Improving HIV Viral Suppression and Care Retention by Enhancing Clinic Social Environment A Randomized Trial

What this Trial Is About

This research aims to reduce racial disparities in HIV outcomes among people living with HIV PLWH, focusing on BlackAfrican American populations who experience lower rates of viral suppression and retention in care. The study evaluates the impact of structural racism and discrimination within healthcare organizations on these outcomes. It uses a randomized controlled trial RCT to test an intervention called Accessibility, Responsiveness, Continuity ARC designed to improve organizational social contexts that affect care quality and patient outcomes. The trial involves four clinics randomized to either receive ARC or continue with standard care. ARC uses evidence-based strategies including principles, tools, and mental models to create supportive organizational environments that help improve care for PLWH by addressing issues like referral and treatment patterns affected by structural racism. The intervention period lasts 36 months following a pre-implementation phase, with a subsequent 12-month post-implementation period to continue measuring outcomes in both groups. Participants include PLWH and clinic staff from the selected clinics. Researchers will collect data on viral suppression and retention in care over 12-month periods, along with intermediate outcomes such as linkage to mental health treatment and staff turnover. They will also evaluate individual and organizational factors influencing outcomes. The study includes assessments of acceptability, sustainability, and the cost of implementing ARC to better understand its impact on HIV care and health services.

Enhancing the Organizational Social Context to Improve Viral Suppression and Retention in HIV Care