Clinic-Community Bridge-to-Care Initiative: Trauma and Violence Informed Care (TVIC) with Women Survivors of Intimate Partner Violence (IPV) and Living with HIV/AIDS

Abstract Johns Hopkins John G. Bartlett Specialty Practice (JGBSP) and Johns Hopkins HIV Women's Health Program (JHHWHP) provides comprehensive HIV care and treatment to women (85% Black/African American) living with HIV/AIDS in Baltimore. The network of Hopkins clinicians practicing in JGBSP and JHHWHP (called the

Hopkins HIV Collaborative) identify multiple complex unmet health and social issues daily, such as intimate partner violence (IPV), housing instability and food insecurity that negatively impacts the health of women in their care. The intersection of IPV, poor mental health, housing instability and food insecurity are associated

with suboptimal HIV prevention and treatment outcomes, such as antiretroviral therapy failure and unsafe sexual practices. Approaches to IPV and social determinants of health in healthcare organizations are evolving from interventions that targets the woman’s behavior (”she should leave the abuser”) to interventions that

partner with community organizations to address IPV as a pervasive health and social problem embedded in structural inequities. Hopkins HIV Collaborative and Hopkins School of Nursing in partnership with community organizations, House of Ruth, Maryland (HRM), Technical Assistance Collaborative (TAC) and Older Women

Embracing Life (OWEL) and expert Advisory Board will adapt and implement a trauma and violence informed care (TVIC) intervention to improve HIV-related and mental outcomes by addressing social determinants of health with abused women living with HIV/AIDS (WLWHA). TVIC is an equity-based approach guided by the

ecological framework to account for the intersecting impacts of HIV, IPV and structural inequities on a woman’s life. The TVIC intervention includes: (1) universal education to create a safe environment in the healthcare setting for IPV disclosure; (2) counseling and advocacy based on women strengths and priorities; (3)

coordination with community partners to address unmet social determinant of health; and 4) integration of technology-facilitated safety planning (myPlan app) for clinic-community providers to support abused WLWHA to develop personalize safety plans that directly link to needed local services. The clinic-community partners

will conduct a hybrid type 2 effectiveness-implementation study to determine the effectiveness of the adapted TVIC intervention on HIV-related (e.g. viral load/CD4 and adherence) and mental health (e.g. depression and PTSD) outcomes with IPV(+) WLWHA and IPV (–) WLWHA. The partners will also examine mechanisms (e.g.,

safety behaviors and resources, housing security, food security) by which the TVIC intervention improves HIV- related and mental health outcomes with abused WLWHA. Our partnership will further examine organizational, program and contextual factors that facilitate the implementation of the TVIC intervention and are critical to

sustaining the intervention and clinic-community based partnerships.