the critical influence of organizational, individual, and systemic factors on successful implementation. The findings provide a valuable foundation for future efforts to enhance healthcare practices and outcomes.

  PublisherOA PDFDOI

• Using the socioecological model to guide service delivery improvements to the prison needle exchange program in Canada: insights from multi-level stakeholders

  BMC Public Health · 2025-10-29 · 4 citations

  articleOpen accessSenior author

  BACKGROUND: In 2018-2019, Canada introduced a Prison Needle Exchange Program (PNEP) across nine federal facilities to mitigate the harms associated with drug injection among incarcerated people. However, program uptake has been limited. We explored the barriers and facilitators to improving PNEP services among key stakeholders in prison. METHODS: Stakeholders in nine federal prisons with active PNEP participated in focus groups using nominal group technique to achieve rapid consensus. Responses were generated, rank-ordered, and prioritized by each stakeholder group (correctional officers, healthcare workers, and people in prison). We identified the highest-ranking responses to questions about barriers and solutions to PNEP uptake and described them using the five levels of the Socioecological Model: individual, interpersonal, organizational, system, and structural/policy. RESULTS: Between September 2023 and February 2024, 34 focus groups were conducted with 215 participants (n = 51 correctional officers (24%); n = 67 healthcare workers (31%); n = 97 people in prison (45%)). Key barriers identified were lack of confidentiality and privacy across all levels and fear of repercussions from drug use and fear of being targeted at the individual-interpersonal levels. Preferred solutions included comprehensive education across all levels, and establishment of supervised/safe injection sites and external program management, potentially involving peers, at the structural level. CONCLUSIONS: Several multi-level modifiable barriers to improving PNEP uptake in Canadian federal prisons were shared among key stakeholders. Structural changes to PNEP delivery, including supervised/safe injecting sites and peer-led programs, were proposed as solution-driven enablers to increasing PNEP uptake among incarcerated people who inject drugs. These data will inform Canadian efforts to expand PNEP provision.

  PublisherOA PDFDOI

• Strengthening HIV Activism Among Clinicians in Malaysia: A Randomised Controlled Trial

  AIDS and Behavior · 2025-07-21

  articleOpen access

  Abstract HIV continues to disproportionately affect key populations in Malaysia, compared to the general population. Lessons learned from decades of research and programmatic experience suggest that HIV activism can be a driver for change. We pilot-tested a tele-training platform, Project ECHO ® for Stigma Reduction (PE-SR), in a randomised controlled trial from July 2022 to March 2023, alongside two comparator groups, i.e., Project ECHO ® -Standard (PE-S) and the conventional HIV training program for clinicians, HIV Connect (HC). We randomised 78 primary care physicians and general practitioners across Malaysia into the three study arms ( n = 26 each). We evaluated changes in HIV activist identity and commitment, and orientation towards day-to-day HIV activism and structural HIV activism. Repeated measure analysis of covariance (ANCOVA), controlling for age, years of practice, and contact with key populations as covariates, compared changes in HIV activism constructs across time and groups. The randomised controlled trial yielded mixed results. We observed statistically significant changes in HIV activist identity and commitment, as well as changes in orientation towards structural activism in all groups. We also found statistically significant mean differences between PE-S and HC in terms of HIV activist identity and commitment, and between PE-SR and HC in terms of orientation towards structural activism. Results suggest that stigma reduction tools embedded in a tele-training platform had a preliminary impact on HIV activism and could be scaled up and tailored to train clinician-activists. Trial Registration NCT05597787.

  PublisherOA PDFDOI

• Alcohol use disorder, antiretroviral therapy adherence, and oral health in Peruvian MSM living with HIV

  HIV Research & Clinical Practice · 2025-11-20

  articleOpen access

  BACKGROUND: In Peru, the HIV epidemic is primarily concentrated among men who have sex with men (MSM), with an estimated prevalence exceeding 10%. This study aimed to assess the interaction between alcohol use and suboptimal adherence to antiretroviral therapy (ART) on AIDS risk and oral health among Peruvian MSM living with HIV. METHODS: We recruited 398 MSM living with HIV from two urban HIV treatment clinics in Lima. Alcohol use disorder (AUD) was assessed using the standard Alcohol Use Disorders Identification Test (AUDIT). ART adherence was self-reported. AIDS risk was defined as a history of having a CD4 count below 200 cells/mm ³ . A joint model was used to estimate the association between AIDS risk and oral conditions. Independent variables included alcohol consumption (binge drink and heavy use), suboptimal ART adherence (not 100% use), and their interaction, controlling for age and education. RESULTS: = 0.0231). This association also holds when modeling the two outcomes separately. CONCLUSIONS: Interaction of suboptimal ART adherence and AUD is strongly associated with increased risk of AIDS and poor oral health among Peruvian MSM with HIV. Our findings support the need for longitudinal studies to better understand the complexity of alcohol consumption, ART adherence, AIDS risk, and oral diseases in this vulnerable population.

  PublisherDOI

Recent grants

• NIH Grant R01AA018944

  NIH · $3.8M · 2015

• NIH Grant R01DA025943

  NIH · $2.7M · 2015

• Integrating Addiction Treatment and HIV Services into Primary Care Clinics in Ukraine

  NIH · $4.4M · 2016–2024

• NIH Grant R21DA019843

  NIH · $405k · 2010

• NIH Grant R01DA030768

  NIH · $4.0M · 2017

Frequent coauthors

• Jeffrey A. Wickersham

  Yale University

  177 shared

• Adeeba Kamarulzaman

  Monash University Malaysia

  137 shared

• Lynn M. Madden

  Yale University

  136 shared

• Roman Shrestha

  136 shared

• Sandra A. Springer

  88 shared

• Adeeba Kamarulzaman

  Monash University Malaysia

  87 shared

• Daniel J. Bromberg

  Charité - Universitätsmedizin Berlin

  68 shared

• R. Douglas Bruce

  Case Western Reserve University

  67 shared

Education

• M.D., Medicine

  Yale University

• M.A., Public Health

  Yale University

• B.A., Psychology

  University of California, Berkeley