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Scaling-Up Trauma-Informed Care in an HIV Clinical Network: Factors that Facilitate Implementation

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Abstract

Traumatic experiences, which are disproportionately common among people living with HIV/AIDS, exacerbate negative HIV care outcomes. Trauma-informed care (TIC) is an evidence-based treatment framework that recognizes and responds to patient trauma and minimizes the risk of re-traumatization. The study objective was to identify strategies to scale-up TIC among a large federally-funded (Ryan White) HIV clinical network in the U.S. Due to the high prevalence of trauma among patients in this network, TIC has been identified as a priority area for the network/federal funders, but minimal implementation guidance exists. To fill this gap, we conducted 37 interviews with administrators, providers, and staff from 20 HIV clinics in the U.S. to understand determinants of TIC adoption. We identified seven key determinants of TIC scale-up including: (1) Available Resources, (2) Networks and Communications, (3) Tension for Change, (4) Access to Knowledge and Information, (5) Culture, (6) Leadership Engagement, and (7) External Partnerships. We identified the different resources, strategies, and supports to promote adoption of each component of TIC. We discuss how to package strategies that fit the needs of various clinics at different stages of readiness to implement TIC.

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Data Availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  • Algarin, A. B., Sheehan, D. M., Varas-Diaz, N., Fennie, K., Zhou, Z., Spencer, E. C., Cook, C. L., Cook, R. L., & Ibanez, G. E. (2021). Enacted HIV-related stigma’s association with anxiety & depression among people living with HIV (PLWH) in Florida. AIDS Behavior, 25(1), 93–103.

    Article  PubMed  Google Scholar 

  • Ali, S., Stanton, M., McCormick, K., & Reif, S. (2023). The landscape of trauma informed care in community-based HIV service organizations in the United States south. AIDS Care, 35(2), 244–248.

    Article  PubMed  Google Scholar 

  • Anderson, J. D., Li, X., Qiao, S., Zhou, Y., & Shen, Z. (2020). The mediating effects of functions of social support on HIV-related trauma and health-related quality of life for PLHIV in China. AIDS Care, 32(6), 673–680.

    Article  PubMed  Google Scholar 

  • Bailey, A., Hutter, I., & Hennink, M. (2020). Qualitative research methods (pp. 1–376). SAGE.

    Google Scholar 

  • Beyrer, C., Crago, A.-L., Bekker, L.-G., Butler, J., Shannon, K., Kerrigan, D., Decker, M. R., Baral, S. D., Poteat, T., Wirtz, A. L., Weir, B. W., Barré-Sinoussi, F., Kazatchkine, M., Sidibé, M., Dehne, K.-L., Boily, M.-C., & Strathdee, S. A. (2015). An action agenda for HIV and sex workers. The Lancet, 385(9964), 287–301.

    Article  Google Scholar 

  • Brezing, C., Ferrara, M., & Freudenreich, O. (2015). The syndemic illness of HIV and trauma: Implications for a trauma-informed model of care. Psychosomatics, 56(2), 107–118.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention [CDC]. (2018). HIV in the Southern United States: CDC Issue Brief. Retrieved 2016, from https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf

  • Centers for Disease Control and Prevention [CDC]. (2021). HIV Surveillence Report, 2019. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

  • Centers for Disease Control and Prevention. (2022). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020. HIV Surveillance Supplemental Report 2022;27(No. 3). Revised edition. Retrieved November, 2023, from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

  • Clark, C., Young, M. S., Jackson, E., Graeber, C., Mazelis, R., Kammerer, N., & Huntington, N. (2008). Consumer perceptions of integrated trauma-informed services among women with co-occurring disorders. The Journal of Behavioral Health Services & Research, 35(1), 71–90.

    Article  Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 1–15.

    Article  Google Scholar 

  • Guajardo, E., Giordano, T. P., Westbrook, R. A., Black, W. C., Njue-Marendes, S., & Dang, B. N. (2022). The effect of initial patient experiences and life stressors on predicting lost to follow-up in patients new to an HIV clinic. AIDS and Behavior, 26(6), 1880–1891.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guarino, K., Soares, P., Konnath, K., Clervil, R., & Bassuk, E. (2009). Trauma-informed organizational toolkit for homeless services. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Daniels Fund, National Child Traumatic Stress Network, WK Kellogg Foundation. http://www.air.org/resource/trauma-informed-organizational-toolkit.

  • Hatcher, A. M., Smout, E. M., Turan, J. M., Christofides, N., & Stöckl, H. (2015). Intimate partner violence and engagement in HIV care and treatment among women: A systematic review and meta-analysis. AIDS, 29(16), 2183–2194.

    Article  PubMed  Google Scholar 

  • Health Resources & Service Administration [HRSA]. (2018). Ryan White HIV/AIDS Program Fact Sheet. https://hab.hrsa.gov/sites/default/files/hab/Publications/factsheets/program-factsheet-program-overview.pdf

  • Health Resources & Service Administration [HRSA]. (2020). About the Ryan White HIV/AIDS Program. https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program

  • Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior, 11(6), 842–853.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hopper, E. K., Bassuk, E. L., & Olivet, J. (2009). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 2, 131–151.

