# Ending the HIV Epidemic with Equity: An All-facility Intervention to Reduce Structural Racism and Discrimination and Its Impact on Patient and Healthcare Staff Wellbeing

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $848,121

## Abstract

Project Summary
The scope of this study is to engage Ryan White HIV/AIDS Program (RWHAP) funded organizations in Ending
the HIV Epidemic (ETHE) areas in the South/East US to co-develop context-responsive programs utilizing evi-
dence-informed interventions to reduce structural racism and discrimination (SRD) against Black, Indigenous,
People of Color (BIPOC) living with HIV (PLH) and BIPOC healthcare workers. SRD directly impacts access to
and uptake of healthcare for BIPOC, including engagement in HIV services across the continuum of prevention
and care. The proposed intervention, titled TRAnscenDS, draws on the evidence-based Health Policy Plus
(HP+) ‘total’ facility HIV stigma-reduction intervention and Contact Theory, which have demonstrated efficacy
in reducing race-related intergroup prejudice. TRAnscenDS targets the clinics’ organizational (e.g., anti-racist
and diversity, equity and inclusion [DEI] policies) and systems (e.g., staff attitudes/behaviors) levels to affect
patient (e.g., experienced and perceived discrimination, HIV care, mental health) outcomes and staff (e.g., job
satisfaction) wellbeing, at the individual level. In Aim 1, we will rigorously select 6 clinics from ETHE areas evi-
dencing full commitment to dismantling SRD (mos 3-9). In Aim 2, after a baseline assessment (N=180; mos
11-12), we will conduct a stepped wedge cluster randomized trial of the SRD reduction intervention. At each of
the 3 steps, two randomized clinics will receive TRAnscenDS. The intervention will support clinics to 1) identi-
fy/create organizational-level anti-racist policies and practices (e.g., clear definitions of racist behavior, ade-
quate training and monitoring systems, and prompt responses for constructive redress) to reduce SRD and
increase race-based equity for BIPOC patients and provider/staff, and 2) deliver race-specific trainings to all
staff (e.g., history of SRD, health consequences of bias and discrimination, cultural humility, intersectional dis-
crimination at the confluence of race, ethnicity, sexuality and gender). Each cluster will receive the intervention
for 6 mos, starting with Cluster Group 1 (mos 13-18), followed by Cluster Groups 2 (mos 19-24) and 3 (mos
25-30). In Aim 3, we will evaluate multi-level outcomes using the CFIR, including within the organization (pri-
mary outcome of SRD Index – ratings of mission/vision statements, anti-racist policy, workforce diversity, equi-
ty and inclusion [DEI], clinic environment), systems (secondary outcomes of provider/staff attitudes; behavior;
DEI indicators), and individual patient level (tertiary outcomes of clinic-level HIV indicators, reports of discrimi-
nation, medical distrust, anxiety, depression, and trauma) outcomes. Assessments will take place every 6
months, with the clinics randomized to the second or third step having multiple assessments before the inter-
vention (with final data collection being in month 49). BIPOC patients at the clinics will be surveyed at each...

## Key facts

- **NIH application ID:** 10474844
- **Project number:** 1R01NR020583-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Felicia Amira Browne
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $848,121
- **Award type:** 1
- **Project period:** 2022-07-01 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474844

## Citation

> US National Institutes of Health, RePORTER application 10474844, Ending the HIV Epidemic with Equity: An All-facility Intervention to Reduce Structural Racism and Discrimination and Its Impact on Patient and Healthcare Staff Wellbeing (1R01NR020583-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10474844. Licensed CC0.

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