Scaling-Up Trauma-Informed Care in an HIV Clinical Network: Factors that Facilitate Implementation

Traumatic experiences, which are disproportionately common among people living with HIV/AIDS, exacerbate negative HIV care outcomes. Trauma-informed care (TIC) is an evidence-based treatment framework that recognizes and responds to patient trauma and minimizes the risk of re-traumatization. The study objective was to identify strategies to scale-up TIC among a large federally-funded (Ryan White) HIV clinical network in the U.S. Due to the high prevalence of trauma among patients in this network, TIC has been identified as a priority area for the network/federal funders, but minimal implementation guidance exists. To fill this gap, we conducted 37 interviews with administrators, providers, and staff from 20 HIV clinics in the U.S. to understand determinants of TIC adoption. We identified seven key determinants of TIC scale-up including: (1) Available Resources, (2) Networks and Communications, (3) Tension for Change, (4) Access to Knowledge and Information, (5) Culture, (6) Leadership Engagement, and (7) External Partnerships. We identified the different resources, strategies, and supports to promote adoption of each component of TIC. We discuss how to package strategies that fit the needs of various clinics at different stages of readiness to implement TIC.