Implementing Trauma Informed Care in HIV Primary Care in the Southeast

在东南部艾滋病毒初级保健中实施创伤知情护理

基本信息

批准号：
10012217
负责人：
Ameeta Shivdas Kalokhe
金额：
$ 76.26万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-23 至 2021-09-22
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10012217
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Administrator Adopted Adoption Age Alcohol or Other Drugs use Attitude Behavior CD4 Positive T Lymphocytes Caring Child Abuse Client Client satisfaction Clinic Comorbidity Continuity of Patient Care Effectiveness Epidemic Evaluation Evidence based treatment Funding Geography Guidelines HIV HIV diagnosis Health Health Promotion Health Services High Prevalence Hybrids Individual Infrastructure Intervention Interview Job Satisfaction Knowledge Literature Low income Measurement Medicaid Medical Mental Health Methods Morale Opportunistic Infections Outcome Patient-Focused Outcomes Patients Phase Policies Population Group Preparation Primary Health Care Procedures Process Provider Publishing Quality Indicator Quality of life Readiness Recording of previous events Recovery Reporting Research Research Design Resources Rural Self Care Service setting Services Sexual abuse Signs and Symptoms Site Social Work Source Substance abuse problem Surveys System Testing Training Trauma Trust Underinsured Uninsured United States United States Health Resources and Services Administration United States National Institutes of Health Viral Viral Load result Visit Well in self Woman Work antiretroviral therapy burnout care providers child physical abuse clinical research site cost effective design ethnic minority population evidence base experience federal poverty level high risk high risk sexual behavior implementation research improved informant information gathering innovation intimate partner violence men mortality organizational structure physical conditioning primary care services primary outcome programs racial and ethnic racial minority response satisfaction screening screening guidelines secondary outcome transgender transmission process trauma exposure trauma symptom urban underserved virtual

项目摘要

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.

抽象的创伤的高流行（即虐待儿童，亲密伴侣暴力）和相关的负面影响关于艾滋病毒患者的健康，促进健康的行为以及参与艾滋病毒的艾滋病毒护理连续性（PLH）强调对艾滋病毒服务的创伤筛查和管理的需求，以优化护理效率并提高保留率，遵守治疗以及整体身心健康。创伤信息护理（TIC）是一个组织结构和治疗框架，涉及理解，认识并应对创伤的影响。 TI系统：1）实现创伤的广泛影响并了解恢复的潜在途径； 2）识别客户，员工和其他参与系统的人； 3）通过将有关创伤的知识充分整合到政策中来做出回应，程序和实践； 4）试图积极抵抗重新塑造。心理健康的证据，药物使用和社会服务环境表明，抽动提高了基于证据的有效性卫生服务，改善患者的成果，提高员工的士气并具有成本效益，导致几个高级将TIC集成到艾滋病毒服务（TI-HIV Care）中的水平要求。但是，证明 TI-HIV护理在HIV护理连续性结果方面的可行性和有效性（保留，病毒抑制）并指导在艾滋病毒护理环境中实施Ti-HIV护理实施和评估缺乏。认识到低收入和种族/族裔少数民族的创伤率更高，我们建议在Ryan White（RW）HIV/AIDS计划的基础设施中工作（联邦政府资助在全国范围内支持全面的初级医疗和支持服务的PLH 未投保的人）执行以下目的：1）管理员之间进行混合方法评估，在美国东南部的RW初级保健诊所（美国艾滋病毒的中心）工作的员工和提供者流行病）以获取可能影响这些诊所采用TIC的内部和外部环境因素，2）行为佐治亚州三家RW资助的HIV诊所的一项混合1型有效性实施研究（一个Urban，亚特兰大遗址；乔治亚州南部的一个农村地点；一个控制站点），两个将抽动集成到他们的服务中，以及同时，评估与TIC覆盖率，采用水平和实施相关的多层次因素以及在这些诊所中，以及3）检查对主要结果实施Ti-HIV护理的功效：HIV 护理保留和病毒负荷抑制和次要结果：患者满意度，生活质量和信任在医疗保健以及提供商/员工的工作满意度，倦怠和参与自我保健方面佐治亚州临床部位相对于控制部位。调查结果将使对高级的循证反应将TIC集成到HIV初级保健服务中的水平呼吁，并为TIC整合提供具体的指导在美国艾滋病毒流行中心的RW诊所中。