Ending the HIV Epidemic With Equity: an Intervention to Reduce the Impact of Racism and Discrimination
- Conditions
- Discrimination, RacialStigmatizationHIV
- Interventions
- Behavioral: TRAncenDS
- Registration Number
- NCT05785169
- Lead Sponsor
- Columbia University
- Brief Summary
The scope of this study is to engage Ryan White HIV/AIDS Program (RWHAP) funded organizations in the South/East US to co-develop context-responsive programs to reduce structural racism and discrimination (SRD) against Black, Indigenous, People of Color (BIPOC) living with HIV (PLH) and BIPOC healthcare workers. Six RWHAP clinics will be selected to participate and be assigned to one of three sequences (two clinics per cluster). All members will complete participate in interactive trainings to raise awareness of and reduce SRD, from the clinic policy level, to attitudes, to the clinic environment. All clinic members and select patients will complete self-administered surveys every 6 months over 24 months.
- Detailed Description
The scope of this study is to engage Ryan White HIV/AIDS Program (RWHAP) funded organizations in the South/East US to co-develop context-responsive programs utilizing evidence-informed interventions to reduce structural racism and discrimination (SRD) against Black, Indigenous, People of Color (BIPOC) living with HIV (PLH) and BIPOC healthcare workers. SRD directly impacts access to and uptake of healthcare for BIPOC, including engagement in HIV services across the continuum of prevention and care. The proposed intervention, titled TRAnscenDS, draws on the evidence-based Health Policy Plus (HP+) 'total' facility HIV stigma-reduction intervention and Contact Theory of demonstrated efficacy in reducing race-related intergroup prejudice. TRAnscenDS targets the clinics' organizational (e.g.,policies) and systems (e.g., staff attitudes/behaviors) levels to affect patient (e.g., experienced and perceived discrimination, HIV care, mental health) outcomes and staff wellbeing, at the individual level. Findings will yield a Manual for implementing total-facility SRD-reduction processes and content. Other RWHAP-funded clinics and facilities serving marginalized groups may be able to adopt this manualized yet highly adaptable intervention packet to support BIPOC.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 2400
- Selected Ryan White Clinics. Selection based on the following:
First, clinic leaders will complete a 15-min Site Characteristics Survey, assessing suitability for participation and clinic comparability for randomization purposes. Staff and leadership at Ryan White clinics will next complete an anonymous 15-minute Eligibility Survey.
Within each clinic, both clinic staff and patients will be invited to participate.
- Non-Ryan White Clinics
- Clinics that do not serve a primarily BIPOC population
- Clinics that are not interested in participating
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Second Cluster TRAncenDS The intervention will be implemented across three steps with a total of 6 clinics (two clinics per step). The earliest roll-out of the intervention will be at the clinics randomized to Cluster 1. The intervention consists of a mix of Workshops, Interactive Trainings and Learning Circles (virtual and in-person). In the first workshop, the investigators will present baseline findings to all clinic members to 1) raise awareness for the need for intervention to reduce Structural Racism and Discrimination (SRD) , 2) facilitate collaborative processes, 3) catalyze change for practice transformation, to 4) guide the intervention process. This workshop will be followed by a series of interactive trainings covering topics from the history of structural racism, to intersectional stigma and discrimination, bias, systems of accountability, and the creation of a manual to guide the implementation and sustainability of SRD reduction efforts. First Cluster TRAncenDS The intervention will be implemented across three steps with a total of 6 clinics (two clinics per step). The earliest roll-out of the intervention will be at the clinics randomized to Cluster 1. The intervention consists of a mix of Workshops, Interactive Trainings and Learning Circles (virtual and in-person). In the first workshop, the investigators will present baseline findings to all clinic members to 1) raise awareness for the need for intervention to reduce Structural Racism and Discrimination (SRD) , 2) facilitate collaborative processes, 3) catalyze change for practice transformation, to 4) guide the intervention process. This workshop will be followed by a series of interactive trainings covering topics from the history of structural racism, to intersectional stigma and discrimination, bias, systems of accountability, and the creation of a manual to guide the implementation and sustainability of SRD reduction efforts. Third Cluster TRAncenDS The intervention will be implemented across three steps with a total of 6 clinics (two clinics per step). The earliest roll-out of the intervention will be at the clinics randomized to Cluster 1. The intervention consists of a mix of Workshops, Interactive Trainings and Learning Circles (virtual and in-person). In the first workshop, the investigators will present baseline findings to all clinic members to 1) raise awareness for the need for intervention to reduce Structural Racism and Discrimination (SRD) , 2) facilitate collaborative processes, 3) catalyze change for practice transformation, to 4) guide the intervention process. This workshop will be followed by a series of interactive trainings covering topics from the history of structural racism, to intersectional stigma and discrimination, bias, systems of accountability, and the creation of a manual to guide the implementation and sustainability of SRD reduction efforts.
- Primary Outcome Measures
Name Time Method Change in Structural Racial Discrimination Index (SRD) Baseline, 6, 12, 18, and 24 months The SRD is a rating of clinic mission/vision statements, the anti-racist policy, and the clinic environment. A change in the mean score of SRD Index, post-intervention implementation will be measured. Scores range from 0-100, with a higher score indicating increased anti-racist policies and procedures.
- Secondary Outcome Measures
Name Time Method Change in Modern Racism Scale (MRS) Score Baseline, 6, 12, 18, and 24 months The MRS is a scale of racial attitudes and consists of 7 items worded as opinion statements. One item, which is considered non-racist is reverse coded before scoring. The response scale is 1= strongly disagree to 5= strongly agree. Scores range from 7-35 with a lower score indicating a better outcome.
Change in Cultural Humility Score Baseline, 6, 12, 18, and 24 months Cultural humility as measured by the adapted Trauma-Informed, Resilience-Oriented Care (TI-ROC) Cultural Humility Scale, which assess staff's perceptions of colleagues and clinic environment. Scores range from 12-60. The negative items are reverse coded such that higher scores indicate higher cultural humility indicating better outcome.
Trial Locations
- Locations (1)
Columbia University School of Nursing
🇺🇸New York, New York, United States