Ending the HIV Epidemic with Equity: An All-facility Intervention to Reduce Structural Racism and Discrimination and Its Impact on Patient and Healthcare Staff Wellbeing

项目摘要 这项研究的范围是让瑞安·怀特艾滋病毒/艾滋病项目(RWHAP)资助的组织参与结束 美国南部/东部的艾滋病毒流行(ETH)地区利用EVI-EVI共同开发上下文响应计划- 登斯知情的干预措施，以减少针对黑人、土著、 有色人种(BIPOC)艾滋病毒携带者(PLH)和BIPOC医护人员。SRD直接影响对 和BIPOC的医疗保健，包括在整个预防过程中参与艾滋病毒服务 和关心。拟议的干预措施名为超越，借鉴了循证卫生政策加 (HP+)“完全”设施艾滋病毒污名减少干预和接触理论，已证明有效 在减少种族相关的群体间偏见方面。超越诊所的组织目标(例如，反种族主义 以及多样性、公平和包容性政策)和制度(例如，工作人员的态度/行为)水平 患者(例如，经历和感觉到的歧视、艾滋病毒护理、精神健康)结果和工作人员(例如，工作 满足感)个人层面的幸福感。在目标1中，我们将严格从这些地区挑选6家诊所- 不完全致力于拆除可持续发展战略(MOS3-9)。在目标2中，在基线评估之后(N=180；MOS 11-12)，我们将进行SRD减少干预的阶梯式楔形群随机试验。在每一个 这3个步骤中，两个随机诊所将获得超越。这项干预将支持诊所1)认识到- FY/创建组织级别的反种族主义政策和做法(例如，明确定义种族主义行为、 快速培训和监测系统，并迅速采取建设性的补救措施)，以减少自杀性疾病和 增加BIPOC患者和提供者/员工基于种族的公平性，以及2)向所有人提供针对种族的培训 工作人员(例如，性功能障碍史、偏见和歧视的健康后果、文化谦逊、跨部门歧视) 在种族、族裔、性取向和性别的交汇处定罪)。每个群集都将接受干预 对于6个MOS，从群组1(MOS 13-18)开始，然后是群组2(MOS 19-24)和3(MOS 25-30)。在目标3中，我们将使用CFIR来评估多层次的成果，包括在组织内部(Pri- SRD指数的玛丽结果-使命/愿景声明的评级，反种族主义政策，劳动力多样性，平等- TY和包容性[DEI]，临床环境)，系统(提供者/工作人员态度的次要结果；行为； DEI指标)和个人患者水平(临床一级艾滋病毒指标的第三结果，区分报告-- 国家、医疗不信任、焦虑、抑郁和创伤)结果。评估将每隔6天进行一次 几个月后，诊所被随机分到第二或第三步，在中间阶段之前进行多次评估 发明(最终数据收集将在第49个月进行)。诊所的BIPOC患者将在每次以下时间接受调查- 评估(N=2,100)。调查结果将产生一份实施全设施SRD减少流程的手册，并 内容(最低标准52-60)。其他由RWHAP资助的为边缘群体提供服务的诊所和设施或许能够 采用这一具有高度适应性的手动干预包来支持BIPOC。

Project Summary The scope of this study is to engage Ryan White HIV/AIDS Program (RWHAP) funded organizations in Ending the HIV Epidemic (ETHE) areas in the South/East US to co-develop context-responsive programs utilizing evi- dence-informed interventions to reduce structural racism and discrimination (SRD) against Black, Indigenous, People of Color (BIPOC) living with HIV (PLH) and BIPOC healthcare workers. SRD directly impacts access to and uptake of healthcare for BIPOC, including engagement in HIV services across the continuum of prevention and care. The proposed intervention, titled TRAnscenDS, draws on the evidence-based Health Policy Plus (HP+) ‘total’ facility HIV stigma-reduction intervention and Contact Theory, which have demonstrated efficacy in reducing race-related intergroup prejudice. TRAnscenDS targets the clinics’ organizational (e.g., anti-racist and diversity, equity and inclusion [DEI] policies) and systems (e.g., staff attitudes/behaviors) levels to affect patient (e.g., experienced and perceived discrimination, HIV care, mental health) outcomes and staff (e.g., job satisfaction) wellbeing, at the individual level. In Aim 1, we will rigorously select 6 clinics from ETHE areas evi- dencing full commitment to dismantling SRD (mos 3-9). In Aim 2, after a baseline assessment (N=180; mos 11-12), we will conduct a stepped wedge cluster randomized trial of the SRD reduction intervention. At each of the 3 steps, two randomized clinics will receive TRAnscenDS. The intervention will support clinics to 1) identi- fy/create organizational-level anti-racist policies and practices (e.g., clear definitions of racist behavior, ade- quate training and monitoring systems, and prompt responses for constructive redress) to reduce SRD and increase race-based equity for BIPOC patients and provider/staff, and 2) deliver race-specific trainings to all staff (e.g., history of SRD, health consequences of bias and discrimination, cultural humility, intersectional dis- crimination at the confluence of race, ethnicity, sexuality and gender). Each cluster will receive the intervention for 6 mos, starting with Cluster Group 1 (mos 13-18), followed by Cluster Groups 2 (mos 19-24) and 3 (mos 25-30). In Aim 3, we will evaluate multi-level outcomes using the CFIR, including within the organization (pri- mary outcome of SRD Index – ratings of mission/vision statements, anti-racist policy, workforce diversity, equi- ty and inclusion [DEI], clinic environment), systems (secondary outcomes of provider/staff attitudes; behavior; DEI indicators), and individual patient level (tertiary outcomes of clinic-level HIV indicators, reports of discrimi- nation, medical distrust, anxiety, depression, and trauma) outcomes. Assessments will take place every 6 months, with the clinics randomized to the second or third step having multiple assessments before the inter- vention (with final data collection being in month 49). BIPOC patients at the clinics will be surveyed at each as- sessment (N=2,100). Findings will yield a manual for implementing total-facility SRD-reduction processes and content (mos 52-60). Other RWHAP-funded clinics and facilities serving marginalized groups may be able to adopt this manualized, yet highly adaptable intervention packet to support BIPOC.