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Piloting Safety and Stabilization: A Multi-component Trauma Intervention to Improve HIV Viral Suppression, Retention in Care, and Post-traumatic Stress Disorder in a Southern United States HIV Service Organization

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Abstract

In this observational study, we assessed the extent to which a community-created pilot intervention, providing trauma-informed care for persons with HIV (PWH), affected HIV care retention and viral suppression among PWH attending an HIV Services Organization in the Southern US. PWH with trauma exposure and/or trauma symptoms (N = 166) were offered a screening and referral to treatment (SBIRT) session. Per self-selection, 30 opted-out, 29 received SBIRT-Only, 25 received SBIRT-only but reported receiving other behavioral health care elsewhere, and 82 participated in the Safety and Stabilization (S&S) Intervention. Estimates from multivariable logistic regression analyses indicated S&S Intervention participants had increased retention in HIV care (adjusted odds ratio [aOR] 5.46, 95% CI 1.70–17.50) and viral suppression (aOR 17.74, 95% CI 1.83–172), compared to opt-out participants. Some evidence suggested that PTSD symptoms decreased for intervention participants. A randomized controlled trial is needed to confirm findings.

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References

  1. Centers for Disease Control &, Prevention. HIV in the Southern United States2019.

  2. McCree DH, Young SR, Henny KD, Cheever L, McCray E. U.S. Centers for Disease Control and Prevention and Health Resources and Services Administration Initiatives to Address Disparate Rates of HIV Infection in the South. AIDS Behav 2019/10/01 2019;23(3):313–318.

  3. Sutton MY, Gray SC, Elmore K, Gaul Z. Social determinants of HIV disparities in the Southern United States and in counties with historically black Colleges and Universities (HBCUs), 2013–2014. PLoS ONE. 2017;12(1):e0170714.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tang C, Goldsamt L, Meng J, et al. Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis. BMJ Open. 2020;10(4):e032435.

    Article  PubMed  PubMed Central  Google Scholar 

  5. LeGrand S, Reif S, Sullivan K, Murray K, Barlow ML, Whetten K. A review of recent literature on trauma among individuals living with HIV. Curr HIV/AIDS Rep. 2015;12(4):397–405.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dale S, Cohen M, Weber K, Cruise R, Kelso G, Brody L. Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States. AIDS Patient Care STDS 2014/03/01. 2014;28(3):136–43.

    Article  Google Scholar 

  7. Aggarwal R, Pham M, Dillingham R, McManus KA. Expanded HIV clinic–based mental health care services: association with viral suppression. Open Forum Infect Dis 2019;6(4).

  8. Mendenhall E, Singer M. What constitutes a syndemic? Methods, contexts, and framing from 2019. Curr Opin HIV AIDS. 2020;15(4):213–7.

    Article  PubMed  Google Scholar 

  9. Brezing C, Ferrara M, Freudenreich O. The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. Psychosom 2015/03/01/. 2015;56(2):107–18.

    Article  Google Scholar 

  10. Substance Abuse and Mental Health Services Administration. Trauma-informed care in behavioral health services. Rockville, MD: HHS Publication; 2014.

    Google Scholar 

  11. Herman JL. Recovery from psychological trauma. Psychiatry and Clinical Neurosciences 1998/09/01 1998;52(S1):S98-S103.

  12. Han H-R, Miller HN, Nkimbeng M, et al. Trauma informed interventions: a systematic review. PLoS ONE. 2021;16(6):e0252747.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chin D, Myers HF, Zhang M, et al. Who improved in a trauma intervention for HIV-positive women with child sexual abuse histories? Psychol Trauma. 2014;6(2):152–8.

    Article  PubMed  Google Scholar 

  14. Hien DA, Campbell ANC, Killeen T et al. The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “Women and Trauma” multi-site study. AIDS Behav 2010/04/01 2010;14(2):421–430.

  15. Wyatt GE, Longshore D, Chin D et al. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS Behav 2004/12/01 2004;8(4):453–462.

