An implementation science study of violence screening practices among Ryan White-funded sites in the Southeastern United States

摘要 在美国，85%的艾滋病病毒感染者（PLWH）知道自己的艾滋病病毒状况，但只有62%的人 只有不到一半（48%）的人继续接受治疗并受到病毒抑制（49%）。暴力一直是 越来越多的人认识到这是艾滋病毒护理连续体沿着参与不足的一个关键决定因素。为 例如，亲密伴侣暴力和虐待儿童的历史在艾滋病毒携带者中很常见。此外，在 东南部是目前全国流行病的中心，也是一个持续受 同性恋恐惧症/变性恐惧症、种族主义、社会保守主义和贫困， 仇恨犯罪和其他社区暴力。因此，艾滋病毒护理中的暴力筛查和干预至关重要 结束艾滋病在南方的流行。但是，鉴于暴力经历的多维度性（即亲密关系）， 伴侣暴力、虐待儿童、社区暴力，包括非伴侣攻击和仇恨犯罪）， Ryan White资助的HIV诊所（RWC）和Ryan White资助的艾滋病服务的资源和时间限制 对于为大多数艾滋病毒携带者和艾滋病患者服务的艾滋病组织来说，首先确定哪些形式的暴力是至关重要的。 最常见的是，对艾滋病毒的结果影响最大。这种洞察力可以帮助RW 各机构将暴力筛查和支助服务列为优先事项。因此，在目标1中，我们全面评估 暴力经历（人际和社区）及其与RW方案指标的关联， 护理（在测量年的最后6个月内未就医的患者百分比;每6个月就医的患者百分比） 在300名艾滋病毒携带者（男性）中， 和妇女，顺性别和变性人）从RWC和ASO在亚特兰大大都会。接下来，为了应对缺乏 关于艾滋病毒携带者和艾滋病患者倾向于暴力筛查的证据，并确保暴力筛查不 在目标2中，我们在一个有目的、有目的的人中进行半结构化的访谈， 样本（n=75）的调查参与者（男性和女性，顺性别和跨性别PLWH，在护理和不护理）， 确定暴力筛查的可接受性和偏好（例如，什么、在哪里、如何、谁）和支持 RWC和ASO可以采用的服务/治疗方案。最后，在认识到需要将RW 机构利益相关者的偏好，并解决提供者、工作人员和机构层面的筛选和支持障碍 服务提供/转介的过程是有效的，在目标3，我们进行了解释性的顺序，混合 方法评估，包括区域针对性调查（N=600）和关键知情人访谈（n=60） 在亚特兰大和东南部的RWC和ASO工作的管理人员，工作人员和供应商中， 评估可能影响采用和实施（a）暴力筛查， 和（B）与暴力有关的治疗/支助。调查结果将为（1）关键股东驱动， 基于证据的暴力筛查协议和（2）概念验证暴力支持模型， * 现有的当地农村妇女委员会和阿索基础设施，以解决艾滋病毒/艾滋病感染者遭受暴力的心理社会后果。

ABSTRACT In the United States (US), 85% of people living with HIV (PLWH) are aware of their HIV status, but only 62% are linked to HIV care and less than half (48%) are retained in care and virally suppressed (49%). Violence has been increasingly recognized as a critical determinant of poor engagement along the HIV care continuum. For example, histories of intimate partner violence and child abuse are common among PLWH. Further, in the Southeast, the current epicenter of the national epidemic and a region plagued by persistent homophobia/transphobia, racism, social conservatism and poverty, PLWH are more likely to also experience hate crimes and other community violence. Thus, violence screening and intervention within HIV care is critical to ending the HIV epidemic in the South. But, given the multi-dimensionality of violence experience (i.e. intimate partner violence, child abuse, community violence including non-partner assault and hate crimes) and the resource and time constraints of Ryan White-funded HIV Clinics (RWCs) and Ryan White-funded AIDS Service Organizations (ASOs) who serve the bulk of PLWH, it is paramount to first determine which forms of violence are experienced most frequently and have greatest impact on HIV outcomes. This insight could help RW agencies prioritize violence screening and support services. Thus in, Aim 1, we comprehensively assess violence experience (interpersonal & community) and its association with RW program indicators of retention in care (% of patients with no medical visit in last 6 months of measurement year; % with medical visit every 6 months over 24-months) and viral suppression (% with HIV viral load <200 copies/ml) among 300 PLWH (men and women, cis and transgender) from RWCs and ASOs in Metro Atlanta. Next, in response to the dearth of evidence regarding preferences of PLWH for violence screening and to ensure violence screening does not inadvertently re-traumatize survivors, in Aim 2, we conduct semi-structured interviews among a purposive sample (n=75) of survey participants (men and women, cis and transgender PLWH, in and out of care) to determine acceptability and preferences for violence screening (e.g., what, where, how, who) and support services/treatment options that RWCs and ASOs could adopt. Lastly, in recognition of the need to integrate RW agency stakeholder preferences and address provider, staff, and agency-level barriers to screening and support service provision/referral for the process to be effective, in Aim 3, we conduct an explanatory sequential, mixed methods assessment consisting of a regionally-targeted survey (N=600) and key informant interviews (n=60) among administrators, staff and providers working in RWCs and ASOs in Atlanta and across the Southeast to assess inner and outer setting factors that may influence adoption and implementation of (a) violence screening, and (b) violence-relevant treatment/support. Findings will inform development of (1) key stakeholder-driven, evidence-based violence screening protocols and (2) a proof-of-concept violence support model that leverages existing local RWC and ASO infrastructure to address psychosocial consequences of violence among PLWH.