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Support for Trauma-informed Care Implementation Among Ryan White HIV Clinics in the Southeastern United States

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Abstract

Trauma histories are common among people with HIV and associated with poor HIV outcomes, underscoring the importance of integrating trauma-informed care (TIC) into HIV services. As part of the quantitative phase of an explanatory sequential mixed-methods study, we assessed individual and clinic-wide support (using the Attitudes Related to Trauma-informed Care-45 (ARTIC-45)) and factors influencing TIC support through surveys with 152 administrators, providers, and staff from 38 Ryan White Clinics (RWCs) in the Southeastern US. Mean responses to the ARTIC-45 Personal and System Support Subscales were 5.18 (SE = 0.09; range 1–7) and 4.45 (SE = 0.16; range 1–7), respectively. In bivariate analysis, higher personal and system support were associated with strong clinic leadership culture (personal support: β = 0.08, t-value = 2.66, p = 0.009; system support: β = 0.16, t-value = 4.71, p < 0.001) and lower staff burnout (personal support: β=-0.05, t-value=-3.10, p = 0.002; system support: β=-0.07, t-value=-3.63, p < 0.001). System support was also associated with rural clinic setting (β = 0.61, t-value = 2.34, p = 0.021), strong staff culture (β = 0.14, t-value = 4.70, p = < 0.001), and resource availability (β = 0.16, t-value = 5.76, p < 0.001), and negatively associated with academic clinic setting (β=-0.52, t-value=-2.25, p = 0.026). Thus, while there is encouraging individual support for TIC, RWCs need tools (training and/or resources) to foster leadership and staff culture and trauma support to enable their transition to trauma-informed HIV care.

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Data Availability

Dataset is available upon request to the authors.

Code Availability

Data analysis codes are available upon request to the authors.

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Acknowledgements

We thank the study participants for openly their sharing their perspectives and the Southeast AIDS Education and Training Center and the Ryan White Clinical Conference organizers for allowing us to publicize the study.

Funding

This work was supported by the National Institutes of Health/National Institute of Mental Health under Grant #R56MH119903-01A1.

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Authors and Affiliations

  1. Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA

    Kalokhe AS & C Root

  2. Emory Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA

    Kalokhe AS

  3. Emory Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA

    E Adam

  4. Emory Rollins School of Public Health, Department of Behavior, Social and Health Education Sciences, Atlanta, GA, USA

    M Livingston III & JM Sales

  5. Claudia Nance Rollins Building, 1518 Clifton Rd, 5003, 30322, Office, Atlanta, GA, USA

    Kalokhe AS

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  1. Kalokhe AS
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Contributions

ASK was responsible for funding acquisition, study design and oversight, and writing the first draft of the manuscript. ES was responsible for data management, data analysis, and manuscript reviewing and editing; ML was responsible for study design, data analysis, and manuscript reviewing and editing; CR was responsible for project administration and data collection and manuscript reviewing and editing. JMS was responsible for funding acquisition, study design and oversight, and manuscript reviewing and editing.

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Correspondence to Kalokhe AS.

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Authors have no conflicts of interest nor competing interests to declare relevant to the content of this article.

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The study was approved by the Emory University Institutional Review Board.

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Written informed consent was obtained from all participants prior to their participation.

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AS, K., Adam, E., Livingston, M. et al. Support for Trauma-informed Care Implementation Among Ryan White HIV Clinics in the Southeastern United States. AIDS Behav 27, 939–947 (2023). https://doi.org/10.1007/s10461-022-03830-2

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