Susie Hoffman, DrPH

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.