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 (US)，85% 的艾滋病毒感染者 (PLWH) 知道自己的艾滋病毒感染状况，但只有 62% 的人知道 与艾滋病毒护理相关，不到一半（48%）的人继续接受护理并抑制病毒（49%）。暴力已 越来越多的人认识到，这是艾滋病毒护理连续过程中参与度不佳的一个关键决定因素。为了 例如，艾滋病病毒感染者中，亲密伴侣暴力和虐待儿童的历史很常见。此外，在 东南部是目前全国疫情的重灾区，也是疫情持续困扰的地区 恐同/变性恐惧症、种族主义、社会保守主义和贫困，艾滋病毒感染者更有可能经历 仇恨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 结束南方的艾滋病毒流行。但是，考虑到暴力经历的多维性（即亲密关系） 伴侣暴力、虐待儿童、社区暴力，包括非伴侣攻击和仇恨犯罪）以及 Ryan White 资助的艾滋病诊所 (RWC) 和 Ryan White 资助的艾滋病服务中心的资源和时间限制 对于为大部分 PLWH 提供服务的组织 (ASO)，首先确定哪些形式的暴力至关重要 经历最频繁，对艾滋病毒结果影响最大。这种见解可以帮助 RW 各机构优先考虑暴力筛查和支持服务。因此，在目标 1 中，我们全面评估 暴力经历（人际和社区）及其与 RW 计划保留指标的关联 护理（在测量年份的最后 6 个月内没有就诊的患者百分比；每 6 个月就诊的患者百分比 300 名 PLWH（男性）中的 24 个月以上）和病毒抑制（HIV 病毒载量 <200 拷贝/毫升的百分比） 以及来自亚特兰大都会区 RWC 和 ASO 的女性（顺性别者和跨性别者）。接下来，针对缺乏 有关艾滋病毒感染者对暴力筛查的偏好的证据，并确保暴力筛查不会 无意中再次伤害幸存者，在目标 2 中，我们对有目的的人进行半结构化访谈 调查参与者的样本（n=75）（男性和女性、顺性别和变性感染者、接受护理和脱离护理的） 确定暴力筛查的可接受性和偏好（例如，内容、地点、方式、人员）和支持 RWC 和 ASO 可以采用的服务/治疗方案。最后，认识到整合 RW 的必要性 机构利益相关者的偏好并解决提供者、员工和机构层面的筛选和支持障碍 为了使流程有效，提供服务/转介，在目标 3 中，我们进行解释性的顺序混合 方法评估包括区域针对性调查 (N=600) 和关键知情人访谈 (n=60) 在亚特兰大和整个东南部的 RWC 和 ASO 中工作的管理人员、员工和提供者 评估可能影响采用和实施 (a) 暴力筛查的内部和外部环境因素， (b) 与暴力相关的治疗/支持。研究结果将为以下方面的发展提供信息：(1) 主要利益相关者驱动的、 基于证据的暴力筛查协议和 (2) 概念验证暴力支持模型 现有的当地 RWC 和 ASO 基础设施，用于解决艾滋病毒感染者暴力行为的社会心理后果。