Ending the HIV Epidemic with Equity: An All-facility Intervention to Reduce Structural Racism and Discrimination and Its Impact on Patient and Healthcare Staff Wellbeing

以公平方式终结艾滋病毒流行：减少结构性种族主义和歧视及其对患者和医护人员福祉的影响的全设施干预措施

• 批准号: 10474844
• 负责人: Felicia Amira Browne
• 金额: $ 84.81万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474844
• 关键词: AIDS/HIV problem; Accountability; Address; Adopted; Affect; Anxiety; Area; Behavior; Behavior monitoring; Black race; Black, Indigenous, People of Color; Caring; Characteristics; Clinic; Cluster randomized trial; Data Collection; Discrimination; Education; Ensure; Environment; Epidemic; Ethnic Origin; Feedback; Fostering; Funding; Gender; Geography; Goals; HIV; Health; Health Personnel; Health Policy; Health Promotion; Healthcare; Incidence; Individual; Institutes; Institutional Racism; Intervention; Job Satisfaction; Justice; Latinx; Lead; Leadership; Manuals; Medical; Mental Depression; Mental Health; Mission; Modality; Modification; Monitor; Outcome; Patients; Personal Satisfaction; Persons; Police; Policies; Prejudice; Prevention; Process; Provider; Race; Racial Equity; Randomized; Recording of previous events; Reporting; Research; Services; Sexual and Gender Minorities; Sexuality; Site; Societies; Staff Attitudes; Strategic Planning; Structural Racism; Surveys; System; Testing; Training; Transcend; Trauma; United States; Vision; anti-racism; base; clinical care; comorbidity; distrust; diversity and equity; evidence base; experience; gender minority group; health care quality; health difference; implementation framework; improved; indexing; individual patient; marginalized population; multi-racial; people of color; perceived discrimination; primary outcome; programs; racial and ethnic; racial discrimination; racism; response; secondary outcome; social stigma; socioeconomics; theories; uptake

Project Summary The scope of this study is to engage Ryan White HIV/AIDS Program (RWHAP) funded organizations in Ending the HIV Epidemic (ETHE) areas in the South/East US to co-develop context-responsive programs utilizing evi- dence-informed interventions to reduce structural racism and discrimination (SRD) against Black, Indigenous, People of Color (BIPOC) living with HIV (PLH) and BIPOC healthcare workers. SRD directly impacts access to and uptake of healthcare for BIPOC, including engagement in HIV services across the continuum of prevention and care. The proposed intervention, titled TRAnscenDS, draws on the evidence-based Health Policy Plus (HP+) ‘total’ facility HIV stigma-reduction intervention and Contact Theory, which have demonstrated efficacy in reducing race-related intergroup prejudice. TRAnscenDS targets the clinics’ organizational (e.g., anti-racist and diversity, equity and inclusion [DEI] policies) and systems (e.g., staff attitudes/behaviors) levels to affect patient (e.g., experienced and perceived discrimination, HIV care, mental health) outcomes and staff (e.g., job satisfaction) wellbeing, at the individual level. In Aim 1, we will rigorously select 6 clinics from ETHE areas evi- dencing full commitment to dismantling SRD (mos 3-9). In Aim 2, after a baseline assessment (N=180; mos 11-12), we will conduct a stepped wedge cluster randomized trial of the SRD reduction intervention. At each of the 3 steps, two randomized clinics will receive TRAnscenDS. The intervention will support clinics to 1) identi- fy/create organizational-level anti-racist policies and practices (e.g., clear definitions of racist behavior, ade- quate training and monitoring systems, and prompt responses for constructive redress) to reduce SRD and increase race-based equity for BIPOC patients and provider/staff, and 2) deliver race-specific trainings to all staff (e.g., history of SRD, health consequences of bias and discrimination, cultural humility, intersectional dis- crimination at the confluence of race, ethnicity, sexuality and gender). Each cluster will receive the intervention for 6 mos, starting with Cluster Group 1 (mos 13-18), followed by Cluster Groups 2 (mos 19-24) and 3 (mos 25-30). In Aim 3, we will evaluate multi-level outcomes using the CFIR, including within the organization (pri- mary outcome of SRD Index – ratings of mission/vision statements, anti-racist policy, workforce diversity, equi- ty and inclusion [DEI], clinic environment), systems (secondary outcomes of provider/staff attitudes; behavior; DEI indicators), and individual patient level (tertiary outcomes of clinic-level HIV indicators, reports of discrimi- nation, medical distrust, anxiety, depression, and trauma) outcomes. Assessments will take place every 6 months, with the clinics randomized to the second or third step having multiple assessments before the inter- vention (with final data collection being in month 49). BIPOC patients at the clinics will be surveyed at each as- sessment (N=2,100). Findings will yield a manual for implementing total-facility SRD-reduction processes and content (mos 52-60). Other RWHAP-funded clinics and facilities serving marginalized groups may be able to adopt this manualized, yet highly adaptable intervention packet to support BIPOC.

