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

田纳西州 CFAR：在田纳西州孟菲斯对感染艾滋病毒的青少年实施文化响应式创伤知情护理

• 批准号: 10820022
• 负责人: SIMON Alexander MALLAL
• 金额: $ 29.31万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10820022
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Appointment; Area; Automobile Driving; Behavior; Behavioral; Behavioral Sciences; Benchmarking; Black race; Caring; Chronic Disease; Clinic; Complex; Coping Skills; County; Development; Disparity; Effectiveness; Ensure; Epidemic; Exposure to; Face; Foundations; Funding; Future; Goals; Grant; HIV; HIV Infections; HIV disparities; Housing; Human Resources; Human immunodeficiency virus test; Incidence; Institutional Practice; Interruption; Intervention; Interview; Measures; Methods; Morbidity - disease rate; Outcome; Participant; Patient-Focused Outcomes; Patients; Persons; Phase; Physicians; Positioning Attribute; Post-Traumatic Stress Disorders; Protocols documentation; Provider; Psychiatry; Psychological Impact; Psychologist; Race; Reduce health disparities; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Resources; Safety; Saint Jude Children' s Research Hospital; Schedule; Scientist; Self Perception; Series; Services; Social Workers; Surveys; System; Tennessee; Testing; Time; Training; Trauma; Trauma patient; Treatment outcome; United States; United States National Institutes of Health; Viral; Work; Youth; aged; care providers; career development; community based participatory research; comparative; design; disease transmission; effectiveness outcome; epidemic preparedness; evidence base; experience; health equity; implementation outcomes; implementation science; improved; improved outcome; innovation; medical schools; novel; patient engagement; primary care provider; professor; psychological trauma; response; screening; syndemic; theories; traumatic event; treatment disparity

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.

项目总结/摘要 我们将加速艾滋病毒感染率第三高地区服务不足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）是美国第一阶段优先管辖区。 终止艾滋病毒流行病（EHE）倡议，其中感染艾滋病毒的黑人青年（BYWH）遭受相对更严重的艾滋病毒 结果：在孟菲斯的所有BYWH中，有一半是未遵守约定的，这是HIV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的和研究不足的 一个机制，推动了许多与艾滋病毒有关的差距，只有通过多层次的 解决方案青年妇女遭受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， 通过确保人员接受充分培训，以识别和应对创伤， 抵制再次创伤。尽管孟菲斯EHE计划将TIC实施列为推进 当地的目标，艾滋病毒诊所在圣裘德儿童研究医院（SJCRH），初级保健提供者杨百翰医院 在该地区，尚未实施TIC。我们已与SJCRH制定了此建议，以支持加强TIC 在艾滋病毒护理诊所系统中为感染艾滋病毒的青年实施TIC-YH。我们将进行一次连续的 变革性混合方法设计研究通过以下两个目标：1）实施和评估影响 新型TIC-YH对HIV预约依从性和创伤反应的患者有效性结局的影响， 2)评估新型TIC-YH干预措施对实施结果的影响，包括可接受性、可行性， 和研究的质量。这项创新和高度重要的研究与NIH完全一致。 减少艾滋病毒感染者在治疗结果方面的健康差距。由 在2年资助期结束时，早期研究者主要研究者将制定一个项目路线， 研究，以推进EHE目标，并准备了R级赠款，以支持多层次和 文化敏感的TIC-YH干预。有很强的理由支持目前的TIC-YH干预 并提出了研究方法，作为解决广泛领域差距的有意义的方法， 包括慢性病。