Improving care for HIV patients by addressing structural racism and discrimination

Improving the Organizational Social Context to Address Structural Racism and Discrimination: A Randomized Controlled Trial to Reduce Racial Disparities in Viral Suppression and Retention in HIV Care

This study is trying to see if changing the way clinics treat patients can improve HIV care for racial and ethnic minorities who are facing discrimination.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 1500 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Pennsylvania (other)
• Locations: 1 site (Philadelphia, Pennsylvania)
• Trial ID: NCT06462807 on ClinicalTrials.gov

What this trial studies

This study aims to enhance the organizational social context within clinics to improve HIV care outcomes for racial and ethnic minority populations disproportionately affected by the epidemic. It focuses on understanding how structural racism and discrimination impact the quality of care and retention in HIV treatment. The intervention involves assessing and modifying the organizational culture and climate in participating clinics to foster better engagement and support for patients living with HIV. The study will involve both patients and clinic workers to create a comprehensive approach to addressing these disparities.

Who should consider this trial

Good fit: Ideal candidates include individuals living with HIV who are receiving care at one of the participating clinics in Philadelphia.

Not a fit: Patients currently incarcerated or those not receiving care at the specified clinics may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to improved retention in HIV care and better health outcomes for racial and ethnic minority populations.

How similar studies have performed: While the specific approach of addressing organizational social context in HIV care may be novel, other studies have shown success in improving health outcomes by addressing social determinants of health.

Eligibility criteria

Inclusion Criteria:

Aim 1:

* PLWH: in care in one of 12 clinics in Philadelphia

  1. HIV diagnosis date at least one year prior to the administration of the clinic OSC measures
  2. Philadelphia address at the time of HIV diagnosis
  3. successfully linked to care at any point during the study period, defined as having documentation of 1 or more CD4 or Viral Load test results after the date of diagnosis
* Clinic workers: clinic leaders, administrators, frontline staff, and providers across participating clinics

Aim 2:

* PLWH: having an established diagnosis of HIV and receiving care at one of the 4 clinics at least 6 months before the pre-implementation period
* Clinic workers: the entire pool of workers employed in the 2 clinics assigned to the intervention arm will be invited to participate in ARC

Aim 3:

\- Clinic staff and PLWH at clinics receiving ARC

Exclusion Criteria:

Aim 1:

* PLWH: Persons in a correctional facility will be excluded from this analysis
* Clinic workers: Participants who are not employed in one of the roles that were designated

Aim 2:

* PLWH: Patients who get discharged from a clinic because they moved (or for other reasons) or who died will not be eligible to enter the pre-implementation cohort.
* Clinic workers: Clinics assigned to SOC will not receive ARC but will be asked to complete surveys using the same schedule as the clinics assigned to receive ARC.

Where this trial is running

Philadelphia, Pennsylvania

• University of Pennsylvania — Philadelphia, Pennsylvania, United States (RECRUITING)

Conditions: HIV/AIDS