Dr. Hoffman's program of research focuses on how gender norms and inequalities influence HIV risk, prevention, and care among both women and men; on scaling up female-initiated and biomedical prevention such as oral pre-exposure prophylaxis (PrEP); and on addressing the challenges of late enrollment, poor retention, and late ART initiation among HIV-positive individuals. She has developed and tested preventive interventions for women, men, and youth in the US and in sub-Saharan Africa. Dr. Hoffman was principal investigator of Pathways to Engagement in HIV Care for Newly-Diagnosed South Africans, a prospective cohort study of individuals newly-diagnosed HIV-positive at three public sector clinics in KwaZulu-Natal aimed at determining the barriers and facilitators of linkage to HIV care. She is co-investigator on several studies designed to implement PrEP in NYC; and a study to develop brief HIV care and treatment adherence interventions that can be delivered by ancillary service providers to NYC individuals living with HIV whose viral load remains unsuppressed. She anticipates receiving NIMH funding to develop a gender-informed workshop to introduce oral PrEP to young South African women at elevated risk of HIV infection. Dr. Hoffman teaches Publications, Presentations, and Grants (P9494) to doctoral Epidemiology students.
Select Urban Health Activities
Project Assist: The goal of this study, a collaboration between the NYC Department of Health and Mental Hygiene and the HIV Center at Columbia University, is to develop feasible and acceptable brief interventions to promote HIV care and treatment adherence among NYC people living with HIV (PLWH) whose viral load remains unsuppressed. We aim to leverage HIV ancillary service providers (i.e., providers of food and nutrition, legal, housing, and harm reduction services) funded under Ryan White Part A (RWPA). Our target population comprises PLWH who receive one or more of these ancillary services, have unsuppressed viral load, but do not receive formal care and treatment adherence support such as medical case management, mental health services, or supportive counseling. We will collect and analyze both qualitative and quantitative data to better characterize how this population uses care; identify barriers to and facilitators of HIV care and treatment adherence and participation in medical case management; identify current efforts of ancillary service agencies and providers to support their clients' HIV care and treatment adherence, and their suggestions for and willingness to implement innovative care and treatment adherence support interventions. The outcome of the study will be the proposal of several brief care and treatment adherence interventions that can be implemented by ancillary service providers. Drs. Susan Tross and Matt Feldman are PIs of this study.
Primary Care for PrEP (PC4PrEP): The objective of this study, a collaboration between Albert Einstein College of Medicine, Montefiore Medical Center, and the HIV Center at Columbia University, is to develop, implement and evaluate Primary Care for PrEP (PC4PrEP), a new multilevel structural intervention that will address diverse barriers to uptake of pre-exposure prophylaxis (PrEP). PC4PrEP has four components. It will: (1) designate a "home" for PrEP in primary care clinics; (2) train and support primary care providers (PCPs) to prescribe and manage PrEP, and create provider norms that promote the value of PrEP; (3) identify high-risk individuals in primary care clinics using a new PrEP Eligibility Tool; and (4) identify high-risk out-of-care individuals (in collaboration with a community-based organization (CBO) that conducts outreach and HIV testing in HIV-risk groups) and link them to PCPs who can provide PrEP. We will conduct a Phase 2 clinic-randomized futility trial of PC4PrEP in six Federally Qualified Health Centers (FQHCs) and several non-randomized community HIV testing sites to determine whether PC4PrEP shows promise for increasing the rate of new PrEP prescriptions, assess its effect on outcomes at each stage of our conceptualization of the "PrEP Cascade," and assess challenges to PrEP adoption at the level of the individual, provider, health center, and community sites. Drs. Joanne Mantell and Laurie Bauman are PIs of this study.
Project PrIDE/PC4PrEP supplement: The aims of this study, a collaboration between the NYC Department of Health and Mental Hygiene (DOHMH) HIV and STD Bureaus, Montefiore Medical Center/Albert Einstein College of Medicine, and the HIV Center at Columbia University, are to identify the factors associated with clinical provider decision-making about PrEP, and to test ways to provide clinical decision support. DOHMH, as part of the End the Epidemic of HIV initiative, has integrated PrEP into its 8 Sexual Health Clinics (SHC) through screening PrEP candidates and providing them with PrEP education, starter kits, and linkage to providers in 9 clinical centers for ongoing management. The study is collecting in-depth qualitative data from all SHC clinical providers about their heuristics in PrEP decision-making. We will combine data from these qualitative interviews with electronic medical record data on actual prescribing practices to identify patient, provider and clinic/organizational factors significantly associated with PrEP-prescribing practices. We also will conduct in-depth interviews with 18 prescribing providers who accepted PrEP referrals from STD providers to understand their experience with the model and their PrEP-prescribing challenges. We will also test the feasibility and efficacy of a new online Community of Practice that the SHC providers can use to post case studies of PrEP eligibility and obtain advice from their peers. Drs. Joanne Mantell and Laurie Bauman are PIs of this study.
