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

• 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
• 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

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.

摘要 创伤(如虐待儿童、亲密伴侣暴力)及其相关负面影响的发生率很高 关于艾滋病毒携带者的健康、健康促进行为和参与艾滋病毒护理连续体 (公共卫生署)强调需要将创伤筛查和管理纳入艾滋病毒服务，以优化 护理有效性和提高保留率，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、 认识到创伤的影响并对其作出反应。心理创伤系统：1)认识到创伤的广泛影响 并了解潜在的康复途径；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纳入政策来应对， 程序和做法；以及4)积极抵制再创伤。精神健康方面的证据， 物质使用和社会服务环境表明，TIC增强了循证医学的有效性 医疗服务，改善患者结局，提高员工士气，并且具有成本效益，导致几个高 一级呼吁将TIC纳入艾滋病毒服务(TI-艾滋病毒护理)。然而，经验证据表明， 从HIV护理的连续性结果(滞留、病毒感染)来看，TI-HIV护理的可行性和有效性 抑制)并指导艾滋病毒护理环境中艾滋病毒感染护理的实施和评价 是缺乏的。认识到低收入和种族/少数民族人口遭受创伤的比率较高， 我们建议在瑞安·怀特(RW)艾滋病毒/艾滋病计划(联邦资助的 全国计划，支持为符合以下条件的PLH提供全面的初级医疗保健和支持服务 联合国/保险不足)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)RW初级保健诊所工作的工作人员和提供者 流行病)了解可能影响这些诊所采用TIC的内部和外部背景因素，2)进行 佐治亚州三家由RW资助的艾滋病毒诊所(一家城市， 亚特兰大站点；一个农村站点，南乔治亚州；一个控制点)，两个正在将TIC纳入其服务的站点，以及 同时，评估与TIC覆盖范围、采用水平和实施相关的多层次因素 和这些诊所，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、病毒载量抑制和次要结果：患者满意度、生活质量和信任 在医疗保健和提供者/员工的工作满意度、职业倦怠和自我护理投入两个干预中 佐治亚州临床站点相对于对照站点。这些发现将使以证据为导向的反应成为可能-- 一级呼吁将TIC纳入艾滋病毒初级保健服务，并为TIC的整合提供具体指导 在美国艾滋病毒流行中心的RW诊所。