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

点击翻译按钮获取中文摘要

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.