Integrating program-tailored universal trauma screening into HIV care: an evidence-based participatory approach

ABSTRACT

Trauma is prevalent among HIV-infected populations and associated with negative HIV care outcomes. While several agencies have called for integrating trauma-informed care into HIV services, uptake has been limited and effective methods have not been delineated. To develop comprehensive trauma screening strategies tailored to a large, urban HIV care center, we aimed to first understand provider and staff perceptions of the center’s current level of trauma screening and barriers and facilitators to universal screening uptake. We used a mixed-methods convergent parallel design: quantitative assessments with 31 providers and staff and in-depth interviews with 19 providers and staff. Quantitative assessments highlighted center strengths (i.e. assessing effects of trauma, explaining care plans to patients, providing opportunities for questions) and gaps (i.e. asking about head injuries, emotional safety). Qualitative interviews suggested center screening practices were highly-variable and limited, identified gaps in interdepartmental communication regarding results of trauma screening that led to repeated screenings and potential patient re-traumatization, screening barriers (i.e. limited time, competing clinical priorities) and facilitators (i.e. provider-driven, standardized, non-disruptive screening with clear cut-points and follow-up steps). This study provides tangible strategies for the center to begin integrating universal trauma screening, many of which could be adapted by other U.S. HIV clinics.

KEYWORDS:

• Trauma
• screening
• assessment
• HIV care
• HIV

Acknowledgements

We would like to thank Drs Gene Farber, Rana Chakraborty, Andres Camacho-Gonzalez, and CHRIS 180 for their input in designing the study, Jasmine Lucas for recruiting participants and conducting the interviews, and study participants for openly sharing their experiences with us. We further acknowledge the Emory Center for AIDS Research (CFAR) Preventive Science Core for supplying tablet computers for the interviews and transcribing interviews and the Emory CFAR Clinical Core for assistance with participant recruitment and provision of research space.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by a developmental grant from the NIH Center for AIDS Research at Emory University (P30AI050409).