Select Global Activities
Developing a Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women: In sub-Saharan Africa, adolescent girls and young adults remain at extraordinarily high risk for HIV infection. Oral pre-exposure prophylaxis (PrEP) has been demonstrated efficacious, but it is not known if young women will take up and adhere to this prevention method. We propose that two innovations can reach young, at-risk AGYW, inform them about PrEP and motivate them to use it: (1) introducing PrEP through a gender lens in a one-session group workshop; and (2) peer-driven recruitment, recruiting women to attend the workshop by those who have already attended it. Therefore, the aims of this study are to develop, along with a group of young South African women, a one-session group-based informational/motivational workshop to introduce PrEP through a gender lens and to motivate young women to consider it for themselves; to pilot the workshop, comparing it with an information-only session, and to evaluate peer-driven recruitment to (PDR) to recruit women to attend the workshop. If promising, these approaches will be tested in a larger study. Drs. Susie Hoffman and Gita Ramjee are the proposed PIs of this study.
Structural and Social Transitions Among Adolescents in Rakai (SSTAR): This study, based at the Rakaii research site in Uganda, will use qualitative and quantitative data to understand how changing social-structural determinants, including expanded access to ART and universal primary education, are influencing the timing, order, and pace of adolescent social transitions--such as marriage and childbearing--which in turn may be altering patterns and determinants of HIV risk for adolescent and young adult women and men. Dr. John Santelli is the PI of this study.
Pathways to Engagement in HIV Care for Newly-Diagnosed South Africans: This prospective cohort study interviewed over 2700 South African women and men who presented for HIV testing and counseling at three public primary care clinics in the Durban, South Africa, region, and followed for eight months after diagnosis 459 of them who were newly-diagnosed HIV-positive. The goal was to identify time to linkage to HIV care and the barriers to and facilitators of linkage and retention. Another goal was to identify additional critical issues for newly diagnosed individuals, including disclosing, addressing stigma, the need for and use of mental health, sexual and reproductive health, and other HIV-related ancillary services. Dr. Hoffman was the PI of this study.
*Hoffman S, Guidry J, Collier K, Mantell J, Boccher-Lattimore D, Kaighobadi F, Sandfort T. A clinical home for pre exposure prophylaxis (PrEP): Diverse health care providers’ perspectives on the “purview paradox.” J Int Assoc Provid AIDS Care 2016 15(1):59-65. PMCID PMC4703503
*Hoffman S, Exner TM, Lince-Deroche N, Leu C-S, Phillip JL, Kelvin EA, Gandhi AD, Levin B, Singh D, Mantell JE, Blanchard K, Ramjee G. Immediate blood draw for CD4+ cell count is associated with linkage to care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care. PLOS One Published: October 5, 2016 http://dx.doi.org/10.1371/journal.pone.0162085. PMC5051894
*Hoffman S, Levasseur M, Mantell JE, Beksinska M, Mabude M, Ngoloyi C, Kelvin EA, Exner T, Leu C-S, Pillay L, Smit JA. Sexual and Reproductive Health Risk Behaviors among South African University Students: Results from a Representative Campus-Wide Survey. African Journal of AIDS Research, published online April 2, 2017. http://dx.doi.org/10.2989/16085906.2016.1259171. PMCID886348.
*Tariq S, Hoffman S, Ramjee G, Mantel JE, Phillip JL, Blanchard K, Lince-Deroche N, Exner TM. "I did not see a need to get tested before, everything was going well with my health”: A qualitative study of HIV testing decision-making in KwaZulu-Natal, South Africa. AIDS Care, published online July 11, 2017. http://dx.DOI/10.1080/09540121.2017.1349277.
*Kulkarni S, Tymejczyk O, Gadisa T, Lahuerta, M, Remien RH, Melaku Z, El-Sadr W, Elul B, Nash D, Hoffman S. “Testing, Testing”: Multiple HIV-positive tests among patients initiating ART in Ethiopia. Journal of the International Association of Providers of AIDS Care, 2017:1-9. DOI: 10.1177/2325957417737840.
*Weintraub A, Mantell JE, Holt K, Street RA, Wilkey C, Dawad S, Hoffman S. ‘These people who dig roots in the forests cannot treat HIV’ Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs (ARVs). Global Public Health, published online August 10, 2017. http://dx.doi.org/10.1080/17441692.2017.1359326.
*Hoffman S, Tymejczyk O, Kulkarni S, Lahuerta S, Gadisa T, Remien RH, Melaku Z, Nash D, Elul B. Stigma and HIV care continuum outcomes among Ethiopian adults initiating ART. J Acquir Immune Defic Syndr. 2017 Dec 1;76(4):382-387. doi: 10.1097/QAI.0000000000001530.
*Fifield J, O’Sullivan L, Kelvin EA, Mantell JE, Exner TM, Ramjee G, Blanchard K, Hoffman S. Social support and violence-prone relationships as predictors of disclosure of HIV status among newly diagnosed HIV-positive South Africans AIDS and Behavior https://doi.org/10.1007/s10461-018-2136-z.