Project Summary While Black persons account for approximately 14.6% of the US population, among those with end-stage renal disease (ESRD) 35% are Black. Treatment options include dialysis, but best outcomes (survival, quality of life, cost) are achieved with kidney transplantation. Yet, Black ESRD patients are less likely referred for kidney transplant evaluation - a national mandate for those with ESRD - less likely listed for kidney transplantation, less likely to receive a kidney transplantation. As outlined by the FOA (RFA-DK-22-014), structural racism is a fundamental cause of the stark racial disparity in health outcomes for Black patients with ESRD in the US. Chicago is one of the most segregated cities in the US and serves as an excellent example of structurally racist communities that have disinvested in Black communities with a mean life-expectancy that is almost 30 years lower than that of affluent predominantly White Chicago neighborhoods. To counteract these severe forces of structural racism, Dr. Simpson, engaged with the Black community to build and name the first and largest African American Transplant Access Program {AATAP) in the nation and has enjoyed national prominence. AATAP is a multi-pronged intervention with 4 pillars: 1. Cultural Congruency, 2. Trust/Activation, 3. Health Literacy, and 4. Psychosocial Support taking a 'Keeping it RE.A.LL.' (Racial concordance between provider and patient, Empathy, Affirmation, Length of visit and Lay person language) approach. Aim 1. To study the impact of African American Transplant Access Program (AATAP) designed to mitigate structural racism and reduce health inequities for Black ESRD patients Aim 1.1. To assess the impact of AATAP on patients' perception of health-related quality of life, social support, patient activation, self-efficacy, knowledge about kidney transplant and perception about discrimination Aim 1.2. To assess impact of AATAP on process measure {e.g., time to listing, completion of work-up, listing) Aim 1.3. To assess impact of community engagement and dissemination of information aboutAATAP on referral for kidney transplant Aim 2: To increase awareness and structural competency among transplant gatekeepers at 2 large kidney transplant centers Aim 2.1. To study the experience of Black patients, providers, and team members in terms of perception of discrimination within the transplant health system through qualitative interviews Aim 2.2. To perform recurrent implicit bias and structural competency training Aim 2.3. To assess perceived discrimination of Black patients over time Aim 3: To demonstrate generalizability by adapting the AATAP program to a second large kidney transplant program in Tampa Florida

Narrative End-stage renal disease afflicts Black persons disproportionately more than other races/ethnicity and although kidney transplantation provides the best outcomes for patients, Black patients with end-stage renal disease are less likely referred for kidney transplant evaluation, less likely listed for kidney transplantation, and less likely to receive a kidney transplantation. Structural racism is a fundamental cause of racial disparity in health outcomes for Black patients with end-stage renal disease and to this end - rooted in the Black experience - Dr. Simpson together with the Black community created the first African American Transplant Access Program {AATAP) in the country at a large transplant center in the heart of diverse Chicago. This grant proposes (i) to study the impact of AATAP on patients and transplant metrics (e.g., listing rates), (ii) to increase awareness and structural competency among transplant gatekeepers {clinicians, staff) and {iii) to demonstrate generalizability by adapting the AATAP program to another large kidney transplant program in Florida.