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Sanders R, Dombrowski JC, Hajat A, Buskin S, Erly S. Associations between adverse childhood experiences, viral suppression, and quality of life among persons living with HIV in Washington state. AIDS Care 2024; 36:937-945. [PMID: 38176057 PMCID: PMC11222305 DOI: 10.1080/09540121.2023.2299339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
Adverse childhood experiences (ACEs) have been linked to numerous negative health outcomes in adulthood and have been recognized as a hurdle to participating in HIV care. However, few studies have examined the cumulative impact that different types of childhood trauma have on HIV care engagement and HIV outcomes. This study characterized the relationship between ACEs, viral suppression, and health-related quality of life (HRQOL) among persons living with HIV (PLWH). We used HIV surveillance data and self-reported information on ACEs and HRQOL from PLWH in Washington State from 2018-2020. Logistic regression was used to assess the relationship between the quantity and type of ACEs and viral suppression. We used Poisson regression to examine the relationship between ACEs and HRQOL as measured by unhealthy days. The majority of PLWH experienced ≥1 ACE (86.8%). ACEs were not significantly associated with the likelihood of viral suppression (OR ≥4 vs 0 ACEs: 0.49, 95% CI: 0.12-2.09), but ACEs were associated with more unhealthy days experienced in a 30-day period (RR ≥4 vs 0 ACEs: 3.19, 95% CI: 1.59-6.40). These findings provide support that trauma is common among PLWH, and efforts to address the impact of childhood trauma may work to improve quality of life.
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Affiliation(s)
- Rachel Sanders
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Susan Buskin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Steven Erly
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Office of Infectious Disease, Washington State Department of Health, Tumwater, WA, USA
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Brown LL, Wilkins ML, Pichon LC, Stewart JL, Sales JM, Audet CM, Hill SV, Pettit AC. Process Mapping to inform implementation of Trauma-Informed Care for youth aged 14-24 with HIV in the Southern United States. RESEARCH SQUARE 2023:rs.3.rs-3234952. [PMID: 37645914 PMCID: PMC10462242 DOI: 10.21203/rs.3.rs-3234952/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Trauma-Informed Care (TIC) is an evidence-based approach for improving health outcomes by providing systematic, trauma- sensitive and -responsive care. Because TIC adoption varies by setting and population, Implementation Science (IS) is particularly well-suited to guide roll-out efforts. Process Mapping (PM) is an IS model for creating shared visual depictions of systems as they are to identify rate-limiting steps of intervention adoption, but guidance on how to apply PM to guide TIC adoption is lacking. Authors of this study aimed to develop a novel method for conducting TIC-focused PM. Methods A real-life TIC implementation study is presented to show how TIC-focused PM was conducted in the case example of a pediatric HIV clinic in a Southern urban area with a high burden of psychological trauma among youth with HIV. A five-phase PM model was applied to evince clinic standards of care, including Preparation, planning and process identification; Data and information gathering; Map generation; Analysis; and Taking it forward. Practices and conditions from four TIC domains were assessed, including Trauma responsive services; Practices of inclusivity, safety, and wellness; Training and sustaining trauma responsiveness; and Cultural responsiveness. Results The TIC-focused PM method indicated the case clinic provided limited and non-systematic patient trauma screening, assessment, and interventions; limited efforts to promote professional quality of life and elicit and integrate patient experiences and preferences for care; no ongoing efforts to train and prepare workforce for trauma- sensitive or -responsive care; and no clinic-specific efforts to promote diversity, equity, and inclusion for patients and personnel. Conclusion Principles and constructs of resilience-focused TIC were synthesized with a five-phase PM model to generate a baseline depiction of TIC in a pediatric HIV clinic. Results will inform the implementation of TIC in the clinic. Future champions may follow the TIC-focused PM model to guide context-tailored TIC adoption.
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Anand P, Wilson J, Carter B, Bronstein A, Schwartz A, Harrington B, Adams T, Saine ME, Norris A, Metzger D, Short WR, Torgersen J. Clinic screening for adverse childhood experiences in people living with HIV to Improve Care Delivery. AIDS Care 2022; 34:1094-1102. [PMID: 34292107 DOI: 10.1080/09540121.2021.1956416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with negative health outcomes; however, screening for ACEs is not routinely performed among people living with HIV (PLWH). We conducted a single-center, cross-sectional pilot study to define the (1) prevalence of ACEs in PLWH and (2) acceptability of ACEs screening in routine out-patient clinical care. One hundred participants completed screening: median age of participants was 49 years (interquartile range: 38.5-59.5), 73% male, 66% Non-Hispanic Black/African American, and 47% gay/lesbian. Clinically significant ACEs score, defined as ≥4, was reported in 51%. High ACEs score was more common among participants <50 years old (64.7% vs. 36.7%; p < 0.01), but the prevalence of ACEs ≥4 did not differ by gender, race, ethnicity, or sexual orientation. Among participants with ≥4 ACEs, 44.4% screened negative on both PHQ-9 and PC-PTSD screens. The majority of participants (89%) reported a positive experience with ACEs screening. The prevalence of clinically significant ACEs in this clinic population of PLWH was more than twice that reported in the general population. Routine ACEs screening can improve delivery of trauma-informed care in the HIV primary care setting.
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Affiliation(s)
- Priyanka Anand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer Wilson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Bryce Carter
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Abby Bronstein
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Alexis Schwartz
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | | | - Tracey Adams
- Penn Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - M Elle Saine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anne Norris
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William R Short
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessie Torgersen
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Chenneville T, Drake H, Cario A, Rodriguez C. Adverse Childhood Experiences among a Sample of Youth Living with HIV in the Deep South. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9740. [PMID: 35955095 PMCID: PMC9368011 DOI: 10.3390/ijerph19159740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/10/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
The southern region of the United States, often referred to as the Deep South, is disproportionately affected by HIV. In fact, the highest rates of new HIV infections occur in the Deep South. Approximately one in five new HIV infections are among youth. Youth living with HIV (YLWH) have several behavioral health risks, including co-occurring mental health and substance abuse disorders, which negatively affect medication adherence, contribute to less engagement in HIV care, and result in poor health outcomes. Research suggests that adverse childhood experiences (ACEs) contribute to HIV risk behaviors and that people living with HIV may be more vulnerable to the negative health outcomes and adverse effects of stressors. Using existing program evaluation data, we examined data from 41 YLWH aged 17-24 screened for ACEs in an integrated care setting. Most participants were Black/African American young men who identified as homosexual, bisexual, or questioning, and who acquired HIV behaviorally. Approximately, one-third of YLWH screened positive or in the high-risk range on an ACEs screener. Scores fell in the intermediate range for nearly half of the sample. Results did not reveal a significant relationship between ACEs and HIV biological indicators. In this paper, we describe these findings and the importance of incorporating trauma-informed approaches into HIV prevention and treatment programs targeting youth in the Deep South.
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Affiliation(s)
- Tiffany Chenneville
- Department of Psychology, University of South Florida, St. Petersburg, FL 33701, USA
| | - Hunter Drake
- Community and Family Health, College of Public Health, University of South Florida, Tampa, FL 33620, USA
| | - Alexandra Cario
- Department of Pediatrics, University of South Florida, Tampa, FL 33620, USA
| | - Carina Rodriguez
- Department of Pediatrics, University of South Florida, Tampa, FL 33620, USA
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