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: 10653267
• 负责人: Felicia Amira Browne
• 金额: $ 80.91万
• 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/10653267
• 关键词: Accountability; Address; Adopted; Affect; Anxiety; Area; Behavior; Black race; Black, Indigenous, People of Color; Caring; Characteristics; Clinic; Cluster randomized trial; Consolidated Framework for Implementation Research; Data Collection; Discrimination; Disparity; Education; Ensure; Environment; Epidemic; Equity; Ethnic Origin; Feedback; Fostering; Funding; Gender; Geography; Goals; HIV; HIV/AIDS; Health; Health Personnel; Health Policy; Health Promotion; Healthcare; Incidence; Individual; Institutional Racism; Intervention; Job Satisfaction; Justice; Latinx; 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; clinical care; comorbidity; distrust; equity, diversity, and inclusion; evidence base; experience; gender minority group; health care quality; health difference; improved; indexing; individual patient; marginalized population; multi-racial; perceived discrimination; primary outcome; programs; 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.

项目摘要 这项研究的范围是与Ryan White HIV/AIDS计划（RWHAP）资助的组织结束 美国南/东部的艾滋病毒流行（ETHE）地区使用EVI-共同开发背景响应计划 DNCE了解的干预措施，以减少对黑人，土著，土著的种族主义和歧视（SRD）（SRD） 有色人种（BIPOC）与艾滋病毒（PLH）和BIPOC医疗保健工人相处。 SRD直接影响访问 以及对BIPOC的医疗保健的吸收，包括在预防连续性的情况下参与艾滋病毒服务 和关心。拟议的干预措施命名为超越，借鉴了基于证据的健康政策加上 （HP+）“总”设施HIV污名干预和接触理论，这表明了效率 在减少与种族相关的群体间偏见中。超越针对诊所的组织（例如，反种族主义者 以及多样性，公平和包容性[DEI]政策）和系统（例如，参与者/行为）都会影响 患者（例如经验丰富且感知的歧视，艾滋病毒护理，心理健康）和员工（例如，工作 满意度）在个人层面上的健康。在AIM 1中，我们将严格从Ethe地区选择6个诊所 全面承诺拆除SRD（MOS 3-9）。在AIM 2中，在基线评估之后（n = 180; MOS 11-12），我们将对SRD还原干预措施进行梯级楔形群集随机试验。在每个 这三个步骤，两个随机诊所将获得超越。干预措施将支持诊所1）确定 - FY/创建组织级反种族主义政策和实践（例如，对种族主义行为的明确定义， 要求培训和监视系统，并迅速对建设性的阅读响应），以减少SRD和 增加基于种族的公平股权，以及提供者/提供者/员工，以及2）向所有人提供特定种族的培训 员工（例如，SRD的历史，偏见和歧视的健康后果，文化谦卑，交叉疾病 种族，种族，性别和性别的融合中的犯罪）。每个集群将接受干预 对于6个MOS，从集群1（MOS 13-18）开始，然后是群集组2（MOS 19-24）和3（MOS） 25-30）。在AIM 3中，我们将使用CFIR评估多层次成果，包括在组织内部（PRI- SRD指数的玛丽结果 - 任务/愿景陈述的评级，反种族主义政策，劳动力多样性，等额 TY和包容[DEI]，诊所环境），系统（提供者/员工参与者的次要结果；行为； DEI指标）和个体患者水平（临床水平HIV指标的第三级结局 国家，医疗不信任，焦虑，抑郁和创伤）。评估每6次进行一次 几个月，随机将诊所随机分为第二或第三步，在间隔之前进行了多次评估 发言（最终数据收集在第49个月）。诊所的BIPOC患者将在每个AS- 会话（n = 2,100）。调查结果将产生一份用于实施总官方SRD降低过程的手册，并且 内容（MOS 52-60）。其他由RWHAP资助的诊所和设施为边缘化群体服务可能能够 采用此手动但高度适应性的干预包来支持BIPOC。