Implementing Trauma Informed Care in HIV Primary Care in the Southeast

摘要 创伤（即虐待儿童、亲密伴侣暴力）和相关负面影响的高发率 关于艾滋病毒感染者的健康、促进健康的行为和参与艾滋病毒护理连续体的活动 (PLH)强调需要将创伤筛查和管理纳入艾滋病毒服务，以优化 护理有效性和改善保留，坚持治疗，以及整体身心健康。 创伤知情护理（TIC）是一种组织结构和治疗框架，涉及理解， 识别并应对创伤的影响。TI系统：1）认识到创伤的广泛影响 并了解潜在的恢复途径; 2）识别客户，工作人员， 其他参与该系统的人; 3）通过将有关创伤的知识充分纳入政策， 程序和实践; 4）寻求积极抵制再次创伤。心理健康方面的证据， 物质使用和社会服务环境表明，TIC增强了循证教育的有效性 卫生服务，改善病人的结果，提高工作人员的士气，并具有成本效益，导致几个高- 一级要求将TIC纳入艾滋病毒服务（TI-HIV Care）。然而，经验证据表明， TI-HIV护理在艾滋病毒护理连续成果方面的可行性和有效性（保留、病毒 在艾滋病毒护理环境中实施和评价TI-HIV Care 缺乏。认识到低收入和种族/族裔少数群体遭受创伤的比例较高， 我们建议在瑞安白色（RW）艾滋病毒/艾滋病计划（一个由联邦政府资助的 一项全国性计划，支持为患有艾滋病毒/艾滋病的人提供全面的初级医疗保健和支持服务， 未投保/投保不足）执行以下目标：1）在管理人员中进行混合方法评估， 在美国东南部（美国艾滋病毒的中心）的RW初级保健诊所工作的工作人员和提供者 流行病）访问可能影响TIC在这些诊所中采用的内外环境因素，2）行为 在格鲁吉亚对三个RW资助的HIV诊所（一个城市， 亚特兰大站点;一个农村、南格鲁吉亚站点;一个控制站点），两个正在将TIC整合到其服务中，以及 同时，评估与TIC覆盖范围、采用水平和实施相关多层次因素， 以及3）检查实施TI-HIV护理对主要结果的有效性：HIV 护理保留和病毒载量抑制以及次要结局：患者满意度、生活质量和信任 在医疗保健，和提供者/工作人员的工作满意度，倦怠，并在两个干预的自我保健参与 相对于对照部位的格鲁吉亚临床部位。调查结果将使证据驱动的反应，高- 一级呼吁将TIC纳入艾滋病初级保健服务，并为TIC整合提供具体指导 在美国艾滋病流行中心的RW诊所。

ABSTRACT The high prevalence of trauma (i.e. child abuse, intimate partner violence) and associated negative impact on health, health-promoting behaviors, and engagement in the HIV care continuum in people living with HIV (PLH) underscore the need for trauma screening and management integrated into HIV services to optimize care effectiveness and improve retention, adherence to therapy, and overall physical and mental well-being. Trauma-informed Care (TIC) is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of trauma. TI-systems: 1) realize the widespread impact of trauma and understand potential paths for recovery; 2) recognize signs and symptoms of trauma in clients, staff, and others involved with the system; 3) respond by fully integrating knowledge about trauma into policies, procedures, and practices; and 4) seek to actively resist re-traumatization. Evidence from mental health, substance use and social service settings demonstrates that TIC enhances the effectiveness of evidence-based health services, improves patient outcomes, increases staff morale, and is cost-effective, leading to several high- level calls for integration of TIC into HIV services (TI-HIV Care). However, empirical evidence demonstrating the feasibility and effectiveness of TI-HIV Care in terms of HIV care continuum outcomes (retention, viral suppression) and guiding the implementation of TI-HIV Care implementation and evaluation in HIV care settings is lacking. Recognizing that low-income and racial/ethnic minority populations experience higher rates of trauma, we propose to work within the infrastructure of the Ryan White (RW) HIV/AIDS Program (a federally-funded nationwide program that supports comprehensive primary medical care and support services for PLH who are un/underinsured) to execute the following aims: 1) conduct a mixed methods assessment among administrators, staff and providers working in RW primary care clinics across the Southeastern US (the epicenter of the US HIV epidemic) to access inner and outer context factors that may influence adoption of TIC in these clinics, 2) conduct a hybrid Type 1 effectiveness implementation study of three RW-funded HIV clinics in Georgia (one urban, Atlanta site; one rural, South Georgia site; one control site), two that are integrating TIC into their services, and in parallel, evaluate multi-level factors associated with TIC reach, level of adoption, and implementation within and across these clinics, and 3) examine the efficacy of implementing TI-HIV care on primary outcomes: HIV care retention and viral load suppression and secondary outcomes: patient satisfaction, quality of life, and trust in medical care, and provider/staff job satisfaction, burnout, and engagement in self-care at the two intervention Georgia clinical sites relative to the control site. Findings will enable an evidence-driven response to the high- level calls for integration of TIC into HIV primary care services and provide concrete guidance for TIC integration in RW clinics at the epicenter of the US HIV epidemic.