An implementation science study of violence screening practices among Ryan White-funded sites in the Southeastern United States

对瑞安·怀特 (Ryan White) 资助的美国东南部网站的暴力筛查实践进行科学研究

• 批准号: 10349578
• 负责人: Ameeta Shivdas Kalokhe
• 金额: $ 66.78万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10349578
• 关键词: Acquired Immunodeficiency Syndrome; Address; Administrator; Adopted; Adoption; Advocacy; Awareness; Blood; Caring; Categories; Cessation of life; Child; Child Abuse; Clinic; Clinical; Communities; Conservatism; Continuity of Patient Care; Counseling; Data; Development; Dimensions; Eligibility Determination; Ensure; Epidemic; Funding; Future; Gender; HIV; HIV Infections; Health; Heart; High Prevalence; Homophobia; Individual; Infrastructure; Interpersonal Violence; Intervention; Interview; Legal; Link; Measurement; Medical; Mental Health; Methods; Modeling; Outcome; Participant; Patient Preferences; Patients; Persons; Pharmacotherapy; Phase; Poverty; Process; Provider; Recording of previous events; Research; Resources; Sampling; Service provision; Services; Sexual abuse; Shelter facility; Site; Southeastern United States; Structure; Surveys; Survivors; System; Time; Treatment/Psychosocial Effects; United States; Violence; Viral; Viral Load result; Visit; Woman; Work; assault; base; care outcomes; care providers; care systems; cis-female; clinically relevant; community violence; evidence base; experience; hate crimes; implementation science; informant; innovation; insight; intimate partner violence; men; preference; primary care setting; programs; psychosocial; racism; response; screening; service organization; sex; social; social determinants; transgender; transphobia; treatment services; violent crime

ABSTRACT In the United States (US), 85% of people living with HIV (PLWH) are aware of their HIV status, but only 62% are linked to HIV care and less than half (48%) are retained in care and virally suppressed (49%). Violence has been increasingly recognized as a critical determinant of poor engagement along the HIV care continuum. For example, histories of intimate partner violence and child abuse are common among PLWH. Further, in the Southeast, the current epicenter of the national epidemic and a region plagued by persistent homophobia/transphobia, racism, social conservatism and poverty, PLWH are more likely to also experience hate crimes and other community violence. Thus, violence screening and intervention within HIV care is critical to ending the HIV epidemic in the South. But, given the multi-dimensionality of violence experience (i.e. intimate partner violence, child abuse, community violence including non-partner assault and hate crimes) and the resource and time constraints of Ryan White-funded HIV Clinics (RWCs) and Ryan White-funded AIDS Service Organizations (ASOs) who serve the bulk of PLWH, it is paramount to first determine which forms of violence are experienced most frequently and have greatest impact on HIV outcomes. This insight could help RW agencies prioritize violence screening and support services. Thus in, Aim 1, we comprehensively assess violence experience (interpersonal & community) and its association with RW program indicators of retention in care (% of patients with no medical visit in last 6 months of measurement year; % with medical visit every 6 months over 24-months) and viral suppression (% with HIV viral load <200 copies/ml) among 300 PLWH (men and women, cis and transgender) from RWCs and ASOs in Metro Atlanta. Next, in response to the dearth of evidence regarding preferences of PLWH for violence screening and to ensure violence screening does not inadvertently re-traumatize survivors, in Aim 2, we conduct semi-structured interviews among a purposive sample (n=75) of survey participants (men and women, cis and transgender PLWH, in and out of care) to determine acceptability and preferences for violence screening (e.g., what, where, how, who) and support services/treatment options that RWCs and ASOs could adopt. Lastly, in recognition of the need to integrate RW agency stakeholder preferences and address provider, staff, and agency-level barriers to screening and support service provision/referral for the process to be effective, in Aim 3, we conduct an explanatory sequential, mixed methods assessment consisting of a regionally-targeted survey (N=600) and key informant interviews (n=60) among administrators, staff and providers working in RWCs and ASOs in Atlanta and across the Southeast to assess inner and outer setting factors that may influence adoption and implementation of (a) violence screening, and (b) violence-relevant treatment/support. Findings will inform development of (1) key stakeholder-driven, evidence-based violence screening protocols and (2) a proof-of-concept violence support model that leverages existing local RWC and ASO infrastructure to address psychosocial consequences of violence among PLWH.

抽象的 在美国（美国），有85％的艾滋病毒（PLWH）的人知道其艾滋病毒状况，但只有62％ 与艾滋病毒护理和少于一半（48％）有关的护理和病毒抑制（49％）保留了一半（48％）。暴力已经存在 越来越多地被认为是在艾滋病毒护理连续体中参与不良的关键决定因素。为了 例如，亲密伴侣暴力和虐待儿童的历史在PLWH中很普遍。此外，在 东南，国家流行病的现任中心和持续困扰的地区 同性恋/恐惧症，种族主义，社会保守主义和贫困，PLWH更有可能体验 讨厌犯罪和其他社区暴力。因此，艾滋病毒护理中的暴力筛查和干预至关重要 结束南部的艾滋病毒流行。但是，鉴于暴力经验的多维性（即亲密 伴侣暴力，虐待儿童，社区暴力，包括非伴侣袭击和仇恨犯罪）和 Ryan White资助的HIV诊所（RWCS）和Ryan White资助的艾滋病服务的资源和时间限制 为大部分PLWH服务的组织（ASO），首先确定暴力形式至关重要 经验最频繁，对艾滋病毒结局产生最大的影响。这种见解可以帮助RW 机构优先考虑暴力筛查和支持服务。因此，在AIM 1中，我们全面评估 暴力经验（人际关系和社区）及其与RW计划保留指标的关联 护理（在测量年份的最后6个月内没有医疗访问的患者的百分比；百分比每6次医疗访问 超过24个月）和病毒抑制（艾滋病毒载荷<200拷贝/ml）300 plWh（男性 以及来自亚特兰大大都会的RWC和ASO的妇女，顺式和变性者）。接下来，回应缺乏 关于PLWH对暴力筛查的偏好的证据，并确保暴力筛查不会 无意间重新创造了幸存者，在AIM 2中，我们进行了半结构化访谈 调查参与者的样本（n = 75）（男性和女性，顺式和跨性别plwh，进出护理） 确定对暴力筛查的可接受性和偏好（例如，什么，何处，如何，谁）和支持 RWC和ASO可以采用的服务/治疗方案。最后，认识到需要集成RW 代理商利益相关者的偏好和向提供商，员工以及代理机构级别筛查和支持的障碍 服务提供/转介，以使该过程有效，在AIM 3中，我们进行了解释性的顺序混合 包括针对区域的调查（n = 600）和关键线人访谈（n = 60）的方法评估 在亚特兰大RWCS和ASOS工作的管理人员，员工和提供者中，在整个东南部 评估可能影响采用和实施（a）暴力筛查的内部和外部设置因素， （b）与暴力相关的治疗/支持。调查结果将为（1）主要利益相关者驱动的发展提供信息， 基于证据的暴力筛查方案和（2）利用的概念证明暴力支持模型 现有的本地RWC和ASO基础设施解决了PLWH中暴力的社会心理后果。