Implementation of Trauma Informed care for Youth Living with HIV in Memphis, TN. - We will accelerate health outcomes among 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 initiative, where youth with HIV suffer comparatively worse HIV outcomes: half of all youth with HIV in Memphis are appointment non-adherent, representing a major threat to HIV viral suppression, morbidity, and disease transmission. Psychological trauma is a critical and under-explored mechanism driving a multitude of HIV-related poor health outcomes that will only be eliminated through multi-level solutions. At the patient-level, youth with HIV endure high levels of post-traumatic stress disorder (47%); 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 is an evidence-based intervention for improving 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 Ending the HIV Epidemic plan cites trauma-informed care implementation as critical to advancing local goals, St. Jude Children’s Research Hospital’s HIV clinic, primary care provider for youth with HIV in the area, has not implemented it. We have developed this proposal with St. Jude to support an enhanced trauma-informed care “intervention” implementation in their HIV care system. We will conduct an exploratory, sequential mixed methods study through the following three aims: 1) Adapt our intervention to enhance access to care for youth with HIV and professional quality of life for HIV care providers; 2) Implement and evaluate an adapted intervention with HIV clinic personnel; and 3) Conduct a pilot trial of the adapted intervention with St. Jude patients. This innovative and highly significant research is wholly consistent with NIH high priority areas of research 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, the intervention, and health outcomes research, enabling the development of a programmatic line of research to advance national 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 intervention. There is strong rationale to support the current intervention and proposed research methods as meaningful approaches to addressing health outcomes across a wide range of areas, including chronic diseases.
