Utility of Collaborative Implementation of Trauma-Informed HIV Care with Youth in Memphis, Tennessee (Preprint)

BACKGROUND Background: Goals for ending the HIV epidemic prioritize implementation of trauma-informed care (TIC), an operating paradigm for fostering multi-level resilience and empowerment. However, a dearth of literature explores strategies for collaboratively conducting TIC implementation. Research co-production could be an effective strategy for facilitating collaborative TIC adoption, but formative research is needed to explore this potential. OBJECTIVE Objective: We present findings from a longitudinal study to co-produce TIC implementation at an adolescent-focused HIV clinic in a nationally prioritized jurisdiction in the Southern United States. Results will contribute to a deeper understanding of local context and be used to tailor TIC implementation for the specific needs of the clinic. METHODS Methods: This study builds on our multi-phase, pre-implementation stage research and applies mixed methods to explore potential barriers and facilitators to collaborative TIC implementation in the HIV care clinic. We employed purposive sampling to conduct semi-structured interviews and surveys with clinic personnel. Thematic analysis was conducted using two implementation science frameworks in order to support locally-responsive and effective TIC implementation. The Consolidated Framework for Implementation Research (CFIR) 2.0 was used to explore general features of the implementation environment, and the Research Quality Plus for Co-Production (RQ+ 4 Co-Pro) framework was used to explore the context for co-producing the implementation strategy at and for the clinic. RESULTS Results: Twenty personnel completed interviews and nine completed surveys. Facilitators included clinic cohesiveness, equity focus, and prioritization/compatibility of TIC. Barriers included perceived disconnect between the clinic and larger hospital, perceived stigma, sustainability, leadership championship, insufficient mental health protocols, a lack of formal patient feedback procedures, and protected time for personnel activity engagement. Survey responses suggest the clinic environment is supportive of collaborative research and empowers participation among personnel. Evidence is seen as prioritized in the environment, with an openness for new approaches and a focus on health disparities. However, there was an identified need to develop a clear path and capacities for systematic collaborative TIC research (e.g., designated time for personnel to devote to research). CONCLUSIONS Conclusions: Collaborative TIC implementation was seen as a strategy likely to be supported by the clinic, but several areas of need were highlighted. Future research will be conducted to adapt a multi-level TIC intervention by addressing and leveraging the identified implementation determinants and test the application of co-production as an implementation strategy.