# 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

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $777,377

## Abstract

Abstract/ Project Summary: Despite the widespread use of effective antiretroviral therapy (ART), the HIV
epidemic continues to impact racial and ethnic minority populations disproportionately. Although Black/African
American persons account for 13% of the U.S. population, they account for 41% of new HIV diagnoses and
experience the lowest rates of retention in HIV care and viral suppression (VS) compared to other racial/ethnic
groups. Structural racism and discrimination (SRD) likely contribute to racial disparities in HIV outcomes.
Although the outpatient setting is a vitally important aspect of care provision for PLWH, there are limited data
on the impact of intra-organizational SRD on HIV outcomes. Longitudinal engagement in HIV care is needed
for sustained VS, decreased community transmission of HIV. The organizational social context (OSC) includes
organizational culture (organizational norms and values that drive quality of care), organizational climate
(perception of the culture and how it impacts personal well-being), and workers' attitudes. Using a
randomized controlled trial, we will implement ARC (Accessibility, Responsiveness, Continuity) to
improve organizational behavior and reduce racial disparities in HIV outcomes for PLWH. ARC is an
evidence-based intervention that uses three strategies (ARC principles, ARC component tools, and ARC
mental models) to create OSCs that support the implementation of interventions to improve patient outcomes.
Clinics will be randomized to ARC (n = 2) or standard of care (SOC; n= 2). Those assigned to ARC will
address SRD occurring at the organizational level affecting care, including referral and treatment patterns for
PLWH. A pre-implementation period will be followed by ARC and ARC-associated implementation strategies
for 36 months and then a 12-month post-implementation period where we will continue to measure HIV
outcomes in both arms. We will compare HIV outcomes, namely VS and retention in care, and intermediate
outcomes, such as linkage to mental health treatment and staff turn-over in clinics assigned to ARC and SOC.
We will also evaluate whether individual (self-efficacy, perceived discrimination) and organizational factors
(OSC and cohesion of OSC measures) mediate the relationship between ARC, intermediate, and HIV
outcomes. In preparation to the RCT, we will evaluate baseline OSC measures across 12 HIV clinics in
Philadelphia and determine aspects of the OSC associated with VS and retention in care in a multi-level model
adjusting for neighborhood SRD, patient-level factors, and clustering of patients nested in clinics and
neighborhoods. We will then test the effectiveness of ARC in improving a primary outcome of VS and
secondary outcome of retention in care at the end of the implementation period. We will examine the
acceptability, sustainability, and cost of implementing ARC in outpatient HIV care. This research will advance
understanding of the impact of SRD on HIV treatment outcomes and...

## Key facts

- **NIH application ID:** 10865072
- **Project number:** 5R01NR020764-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** JOHN BARTON JEMMOTT
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $777,377
- **Award type:** 5
- **Project period:** 2022-09-16 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10865072

## Citation

> US National Institutes of Health, RePORTER application 10865072, 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 (5R01NR020764-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10865072. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*