    Google Scholar 

  • Hughes, A. M., Zajac, S., Woods, A. L., & Salas, E. (2020). The role of work environment in training sustainment: A meta-analysis. Human Factors, 62(1), 166–183.

    Article  PubMed  Google Scholar 

  • Interagency Federal Working Group. (2013). Addressing the intersection of HIV/AIDS, violence against women and girls, & gender-related health disparities. Washington. https://www.whitehouse.gov/sites/default/files/docs/vaw-hiv_working_group_report_final_-_9-6--2013.pdf

  • Kalokhe, A. S., Adam, E., Colasanti, J., Livingston, M., III., Root, C., & Sales, J. M. (2022). Differences in trauma-informed care implementation by clinic-level factors across Ryan White HIV clinics in the Southeastern United States. AIDS Care, 35, 222.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalokhe, A. S., Paranjape, A., Bell, C. E., Cardenas, G. A., Kuper, T., Metsch, L. R., & del Rio, C. (2012). Intimate partner violence among HIV-infected crack cocaine users. AIDS Patient Care and STDs, 26(4), 234–240.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalokhe, A. S., Riddick, C., Piper, K., Schiff, J., Getachew, B., Del Rio, C., & Sales, J. M. (2020a). Integrating program-tailored universal trauma screening into HIV care: An evidence-based participatory approach. AIDS Care, 32(2), 209–216.

    Article  PubMed  Google Scholar 

  • Kalokhe, A. S., Riddick, C., Piper, K., Schiff, J., Getachew, B., Del Rio, C., & Sales, J. M. (2020b). Integrating program-tailored universal trauma screening into HIV care: An evidence-based participatory approach. AIDS Care, 32(2), 209–216.

    Article  PubMed  Google Scholar 

  • Kelly, A., & Garland, E. L. (2016). Trauma-informed mindfulness-based stress reduction for female survivors of interpersonal violence: Results from a stage I RCT. Journal of Clinical Psychology, 72(4), 311–328.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leddy, A. M., Weiss, E., Yam, E., & Pulerwitz, J. (2019). Gender-based violence and engagement in biomedical HIV prevention, care and treatment: A scoping review. BMC Public Health, 19(1), 897–897.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science, 12(1), 125.

    Article  PubMed  PubMed Central  Google Scholar 

  • Machtinger, E. L., Wilson, T. C., Haberer, J. E., & Weiss, D. S. (2012). Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS and Behavior, 16(8), 2091–2100.

    Article  CAS  PubMed  Google Scholar 

  • Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services (washington, DC), 56(10), 1213–1222.

    Article  Google Scholar 

  • Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23(1), 51–59.

    Article  PubMed  Google Scholar 

  • National strategy group to develop a model of trauma-informed primary care for women living with HIV. (2013). Executive summary: strategy meeting on trauma-informed primary care for U.S. women living with HIV. https://pwnusa.wordpress.com/policy-agenda/violence-against-women/strategy-meeting-tipc/

  • Oram, S., Fisher, H. L., Minnis, H., Seedat, S., Walby, S., Hegarty, K., Rouf, K., Angénieux, C., Callard, F., Chandra, P. S., Fazel, S., Garcia-Moreno, C., Henderson, M., Howarth, E., MacMillan, H. L., Murray, L. K., Othman, S., Robotham, D., Rondon, M. B., … Howard, L. M. (2022). The Lancet Psychiatry Commission on intimate partner violence and mental health: Advancing mental health services, research, and policy. Lancet Psychiatry, 9(6), 487–524.

    Article  PubMed  Google Scholar 

  • Piper, K. N., Brown, L. L., Tamler, I., Kalokhe, A. S., & Sales, J. M. (2021a). Application of the consolidated framework for implementation research to facilitate delivery of trauma-informed HIV care. Ethnicity and Disease, 31(1), 109–118.

    Article  PubMed  PubMed Central  Google Scholar 

  • Piper, K. N., Schiff, J., Riddick, C., Getachew, B., Farber, E. W., Kalokhe, A., & Sales, J. M. (2021b). Barriers and facilitators to implementation of trauma support services at a large HIV treatment center in the Southern United States. AIDS Care, 33(3), 316–325.

    Article  PubMed  Google Scholar 

  • Raja, S., Hasnain, M., Hoersch, M., Gove Yin, S., & Rajagopalan, C. (2015). Trauma informed care in medicine: current knowledge and future research directions. Family & Community Health, 38(3), 216–226.

    Article  Google Scholar 

  • Ramachandran, S., Yonas, M. A., Silvestre, A. J., & Burke, J. G. (2010). Intimate partner violence among HIV-positive persons in an urban clinic. AIDS Care, 22(12), 1536–1543.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reeves, E. (2015). A Synthesis of the literature on trauma-informed care. Issues in Mental Health Nursing, 36(9), 698–709.

