Trauma-informed Care for Youth With HIV in Memphis

Investigators will reduce health disparities among underserved youth in a region with the third 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 youth with HIV (YWH) suffer comparatively worse HIV outcomes: half of all YWH in Memphis are appointment non-adherent, representing a major threat to HIV viral suppression, morbidity, and disease transmission. Psychological 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 rates of post-traumatic stress disorder (47%), with adversity due to skin color intensifying experiences among 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 care (TIC) is an evidence-based approach that improves multi-level outcomes (e.g., personnel practices, clinic climate, and patient appointment adherence) by ensuring personnel are adequately trained to Recognize and Respond to trauma and Resist Re-traumatization. Though the Memphis EHE plan cites TIC implementation as critical to advancing local goals, the HIV clinic at St. Jude Children's Research Hospital (SJCRH), primary care provider for YWH in the area, has not implemented TIC. Investigators have developed this proposal with SJCRH to support enhanced TIC for youth with HIV (TIC-YH) implementation in their HIV care clinic system. Investigators will conduct a Sequential Transformative Mixed Methods design study through the following three aims: 1) Adapt TIC protocols by incorporating novel contextual components; 2) Implement and assess impact of novel TIC-YH intervention on personnel attitudes, practices, and system culture; and 3) Implement and assess impact of novel TIC-YH on patient HIV appointment adherence and trauma response. 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 and mixed methods design, enabling the development of a programmatic line of research to advance EHE goals. There is strong rationale to support the current TIC-YH intervention and proposed research methods as meaningful approaches to addressing disparities across a wide range of areas, including chronic diseases.