Implementing Trauma Informed Care in HIV Primary Care in the Southeast

在东南部艾滋病毒初级保健中实施创伤知情护理

基本信息

批准号：
10012217
负责人：
Ameeta Shivdas Kalokhe
金额：
$ 76.26万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-23 至 2021-09-22
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10012217
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Administrator Adopted Adoption Age Alcohol or Other Drugs use Attitude Behavior CD4 Positive T Lymphocytes Caring Child Abuse Client Client satisfaction Clinic Comorbidity Continuity of Patient Care Effectiveness Epidemic Evaluation Evidence based treatment Funding Geography Guidelines HIV HIV diagnosis Health Health Promotion Health Services High Prevalence Hybrids Individual Infrastructure Intervention Interview Job Satisfaction Knowledge Literature Low income Measurement Medicaid Medical Mental Health Methods Morale Opportunistic Infections Outcome Patient-Focused Outcomes Patients Phase Policies Population Group Preparation Primary Health Care Procedures Process Provider Publishing Quality Indicator Quality of life Readiness Recording of previous events Recovery Reporting Research Research Design Resources Rural Self Care Service setting Services Sexual abuse Signs and Symptoms Site Social Work Source Substance abuse problem Surveys System Testing Training Trauma Trust Underinsured Uninsured United States United States Health Resources and Services Administration United States National Institutes of Health Viral Viral Load result Visit Well in self Woman Work antiretroviral therapy burnout care providers child physical abuse clinical research site cost effective design ethnic minority population evidence base experience federal poverty level high risk high risk sexual behavior implementation research improved informant information gathering innovation intimate partner violence men mortality organizational structure physical conditioning primary care services primary outcome programs racial and ethnic racial minority response satisfaction screening screening guidelines secondary outcome transgender transmission process trauma exposure trauma symptom urban underserved virtual

项目摘要

ABSTRACT The high prevalence of trauma (i.e. child abuse, intimate partner violence) and associated negative impact on health, health-promoting behaviors, and engagement in the HIV care continuum in people living with HIV (PLH) underscore the need for trauma screening and management integrated into HIV services to optimize care effectiveness and improve retention, adherence to therapy, and overall physical and mental well-being. Trauma-informed Care (TIC) is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of trauma. TI-systems: 1) realize the widespread impact of trauma and understand potential paths for recovery; 2) recognize signs and symptoms of trauma in clients, staff, and others involved with the system; 3) respond by fully integrating knowledge about trauma into policies, procedures, and practices; and 4) seek to actively resist re-traumatization. Evidence from mental health, substance use and social service settings demonstrates that TIC enhances the effectiveness of evidence-based health services, improves patient outcomes, increases staff morale, and is cost-effective, leading to several high- level calls for integration of TIC into HIV services (TI-HIV Care). However, empirical evidence demonstrating the feasibility and effectiveness of TI-HIV Care in terms of HIV care continuum outcomes (retention, viral suppression) and guiding the implementation of TI-HIV Care implementation and evaluation in HIV care settings is lacking. Recognizing that low-income and racial/ethnic minority populations experience higher rates of trauma, we propose to work within the infrastructure of the Ryan White (RW) HIV/AIDS Program (a federally-funded nationwide program that supports comprehensive primary medical care and support services for PLH who are un/underinsured) to execute the following aims: 1) conduct a mixed methods assessment among administrators, staff and providers working in RW primary care clinics across the Southeastern US (the epicenter of the US HIV epidemic) to access inner and outer context factors that may influence adoption of TIC in these clinics, 2) conduct a hybrid Type 1 effectiveness implementation study of three RW-funded HIV clinics in Georgia (one urban, Atlanta site; one rural, South Georgia site; one control site), two that are integrating TIC into their services, and in parallel, evaluate multi-level factors associated with TIC reach, level of adoption, and implementation within and across these clinics, and 3) examine the efficacy of implementing TI-HIV care on primary outcomes: HIV care retention and viral load suppression and secondary outcomes: patient satisfaction, quality of life, and trust in medical care, and provider/staff job satisfaction, burnout, and engagement in self-care at the two intervention Georgia clinical sites relative to the control site. Findings will enable an evidence-driven response to the high- level calls for integration of TIC into HIV primary care services and provide concrete guidance for TIC integration in RW clinics at the epicenter of the US HIV epidemic.

抽象的创伤（即虐待儿童、亲密伴侣暴力）发生率高以及相关的负面影响关于艾滋病毒感染者的健康、健康促进行为和参与艾滋病毒护理连续性 (PLH) 强调需要将创伤筛查和管理纳入艾滋病毒服务以优化护理效果并提高保留率、治疗依从性以及整体身心健康。创伤知情护理 (TIC) 是一种组织结构和治疗框架，涉及理解、认识并应对创伤的影响。 TI 系统：1) 认识到创伤的广泛影响并了解潜在的恢复途径； 2) 识别客户、员工和员工的创伤迹象和症状与系统相关的其他人； 3）通过将有关创伤的知识充分纳入政策来做出反应，程序和做法； 4）寻求积极抵抗再次创伤。来自心理健康的证据，物质使用和社会服务环境表明 TIC 增强了基于证据的有效性卫生服务，改善患者治疗效果，提高员工士气，并且具有成本效益，从而导致了一些高级别呼吁将 TIC 纳入 HIV 服务（TI-HIV Care）。然而，经验证据表明 TI-HIV 护理在 HIV 护理连续结果（保留、病毒感染）方面的可行性和有效性抑制）并指导在 HIV 护理机构中实施 TI-HIV 护理实施和评估缺乏。认识到低收入和种族/族裔少数群体遭受创伤的几率较高，我们建议在 Ryan White (RW) HIV/AIDS 计划（联邦政府资助的一个项目）的基础设施内开展工作全国性计划，为患有艾滋病的患者提供全面的初级医疗保健和支持服务未投保/保险不足）以实现以下目标：1）在管理人员中进行混合方法评估，在美国东南部（美国艾滋病毒疫情中心）RW 初级保健诊所工作的工作人员和提供者流行病）以获取可能影响这些诊所采用 TIC 的内部和外部背景因素，2）进行对佐治亚州三个 RW 资助的艾滋病毒诊所（一个城市、一个亚特兰大站点；南乔治亚州一处乡村地点；一个控制站点），两个将 TIC 集成到其服务中，以及同时，评估与 TIC 范围、采用水平和实施相关的多层次因素以及在这些诊所中，3) 检查实施 TI-HIV 护理对主要结局的功效：HIV 护理保留和病毒载量抑制以及次要结果：患者满意度、生活质量和信任两次干预中的医疗保健、提供者/员工的工作满意度、倦怠和自我护理参与度乔治亚州临床地点相对于对照地点。研究结果将使对高风险的证据驱动的反应成为可能级别呼吁将 TIC 纳入艾滋病初级保健服务，并为 TIC 整合提供具体指导位于美国艾滋病毒流行中心的 RW 诊所。