项目概要 本研究的范围是让 Ryan White HIV/AIDS 计划 (RWHAP) 资助的组织参与结束 美国南部/东部的艾滋病毒流行区 (ETHE) 共同开发利用 evi- 的环境响应计划 采取知情干预措施，减少针对黑人、原住民、 有色人种 (BIPOC) 感染艾滋病毒 (PLH) 和 BIPOC 医护人员直接影响获得服务的机会。 BIPOC 的医疗保健服务，包括在整个预防过程中参与艾滋病毒服务 拟议的干预措施名为 TRnscenDS，借鉴了基于证据的健康政策+。 (HP+)“全部”设施艾滋病毒耻辱减少干预和接触理论，已证明有效 减少与种族有关的群体间偏见。 以及多样性、公平性和包容性 [DEI] 政策）和系统（例如，员工态度/行为）水平来影响 患者（例如，经历过和感知到的歧视、艾滋病毒护理、心理健康）结果和工作人员（例如，工作） 在目标 1 中，我们将从 ETHE 地区严格选择 6 家诊所。 在目标 2 中，经过基线评估（N=180；mos）后，全面承诺拆除 SRD（mos 3-9）。 11-12），我们将在每个阶段进行 SRD 减少干预的阶梯式楔形整群随机试验。 通过 3 个步骤，两个随机诊所将接受 TRnscenDS 该干预措施将支持诊所 1) 识别。 fy/制定组织层面的反种族主义政策和做法（例如，种族主义行为的明确定义、 充分的培训和监测系统，并及时做出建设性补救措施），以减少SRD和 增加 BIPOC 患者和提供者/工作人员基于种族的公平性，以及 2) 向所有人提供针对种族的培训 工作人员（例如，SRD 的历史、偏见和歧视的健康后果、文化谦逊、跨部门分歧 每个群体都将接受干预。 持续 6 个月，从集群组 1 (mos 13-18) 开始，然后是集群组 2 (mos 19-24) 和集群组 3 (mos 19-24) 在目标 3 中，我们将使用 CFIR 评估多层次的成果，包括组织内部的成果（优先）。 SRD 指数的玛丽结果 – 使命/愿景声明、反种族主义政策、劳动力多样性、公平性的评级 ty 和包容性 [DEI]、诊所环境）、系统（提供者/员工态度的次要结果；行为； DEI 指标）和个体患者水平（临床水平 HIV 指标的三级结果、歧视报告 国家、医疗不信任、焦虑、抑郁和创伤）结果将每 6 次进行一次。 几个月，诊所被随机分配到第二步或第三步，在中间阶段之前进行多次评估 干预（最终数据收集将在第 49 个月进行）。 评估（N=2,100）。调查结果将产生一份用于实施总体设施 SRD 削减流程的手册。 内容（mos 52-60）。其他 RWHAP 资助的诊所和设施或许能够为边缘群体提供服务。 采用这种手动但适应性强的干预包来支持 BIPOC。