  16. Petrie KJ, Fontanilla I, Thomas MG, Booth RJ, Pennebaker JW. Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosom Med 2004;66(2).

  17. Sikkema KJ, Mulawa MI, Robertson C et al. Improving AIDS care After Trauma (ImpACT): pilot outcomes of a coping intervention among HIV-infected women with sexual trauma in South Africa. AIDS Behav 2018/03/01 2018;22(3):1039–1052.

  18. Goldhammer H, Marc LG, Chavis NS et al. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2022/04/03 2022;34(4):505–514.

  19. Williams JK, Glover DA, Wyatt GE, Kisler K, Liu H, Zhang M. A sexual risk and stress reduction intervention designed for HIV-positive bisexual African American men with childhood sexual abuse histories. Am J Public Health 2013/08/01 2013;103(8):1476–1484.

  20. Collier KL, Colarossi LG, Hazel DS, Watson K, Wyatt GE. Healing our women for transgender women: adaptation, acceptability, and pilot testing. AIDS Educ Prev. 2015;27(5):418–31.

    Article  PubMed  Google Scholar 

  21. Dale SK, Safren SA. Striving towards Eempowerment and medication adherence (STEP-AD): A tailored cognitive behavioral treatment approach for Black women living with HIV. Cognitive and Behavioral Practice 2018/08/01/ 2018;25(3):361–376.

  22. Empson S, Cuca YP, Cocohoba J, Dawson-Rose C, Davis K, Machtinger EL. Seeking safety group therapy for co-occurring substance use disorder and PTSD among transgender women living with HIV: a pilot study. J Psychoact Drugs 2017/08/. 2017;49(08):344–51.

    Article  Google Scholar 

  23. Wagner LJ, Hilker KA, Hepworth JT, Wallston KA. Cognitive Adaptability as a Moderator of Expressive Writing Effects in an HIV Sample. AIDS Behav 2010/04/01 2010;14(2):410–420.

  24. Ironson G, O’Cleirigh C, Leserman J, et al. Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial. J Consult Clin Psychol. 2013;81:284–98.

    Article  PubMed  Google Scholar 

  25. Rosenberg ES, Millett GA, Sullivan PS, del Rio C, Curran JW. Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. The Lancet HIV. 2014;1(3):e112–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Friedman MR, Stall R, Silvestre AJ, et al. Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS. 2015;29(9):1087–96.

    Article  PubMed  Google Scholar 

  27. Substance Abuse and Mental Health Services Administration. Screening, brief intervention, and referral to treatment (SBIRT). U.S. Department of Health & Human Services; 2017.

  28. Brown LL, Pennings J, Steckel S, Van Zyl M. The organizational trauma resilience assessment: Methods and psychometric properties. Psychol Trauma 2021:No Pagination Specified-No Pagination Specified.

  29. Diclemente RJ, Prochaska JJ. Processes and stages of change: coping and competence in smoking behavior change. In: Shiffman S, Wills TA, editors. Coping and Substance Avuse. New York: Academic Press; 1985. pp. 319–42.

    Google Scholar 

  30. Meichenbaum D. A clinical handbook/practical therapist manual for assessing and treating adults with post-traumatic stress disorder (PTSD). Institute Press; 1994.

  31. Smith V, Daly D, Lundgren I, Eri T, Benstoem C, Devane D. Salutogenically focused outcomes in systematic reviews of intrapartum interventions: a systematic review of systematic reviews. Midwifery 2014/04/01/. 2014;30(4):e151–6.

    Article  Google Scholar 

  32. Centers for Disease Control & Prevention. Behavioral Risk Factor Surveillance System (BRFSS) Adverse Childhood Experiences Scale2020.

  33. Harvey MR, Liang B, Harney PA, Koenen K, Tummala-Narra P, Lebowitz L. A multidimensional approach to the assessment of trauma impact, recovery and resiliency: initial psychometric findings. J Aggress Maltreat Trauma. 2003;6(2):87–109.

