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

项目摘要/摘要 我们将在艾滋病病毒感染第三高的地区，促进未得到充分服务的黑人青年的健康公平 全国范围内的发病率。田纳西州谢尔比县(田纳西州；孟菲斯)是美国 结束艾滋病毒流行(EHE)倡议，在该倡议中，感染艾滋病毒的黑人青年(BYWH)的艾滋病毒感染情况相对较差 结果：孟菲斯所有BYWH中有一半是未遵守预约的人，这是对艾滋病毒病毒的主要威胁 抑制、发病率和疾病传播。心理创伤是一个关键而又未被充分研究的问题 推动艾滋病毒相关差异的机制，只有通过多层面才能消除这些差异 解决办法。YWH忍受着高比例的创伤后应激障碍(47%)，种族创伤加剧 黑人青年的经历。创伤知情护理(TIC)是一种基于证据的方法，可以改善 通过确保人员接受足够的培训来识别和应对创伤和 抵抗再创痛。尽管孟菲斯的EHE计划将TIC的实施作为推进 当地目标，圣犹大儿童研究医院(SJCRH)的艾滋病毒诊所，BYWH的初级保健提供者 在该地区，尚未实施TIC。我们已与新界西医院发展这项建议，以支援增强型旅游业议会 为感染艾滋病毒的青年在其艾滋病毒护理诊所系统中实施。我们将进行一系列的 通过以下两个目标进行变革性混合方法设计研究：1)实施和评估影响 新型TIC-YH对HIV预约依从性和创伤反应患者疗效的影响 2)评估新的TIC-YH干预措施对执行结果的影响，包括可接受性、可行性、 和感知到的研究质量。这项具有创新性和重大意义的研究与美国国立卫生研究院完全一致 高度优先的研究领域，以减少艾滋病毒携带者治疗结果中的健康差距。由 在两年资助期结束后，早期调查员PI将制定一项方案线 研究以推进EHE目标，并准备了R级赠款，以支持多层次和 文化响应的TIC-YH干预。有充分的理由支持目前的TIC-YH干预 并提出了研究方法，作为解决广泛领域差异的有意义的方法 地区，包括慢性病。

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.