Tennessee CFAR: Implementation of Culturally Responsive Trauma-Informed Care with Youth with HIV in Memphis, TN

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PROJECT SUMMARY/ABSTRACT We will accelerate health equity among underserved Black youth in a region with the third highest HIV incidence nationally. Shelby County, Tennessee (TN; Memphis) is a Phase I priority jurisdiction for the U.S. Ending the HIV Epidemic (EHE) initiative, where Black youth with HIV (BYWH) suffer comparatively worse HIV outcomes: half of all BYWH in Memphis are appointment non-adherent, representing a major threat to HIV viral suppression, morbidity, and disease transmission. Psychological trauma is a critical and understudied mechanism driving a multitude of HIV-related disparities that will only be eliminated through multi-level solutions. YWH endure high rates of post-traumatic stress disorder (47%), with racial trauma intensifying experiences among Black youth. Trauma-Informed care (TIC) is an evidence-based approach that improves patient outcomes by ensuring personnel are adequately trained to Recognize and Respond to trauma and Resist Re-traumatization. Though the Memphis EHE plan cites TIC implementation as critical to advancing local goals, the HIV clinic at St. Jude Children’s Research Hospital (SJCRH), primary care provider for BYWH in the area, has not implemented TIC. We have developed this proposal with SJCRH to support enhanced TIC for youth with HIV (TIC-YH) implementation in their HIV care clinic system. We will conduct a Sequential Transformative Mixed Methods design study through the following two aims: 1) Implement and assess impact of novel TIC-YH on patient effectiveness outcomes of HIV appointment adherence and trauma response and 2) Assess impact of novel TIC-YH intervention on implementation outcomes, including acceptability, feasibility, and perceived quality of research. This innovative and highly significant research is wholly consistent with NIH high priority area of research to reduce health disparities in treatment outcomes of those living with HIV. By the end of the 2-year grant period, the early-stage investigator PI will have development of a programmatic line of research to advance EHE goals and prepared a R-level grant to support the scale out of the multi-level and culturally responsive TIC-YH intervention. There is strong rationale to support the current TIC-YH intervention and proposed research methods as meaningful approaches to addressing disparities across a wide range of areas, including chronic diseases.