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

项目总结/摘要 我们将在艾滋病毒发病率第四高的地区加快服务不足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管辖区。 艾滋病毒流行病（EHE）倡议，其中感染艾滋病毒的黑人青年（BYWH）遭受相对更严重的艾滋病毒后果： 孟菲斯所有BYWH中有一半是未遵守约定的，这对HIV病毒抑制构成了主要威胁， 发病率和疾病传播。心理创伤，包括种族创伤，是一个关键的和研究不足的问题。 这是一种机制，造成了许多与艾滋病毒有关的差距，只有通过多层次的解决方案才能消除。 在病人层面，YWH忍受高水平的创伤后应激障碍（47%），种族创伤 强化黑人青年的经历;在人员层面，与 提供艾滋病毒护理会造成替代性创伤，降低职业生活质量。在诊所一级， 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， 脱离接触和病毒式失败创伤知情艾滋病护理（TIHC）是一种循证干预（EBI）， 改善多层次的结果（例如，患者预约依从性和人员职业生活质量） 通过确保机构卫生做法充分认识和应对创伤和抵制再- 所有人的创伤。尽管孟菲斯EHE计划将TIHC的实施列为推进当地 目标，圣裘德儿童研究医院的艾滋病毒诊所，杨百翰在该地区的初级保健提供者，还没有 实施TIHC。我们与圣裘德一起制定了这一提案，以支持加强青年TIHC（TIHC- （三）在艾滋病防治体系中。我们将进行一项探索性、序贯混合方法研究 通过以下三个目标：1）调整我们的TIHC-Y，以提高BYWH和专业人员获得护理的机会 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经调整的TIHC-Y;以及 3)在St. Jude患者中进行适应性TIHC-Y的初步试验。这项创新的、意义重大的研究 完全符合NIH的高优先级研究领域，以减少治疗结果中的健康差异 对艾滋病毒感染者进行培训，并培训从事高度优先的艾滋病毒相关研究的工作人员。结束时 5-在一年的资助期内，K 01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、反种族主义干预措施和健康公平研究， 制定一个研究的纲领性路线，以推进EHE目标，并导致至少10个第一- 撰写出版物。我们还将提交一份R级赠款，以支持多层次 和文化上敏感的TIHC-Y干预。目前的TIHC-Y有很强的理由支持 干预措施和拟议的研究方法作为解决广泛的不平等问题的有意义的方法， 包括慢性病在内的一系列领域。

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.