Implementation of Trauma Informed care for Youth Living with HIV in Memphis, TN.

在田纳西州孟菲斯对感染艾滋病毒的青少年实施创伤知情护理。

• 批准号: 10619732
• 负责人: Leslie Lauren Brown
• 金额: $ 14.95万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619732
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Appointment; Area; Automobile Driving; Benchmarking; Black race; Caring; Chronic Disease; Clinic; Clinical Trials Design; Consensus; County; Data; Development; Dimensions; Disparity; Dose; Educational workshop; Effectiveness; Ensure; Epidemic; Equity; Evidence based intervention; Faculty; Failure; Fatigue; Feedback; Focus Groups; Foundations; Funding; Future; Goals; Grant; HIV; HIV Infections; HIV disparities; Health; Health Services Accessibility; Historically Black Colleges and Universities; Human Resources; Human immunodeficiency virus test; Hybrids; Incidence; Institution; Intervention; Interview; Justice; Lead; Leadership; Medical; Medical Records; Mentorship; Methods; Modality; Morbidity - disease rate; Outcome; Patient Appointment; Patients; Phase; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Production; Provider; Publications; Quality of Care; Quality of life; Race; Reduce health disparities; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Resources; Role; Saint Jude Children' s Research Hospital; Socialization; Structure; Surveys; Tennessee; Testing; Time; Training; Trauma; Treatment outcome; Trust; United States; United States National Institutes of Health; Viral; Youth; anti-racism; care providers; care systems; career development; community based participatory research; comparative; design; disease transmission; disparity gap; epidemic preparedness; experience; experimental arm; group intervention; health equity; health equity promotion; implementation science; improved; improved outcome; innovation; medical schools; pilot trial; primary care provider; primary outcome; psychological trauma; randomized, clinical trials; resilience; response; skills; trauma exposure; treatment disparity

PROJECT SUMMARY/ABSTRACT We will accelerate health equity among underserved Black youth in a region with the fourth 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, including racial trauma, is a critical and understudied mechanism driving a multitude of HIV-related disparities that will only be eliminated through multi-level solutions. At the patient-level, YWH endure high levels of post-traumatic stress disorder (47%), with racial trauma intensifying experiences among Black youth; at the personnel-level, repeated trauma exposures associated with HIV care provision contribute to vicarious trauma and degrades professional quality of life. At the clinic-level, trauma sequalae thwart patient-provider relationships and trust, which contributes to treatment fatigue, disengagement, and viral failure. Trauma-Informed HIV care (TIHC) is an evidence-based intervention (EBI) that improves multi-level outcomes (e.g., patient appointment adherence and personnel professional quality of life) by ensuring institutional health practices adequately Recognize and Respond to trauma and Resist Re- traumatization for all. Though the Memphis EHE plan cites TIHC implementation as critical to advancing local goals, St. Jude Children’s Research Hospital’s HIV clinic, primary care provider for BYWH in the area, has not implemented TIHC. We have developed this proposal with St. Jude to support enhanced TIHC for youth (TIHC- Y) implementation in their HIV care system. We will conduct an exploratory, sequential mixed methods study through the following three aims: 1) Adapt our TIHC-Y to enhance access to care for BYWH and professional quality of life for HIV care providers; 2) Implement and evaluate adapted TIHC-Y with HIV clinic personnel; and 3) Conduct a pilot trial of adapted TIHC-Y with St. Jude patients. This innovative and highly significant research is wholly consistent with NIH high priority areas of research to reduce health disparities in treatment outcomes of those living with HIV and training of workforce conducting high priority HIV-related research. By the end of the 5-year grant period, K01 candidate will have received extensive career development in the areas of implementation science, mixed methods design, antiracist interventions, and health equity research, enabling the development of a programmatic line of research to advance EHE goals and resulting in at least 10 first- authored publications. We will have also submitted an R-level grant to support the scale out of the multi-level and culturally responsive TIHC-Y intervention. There is strong rationale to support the current TIHC-Y intervention and proposed research methods as meaningful approaches to addressing disparities across a wide range of areas, including chronic diseases.

项目摘要/摘要 在艾滋病发病率第四高的地区，我们将促进未得到充分服务的黑人青年的健康公平 全国范围内。田纳西州谢尔比县(田纳西州；孟菲斯)是美国第一阶段优先司法管辖区。 艾滋病毒流行(EHE)倡议，其中感染艾滋病毒的黑人青年(BYWH)的艾滋病毒结果相对较差： 孟菲斯所有BYWH中有一半是不遵守约定的人，这是对HIV病毒抑制的主要威胁， 发病率和疾病传播。心理创伤，包括种族创伤，是一个关键且未被充分研究的问题。 这一机制导致了大量与艾滋病毒有关的差距，只有通过多层面的解决方案才能消除这种差距。 在病人层面，基督教青年会忍受着高度的创伤后应激障碍(47%)，并伴有种族创伤。 加强黑人青年的经历；在人员一级，反复暴露与以下方面有关的创伤 艾滋病毒护理的提供助长了替代性创伤，并降低了职业生活质量。在诊所层面， 创伤后遗症阻碍了患者与提供者的关系和信任，这导致了治疗疲劳， 脱离接触和病毒失效。创伤知情艾滋病毒护理(TIHC)是一种循证干预(EBI)， 改善多层次的结果(例如，患者预约的遵守情况和人员的职业生活质量) 通过确保机构卫生实践充分认识和应对创伤并抵制再次 对所有人来说都是精神创伤。尽管孟菲斯的EHE计划指出TIHC的实施对推进当地 圣犹大儿童研究医院的艾滋病毒诊所，该地区BYWH的初级保健提供者Goals，还没有 实施了TIHC。我们与圣犹大共同制定了这项建议，以支持加强青年TIHC(TIHC- Y)在其艾滋病毒护理系统中实施。我们将进行探索性的、顺序的混合方法研究。 通过以下三个目标：1)调整我们的TIHC-Y，以增强BYWH和专业人员的护理机会 艾滋病毒护理提供者的生活质量；2)与艾滋病毒诊所人员一起实施和评估适应的TIHC-Y；以及 3)在圣犹大患者中进行适应的TIHC-Y的试点试验。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为减少治疗结果中的健康差距而进行的高度优先研究领域完全一致 对艾滋病毒携带者和从事与艾滋病毒有关的高度优先研究的工作人员进行培训。到年底的时候 在5年的资助期内，K01候选人将在以下领域获得广泛的职业发展 实施科学、混合方法设计、反种族主义干预和卫生公平研究，使 发展一系列方案研究，以推进EHE目标，并导致至少10个第一 创作的出版物。我们还将提交R级拨款，以支持多级别的扩展 以及响应文化的TIHC-Y干预。有充分的理由支持目前的TIHC-Y 干预和建议的研究方法，作为解决广泛差异的有意义的方法 包括慢性病在内的一系列领域。