    Article  Google Scholar 

  34. Felitti VJ, Anda RF, Nordenberg D, et al. REPRINT OF: relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 2019;56(6):774–86.

    Article  PubMed  Google Scholar 

  35. U.S. Department of Health and Human Services. HHS Poverty Guidelines. Services DoHaH, ed: Office of the Assistant Secretary for Planning and Education; 2022.

  36. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. HIV Surveillance Supplemental Report 2020;25(3).

  37. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5)2013.

  38. Guo S, Fraser M, Chen Q. Propensity score analysis: recent debate and discussion. J Soc Social Work Res. 2020;11(3):463–82.

    Article  Google Scholar 

  39. U.S. Department of Health and Human Services. What is Ending the HIV Epidemic in the U.S.? 2022; https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed July 12th, 2022.

  40. Sacks V, Murphey D. The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. 2018; https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-raceethnicity#:~:text=At%20the%20national%20level%2 C%20about%20one%20in%20ten,a%20significantly%20higher%20ratio%20than%20the%20national%20average. Accessed July 12th, 2022.

  41. Merrick MT, Ford DC, Ports KA, Guinn AS. Prevalence of adverse childhood experiences from the 2011–2014 behavioral risk factor Surveillance System in 23 States. JAMA Pediatr. 2018;172(11):1038–44.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sales JM, Piper K, Riddick C, Getachew B, Colasanti J, Kalokhe A. Low provider and staff self-care in a large safety-net HIV clinic in the Southern United States: implications for the adoption of trauma-informed care. SAGE Open Medicine. 2019;7:2050312119871417.

    Article  PubMed  PubMed Central  Google Scholar 

  43. van Dernoot Lipsky L. Trauma stewardship: an everyday guide to caring for self while caring for others. ReadHowYouWant. com; 2010.

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Acknowledgements

We would like to acknowledge the people living with HIV who bravely shared their trauma experiences and embraced this intervention. We would also like to acknowledge the staff members and clients who helped adapt the intervention, the staff who administered the study, and the Tennessee Center for AIDS Research for ongoing support.

Funding

LLB acknowledges funding support from P30AI110527. JMP acknowledges salary support from NIH K01MH115811. ACP acknowledges support from MH113438 and P30 AI110527.

Author information

Authors and Affiliations

  1. Psychiatry and Behavioral Sciences, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37203, USA

    Leslie Lauren Brown

  2. Nashville CARES, Nashville, TN, USA

    Amna Osman & Tiye Link

  3. Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA

    Leslie Lauren Brown, Bryan E. Shepherd, Shobana Ramasamy, Megan Turner & April C. Pettit

  4. Human and Organizational Development, Vanderbilt University, Nashville, TN, USA

    Jessica M. Perkins & Sarah V. Suiter

  5. Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA

    Jessica M. Perkins

  6. Infectious Disease Clinic, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Megan Wilkins

  7. Department of Family & Community Medicine, Meharry Medical College, Nashville, TN, USA

    Ryan Edgerton

Authors
  1. Leslie Lauren Brown
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Contributions

LLB conceived of and designed the study. LLB, MT, & SS participated in the data collection. LLB wrote the first draft. LB, JMP, SR, MW, BES, AO, BH, MT, RE, TL, SS, & AP participated in interpretation of the data and provided critical revisions. SS and AP provided study oversight. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leslie Lauren Brown.

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Conflicts of Interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

Approval was obtained from the Vanderbilt Institutional Review Board (IRB, 171596). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Written informed consent to participate was obtained from each participant.

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Brown, L.L., Perkins, J.M., Shepherd, B.E. et al. Piloting Safety and Stabilization: A Multi-component Trauma Intervention to Improve HIV Viral Suppression, Retention in Care, and Post-traumatic Stress Disorder in a Southern United States HIV Service Organization. AIDS Behav 28, 174–185 (2024). https://doi.org/10.1007/s10461-023-04174-1

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