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

在田纳西州孟菲斯对感染艾滋病毒的青少年实施创伤知情护理。

• 批准号: 10619732
• 负责人: Leslie Lauren Brown
• 金额: $ 14.95万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619732
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Appointment; Area; Automobile Driving; Benchmarking; Black race; Caring; Chronic Disease; Clinic; Clinical Trials Design; Consensus; County; Data; Development; Dimensions; Disparity; Dose; Educational workshop; Effectiveness; Ensure; Epidemic; Equity; Evidence based intervention; Faculty; Failure; Fatigue; Feedback; Focus Groups; Foundations; Funding; Future; Goals; Grant; HIV; HIV Infections; HIV disparities; Health; Health Services Accessibility; Historically Black Colleges and Universities; Human Resources; Human immunodeficiency virus test; Hybrids; Incidence; Institution; Intervention; Interview; Justice; Lead; Leadership; Medical; Medical Records; Mentorship; Methods; Modality; Morbidity - disease rate; Outcome; Patient Appointment; Patients; Phase; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Production; Provider; Publications; Quality of Care; Quality of life; Race; Reduce health disparities; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Resources; Role; Saint Jude Children' s Research Hospital; Socialization; Structure; Surveys; Tennessee; Testing; Time; Training; Trauma; Treatment outcome; Trust; United States; United States National Institutes of Health; Viral; Youth; anti-racism; care providers; care systems; career development; community based participatory research; comparative; design; disease transmission; disparity gap; epidemic preparedness; experience; experimental arm; group intervention; health equity; health equity promotion; implementation science; improved; improved outcome; innovation; medical schools; pilot trial; primary care provider; primary outcome; psychological trauma; randomized, clinical trials; resilience; response; skills; trauma exposure; treatment disparity

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.

项目概要/摘要 我们将加快艾滋病毒发病率第四高地区服务不足的黑人青年的健康公平 田纳西州谢尔比县（田纳西州；孟菲斯）是美国的第一阶段优先管辖区。 艾滋病毒流行 (EHE) 倡议，其中感染艾滋病毒的黑人青年 (BYWH) 遭受相对较差的艾滋病毒结果： 孟菲斯一半的 BYWH 不遵守预约，这对艾滋病病毒抑制构成了重大威胁， 发病率和疾病传播，包括种族创伤，是一个至关重要且尚未得到充分研究的问题。 这种机制导致了许多与艾滋病毒相关的差异，只有通过多层次的解决方案才能消除这些差异。 在患者层面，YWH 患有高度创伤后应激障碍 (47%)，并伴有种族创伤 黑人青年的经历不断加剧；在人员层面上，反复遭受与创伤相关的经历； 在诊所层面，提供艾滋病毒护理会造成替代性创伤并降低职业生活质量。 创伤后遗症阻碍了医患关系和信任，从而导致治疗疲劳， 创伤知情艾滋病治疗 (TIHC) 是一种基于证据的干预措施 (EBI)。 改善多层次的结果（例如，患者预约依从性和人员的专业生活质量） 通过确保机构卫生实践充分认识和应对创伤并抵抗重新 尽管孟菲斯 EHE 计划指出 TIHC 的实施对于推动当地发展至关重要。 为了实现这一目标，圣裘德儿童研究医院的艾滋病毒诊所（该地区 BYWH 的初级保健提供者）尚未 我们与 St. Jude 共同制定了这项提案，以支持加强青年 TIHC（TIHC- Y) 在艾滋病毒护理系统中的实施我们将进行一项探索性、连续的混合方法研究。 通过以下三个目标： 1) 调整我们的 TIHC-Y，以提高 BYWH 和专业人士获得护理的机会 HIV 护理人员的生活质量； 2) 与 HIV 诊所人员一起实施和评估经过调整的 TIHC-Y； 3) 对 St. Jude 患者进行改编后的 TIHC-Y 试点试验，这项创新且意义重大的研究。 与 NIH 的高度优先研究领域完全一致，以减少治疗结果的健康差异 艾滋病毒感染者的数量以及对进行高度优先的艾滋病毒相关研究的人员进行培训。 5年资助期，K01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，使 开发计划性研究路线以推进 EHE 目标，并产生至少 10 个第一- 我们还将提交 R 级资助，以支持多层次的扩展。 和文化响应的 TIHC-Y 干预 有充分的理由支持当前的 TIHC-Y。 干预措施和拟议的研究方法是解决广泛领域差异的有意义的方法 范围广泛，包括慢性病。