Ending the HIV Epidemic through stigma-reduction: Applying Getting-To-Outcomes' in a Ryan White Healthcare Site

PROJECT SUMMARY HIV-related stigma is driving suboptimal HIV-related care, thwarting efforts to end the HIV epidemic. Available evidence must be leveraged on how to mitigate HIV-related stigma by implementing evidence-based approaches within healthcare settings. This requires an empirical understanding of how such interventions can best be implemented in real-world environments. Building on the outcomes from our EHE planning supplement ?Building a Coalition to Overcome Intersecting Stigmas and Improve HIV Prevention, Care Access, and Health Outcomes in New York City? and ongoing activities, this study will investigate whether ?Getting To Outcomes? (GTO) ? an evidence-based implementation model that guides institutions through the adoption, implementation, and evaluation of evidence-based intervention programs ? is a feasible and acceptable implementation strategy for addressing HIV-related stigma in a healthcare setting in New York City. By focusing on healthcare, this supplement primarily addresses the EHE pillar Treat and indirectly Diagnose and Prevent. GTO is grounded in implementation theory by integrating all major domains that influence implementation according to the Consolidated Framework for Implementation Research. Three research questions will be answered: (1) Is GTO an acceptable, feasible, and appropriate implementation strategy in healthcare settings for the planning, delivery, and evaluation of an evidence-informed multilevel intervention to reduce HIV-related stigma? (2) Which specific implementation determinants and strategies facilitate engagement in GTO? and (3) Which specific implementation determinants and strategies are associated with the quality of the planning, delivery, and evaluation of an evidence- informed stigma intervention? We will collaborate with the Ryan Chelsea-Clinton Community Health Center (RCC) by training a multidisciplinary Clinic Team in GTO and supporting this team through stigma intervention selection, implementation, and evaluation. As a healthcare clinic, RCC has identified the need to address stigma at the provider and system levels to enhance client engagement and retention, including for the promotion of viral suppression. The GTO process is facilitated by: (1) adapted tools; (2) training of the Clinic Team in using GTO; and (3) technical assistance by an Implementation Coach (IC). To answer research questions, data will be informed by the Consolidated Framework for Implementation Research; Expert Recommendations for Implementing Change; and the Stages of Implementation Completion, and will be collected from a variety of sources over the course of the project including interviews, the IC?s log, meeting minutes, and GTO tools.