    Article  PubMed  Google Scholar 

  • Sales, J. M., Anderson, K. M., & Kokubun, C. W. (2021). Application of the consolidated framework for implementation research to facilitate violence screening in HIV care settings: A review of the literature. Current HIV/AIDS Reports, 18(4), 309–327.

    Article  PubMed  Google Scholar 

  • Sales, J. M., Piper, K., Riddick, C., Getachew, B., Colasanti, J., & Kalokhe, A. (2019). 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. https://doi.org/10.1177/2050312119871417

    Article  PubMed  PubMed Central  Google Scholar 

  • SAMHSA. (2022). Trauma and Violence: What is Trauma? Substance Abuse and Mental Health Services Administration [SAMHSA]. Retrieved August 17, 2023, from https://www.samhsa.gov/trauma-violence

  • Scheer, J. R., & Poteat, V. P. (2018). Trauma-informed care and health among LGBTQ intimate partner violence survivors. Journal of Interpersonal Violence, 36(13–14), 6670–6692.

    PubMed  PubMed Central  Google Scholar 

  • Scholl, I., LaRussa, A., Hahlweg, P., Kobrin, S., & Elwyn, G. (2018). Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them - a scoping review. Implementation Science, 13(1), 40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–1385.

    Article  PubMed  Google Scholar 

  • Stanhope, V., Ross, A., Choy-Brown, M., & Jessell, L. (2019). A mixed methods study of organizational readiness for change and leadership during a training initiative within community mental health clinics. Administration and Policy in Mental Health, 46(5), 678–687.

    Article  PubMed  PubMed Central  Google Scholar 

  • Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Rockville: Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  • The White House. (2014). Update on efforts to address the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities. Washington. https://www.whitehouse.gov/sites/default/files/docs/hiv_vaw_grhd_report.pdf.

  • Theuninck, A. C., Lake, N., & Gibson, S. (2010). HIV-related posttraumatic stress disorder: Investigating the traumatic events. AIDS Patient Care and STDs, 24(8), 485–491.

    Article  PubMed  Google Scholar 

  • Williams, B., Amico, K. R., & Konkle-Parker, D. (2011). Qualitative to assessment of barriers and facilitators to HIV treatment. The Journal of the Association of Nurses in AIDS Care : JANAC, 22(4), 307–312.

    Article  PubMed  Google Scholar 

  • Williams, E. S., Manwell, L. B., Konrad, T. R., & Linzer, M. (2007). The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study. Health Care Management Review, 32(3), 203–212.

    Article  PubMed  Google Scholar 

  • Wirtz, A. L., Burns, P. A., Poteat, T., Malik, M., White, J. J., Brooks, D., Kasaie, P., & Beyrer, C. (2022). Abuse in the continua: HIV prevention and care outcomes and syndemic conditions associated with intimate partner violence among black gay and bisexual men in the southern United States. AIDS Behavior. https://doi.org/10.1007/s10461-022-03705-6

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the clinic staff and providers that generously gave of their time to talk with us during the COVID-19 pandemic as well as to recognize the invaluable work they do every day to improve the lives of the clients they care for and about. We would also like to recognize the contributions and support of our Graduate Research Assistants, Shanti Varma-Lenz and Mahitha Murali, and Project Manager Christin Root.

Funding

Funding was provided by Grant R56MH119903 from the National Institute of Mental Health (NIMH) to JS and AK. KP is also funded by NIH/NIDA F31DA053005 and NIH/NIDA R25DA037190. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, NIMH, or NIDA.

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Authors and Affiliations

  1. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Kaitlin N. Piper, Katherine M. Anderson, Caroline W. Kokubun & Jessica M. Sales

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

    Olivia C. Manders & Ameeta S. Kalokhe

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

    Ameeta S. Kalokhe

  4. Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm. 523, Atlanta, GA, USA

    Kaitlin N. Piper

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  1. Kaitlin N. Piper
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  2. Katherine M. Anderson
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  3. Olivia C. Manders
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  4. Caroline W. Kokubun
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  5. Ameeta S. Kalokhe
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  6. Jessica M. Sales
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Contributions

OM and CK: collected the data. KP, CK, KA, OM: coded the interviews. KP: analyzed the data, interpreted the findings, and wrote the manuscript. KA: assisted with manuscript writing. JS and AK: conceptualized and designed the study. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Kaitlin N. Piper.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Approval to conduct the study was gained from Emory University Institutional Review Board. This study was performed in line with the principles of the Declaration of Helsinki.

Consent to Participate

All participants provided consent before participating in the study.

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Supplementary file1 (DOCX 32 KB)

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Piper, K.N., Anderson, K.M., Manders, O.C. et al. Scaling-Up Trauma-Informed Care in an HIV Clinical Network: Factors that Facilitate Implementation. Glob Implement Res Appl 4, 89–101 (2024). https://doi.org/10.1007/s43477-023-00108-0

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