The high prevalence of trauma (i.e. child abuse, intimate partner violence) and associated negative impact on health, health-promoting behaviors, and engagement in the HIV care continuum in people living with HIV (PLH) underscore the need for trauma screening and management integrated into HIV services to optimize care effectiveness and improve retention, adherence to therapy, and overall physical and mental well-being. Trauma-informed Care (TIC) is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of trauma. TI-systems: 1) realize the widespread impact of trauma and understand potential paths for recovery; 2) recognize signs and symptoms of trauma in clients, staff, and others involved with the system; 3) respond by fully integrating knowledge about trauma into policies, procedures, and practices; and 4) seek to actively resist re-traumatization. Evidence from mental health, substance use and social service settings demonstrates that TIC enhances the effectiveness of evidence-based health services, improves patient outcomes, increases staff morale, and is cost-effective, leading to several high- level calls for integration of TIC into HIV services (TI-HIV Care). However, empirical evidence demonstrating the feasibility and effectiveness of TI-HIV Care in terms of HIV care continuum outcomes (retention, viral suppression) and guiding the implementation of TI-HIV Care implementation and evaluation in HIV care settings is lacking. Recognizing that low-income and racial/ethnic minority populations experience higher rates of trauma, we propose to work within the infrastructure of the Ryan White (RW) HIV/AIDS Program (a federally-funded nationwide program that supports comprehensive primary medical care and support services for PLH who are un/underinsured) to execute the following aims: 1) conduct a mixed methods assessment among administrators, staff and providers working in RW primary care clinics across the Southeastern US (the epicenter of the US HIV epidemic) to access inner and outer context factors that may influence adoption of TIC in these clinics, 2) conduct a hybrid Type 1 effectiveness implementation study of three RW-funded HIV clinics in Georgia (one urban, Atlanta site; one rural, South Georgia site; one control site), two that are integrating TIC into their services, and in parallel, evaluate multi-level factors associated with TIC reach, level of adoption, and implementation within and across these clinics, and 3) examine the efficacy of implementing TI-HIV care on primary outcomes: HIV care retention and viral load suppression and secondary outcomes: patient satisfaction, quality of life, and trust in medical care, and provider/staff job satisfaction, burnout, and engagement in self-care at the two intervention Georgia clinical sites relative to the control site. Findings will enable an evidence-driven response to the high- level calls for integration of TIC into HIV primary care services and provide concrete guidance for TIC integration in RW clinics at the epicenter of the US HIV epidemic.

Public Health Relevance

The high prevalence and associated negative impact of trauma (i.e. child abuse, intimate partner violence) on the mental and physical health of people living with HIV and their engagement in HIV care underscore the need for systematically addressing trauma within HIV services. Trauma-informed Care (TIC) is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of trauma, and has shown promise in impacting the mental and physical health of patients and their care providers in non-HIV settings; however, limited published literature exists about methods for and the effectiveness of integrating TIC within HIV primary care (TI-HIV care). The proposed study will provide critical evidence about capacity and readiness, as well as feasibility and effectiveness of implementing TI-HIV care in rural and urban, underserved Ryan White-funded HIV clinics at the epicenter of the United States HIV epidemic on HIV care continuum outcomes.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
High Priority, Short Term Project Award (R56)
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Population and Public Health Approaches to HIV/AIDS Study Section (PPAH)
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Senn, Theresa Elaine
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Emory University
Schools of Public Health
United States
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