Project INTEGRA gives former opioid user purpose on his road to recovery

Frank Williams was raised in the church playing the keyboard, but by the age of 13, he was introduced to illegal substances and began selling marijuana by his freshman year of high school. A decade later, Williams was selling heroin and slowly became addicted to the substance through what he called a “shake habit” — which is when the substance seeps into your pores from touching it so much.

“I didn’t know I was addicted until I didn’t have any more drugs to sell and I would begin to feel sick,” said the 35-year-old Williams, now in recovery from opioid use disorder. “Once I was able to get my hands on some more, literally, to sell, I realized I felt better, and after that, it was downhill.”

About 10 years into his heroin use disorder, Williams stumbled upon the UTHealth Houston’s Project INTEGRA van, a mobile research unit that provides integrated health services to people with opioid use disorder. About four months after seeing the van in a grocery store parking lot in Southeast Houston, Williams finally made an appointment after he had a close call with fentanyl and broke his neck after blacking out.

“I was just tired and depressed,” Williams said. “I remember not even wanting to wake up some days and I could see the walls closing in. If it wasn’t for my daughter, I would’ve easily given up.” 

Project INTEGRA is a first-of-its-kind, vanguard research study being conducted in five cities in the United States. Funded by the National Institutes of Health, it provides free services to individuals struggling with substance misuse, primarily people who inject substances, through medication-assisted recovery for opioid use disorder, and antiretroviral therapy or pre-exposure prophylaxis for HIV treatment and prevention.

“It may seem like common sense that if you bring compassionate, integrated health care services to people, you are removing barriers and they will be more likely to be able to engage in care. But providing care this way is actually fairly novel,” said Jordan E. Lake, MD, MSc, an associate professor of infectious diseases at McGovern Medical School at UTHealth Houston at UTHealth Houston and the study’s local principal investigator. “Houston is a hot spot both for overdoses and HIV. Project INTEGRA aims to prove that we can use the mobile unit to engage people who inject drugs, and compassionately and effectively provide them with services that will reduce drug overdoses and deaths and reduce transmission of HIV and other infections that are acquired sexually or through injection drug use. Essentially, the goal of Project INTEGRA is to save lives in Houston.” 

Houston is the only Project INTEGRA site in the southern United States. The INTEGRA team meets people “where they are” by bringing integrated and judgment-free health services, supported by peer navigation, said James Langabeer, PhD, EdD, MBA, a co-investigator on the study and a professor of biomedical informatics, emergency medicine, and public health at UTHealth Houston.

Participants in the intervention group of the study receive mobile, integrated health care as well as peer navigation from medical and recovery experts for 26 weeks. These services include medication and harm reduction services for opioid use disorder, medications for HIV/STI treatment and prevention, and testing and referrals for other health care needs.

Following the first 26 weeks of the trial intervention, participants will be transitioned to other community-based services to address their health care needs, such as the university’s Houston Emergency Response Opioid Engagement System, or HEROES, program, which is led by Langabeer.

“The Greater Houston area is a vast, geographically diverse blend of communities, with thousands of square miles. One barrier common to nearly all of this area is access to quality medical care,” Langabeer said. “Especially vulnerable are those with opioid use and immunodeficiency disorders, where transportation, health insurance, and financial resources limit ongoing care for these chronic conditions. The INTEGRA van enables UTHealth Houston to effectively cover areas with the greatest need, so we can provide evidence-based care to as many Houstonians as possible.”

Williams met peer navigator coach Kristina Davis the moment he walked up to the Project INTEGRA van to seek services. Kristina has walked alongside Williams throughout his process of change, encouraging him, and connecting him to community services for ongoing care each step of the way.

“When Frank came to us, he was in a very tough area,” Davis said. “From day one, he had a strong mindset and once we removed him from that environment, he excelled so quickly.”

As a peer recovery coach, Davis has the advantage of understanding where patients are mentally, physically, and spiritually to provide them with the support they need. She said being persistent is critical in gaining the trust of people who inject substances. 

“We make sure we’re right next to them, going through their journey with them, being a guide, a mentor, a resource broker,” Davis said. “We are there from day one through their whole journey because we love them until they start to love themselves. It's just the role of a peer.”

Williams went to rehab in December 2021, and has been in recovery since. He says the love and support he has received is what keeps him going, along with his 10-year-old daughter, and with the help from Davis and the other peer coaches, Williams is back in church playing the keyboard.

“I needed to get back to what really stimulates me, what really helps me and that’s being in church,” Williams said. “I am making money playing the keyboard and as cliché as it sounds, my dreams are really coming true.”

Other UTHealth Houston INTEGRA study team members include Roberto Arduino, MD; Karen Vigil, MD; Qiana Allen, NP; Tom Fadial, MD; Shabana Walia, MD, MPH; Maria Martinez, PhD; Jonatan Gioia; Olga Popova, PhD; and Olatunde Oladipupo. The peer coaching team, led by Jessica Yeager, includes Davis and Yami Thomas. Study coordinator is Sebastian Guerrero, MD.

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