Evaluation of a novel community-based COVID-19 'Test-to-Care' model for low-income populations.
Evaluation of a novel community-based COVID-19 'Test-to-Care' model for low-income populations.
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DOI：
10.1371/journal.pone.0239400
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Marquez C
中科院分区：
文献类型：
--
作者：
Kerkhoff AD;Sachdev D;Mizany S;Rojas S;Gandhi M;Peng J;Black D;Jones D;Rojas S;Jacobo J;Tulier-Laiwa V;Petersen M;Martinez J;Chamie G;Havlir DV;Marquez C
在COVID-19确诊后，脆弱人群在隔离和检疫方面面临相当大的后勤和财政挑战。我们开发并评估了一种新的基于社区的方法（“测试到护理”模型），旨在为新诊断出COVID-19的社会经济脆弱的拉丁裔个人及其家庭解决这些障碍。这个为期三周的示范项目是嵌套在一个流行病学监测研究在弗朗西斯科，加州州的使命区的主要拉丁裔社区。从测试到护理模式是在社区成员和公共卫生领导人的投入下开发的。主要组成部分包括：（1）提供与COVID-19相关的教育和有关可用社区资源的信息;（2）送货上门，以促进安全隔离和检疫（杂货、个人防护设备和清洁用品）;以及（3）纵向临床和社会支持。新的SARS-CoV-2 PCR阳性参与者有资格参加。该模型的组成部分由测试到护理团队提供，该团队由医疗保健提供者和社区卫生工作者（CHW）组成，他们在隔离期间提供纵向诊所和社区支持，以加强公共卫生部（DPH）的现有服务。我们使用覆盖、有效性、采用、实施、维护（RE-AIM）框架评估了测试到护理模型，并利用了多个数据源，包括：计划数据、与参与者和提供者/CHW的非正式访谈以及提供者/CHW之间的结构化调查。总体而言，监测研究中有83名参与者被诊断患有COVID-19，其中95%（79/83）是拉丁裔，88%（65/74）的家庭年收入<50，000美元。96%（80/83）的参与者获得了结果披露、需求评估和接触者追踪的DPH联系。在接受初步需求评估的人中，45%（36/80）没有保险，55%（44/80）没有与初级保健联系。67%（56/83）的参与者请求社区卫生工作者支持，以便在其当前地址安全隔离，65%（54/83）的COVID-19参与者在整个自我隔离期间通过社区卫生工作者获得持续的社区支持。参与者报告说，干预是高度可接受的，他们的信任随着时间的推移而增加，这导致9个人谁披露了更多的家庭成员比第一次报告，和6人谁要求临时搬迁到酒店房间隔离，尽管最初拒绝这项服务，没有意外的伤害被确定。测试到护理模式被认为是可以接受的和可行的供应商和CHW。查明的挑战包括，尽管有支助，但与初级保健有关的参与者比例很低（一个月后约为10%），以及无法充分获得工资替代的财政支助。检测到护理模式是一种可行且可接受的干预措施，通过直接解决社会经济弱势群体面临的主要障碍，支持新诊断的COVID-19患者及其家庭的自我隔离和隔离。
After a COVID-19 diagnosis, vulnerable populations face considerable logistical and financial challenges to isolate and quarantine. We developed and evaluated a novel, community-based approach (‘Test-to-Care’ Model) designed to address these barriers for socioeconomically vulnerable Latinx individuals with newly diagnosed COVID-19 and their households. This three-week demonstration project was nested within an epidemiologic surveillance study in a primarily Latinx neighborhood in the Mission district of San Francisco, California. The Test-to-Care model was developed with input from community members and public health leaders. Key components included: (1) provision of COVID-19-related education and information about available community resources, (2) home deliveries of material goods to facilitate safe isolation and quarantine (groceries, personal protective equipment and cleaning supplies), and (3) longitudinal clinical and social support. Newly SARS-CoV-2 PCR-positive participants were eligible to participate. Components of the model were delivered by the Test-to-Care team, which was comprised of healthcare providers and community health workers (CHWs) who provided longitudinal clinic- and community-based support for the duration of the isolation period to augment existing services from the Department of Public Health (DPH). We evaluated the Test-to-Care Model using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework and drew upon multiple data sources including: programmatic data, informal interviews with participants and providers/CHWs and structured surveys among providers/CHWs. Overall, 83 participants in the surveillance study were diagnosed with COVID-19, of whom 95% (79/83) were Latinx and 88% (65/74) had an annual household income <$50,000. Ninety-six percent (80/83) of participants were reached for results disclosure, needs assessment and DPH linkage for contact tracing. Among those who underwent an initial needs assessment, 45% (36/80) were uninsured and 55% (44/80) were not connected to primary care. Sixty-seven percent (56/83) of participants requested community-based CHW support to safely isolate at their current address and 65% (54/83) of all COVID-19 participants received ongoing community support via CHWs for the entire self-isolation period. Participants reported that the intervention was highly acceptable and that their trust increased over time–this resulted in 9 individuals who disclosed a larger number of household members than first reported, and 6 persons who requested temporary relocation to a hotel room for isolation despite initially declining this service; no unintended harms were identified. The Test-to-Care Model was found to be both acceptable and feasible to providers and CHWs. Challenges identified included a low proportion of participants linked to primary care despite support (approximately 10% after one month), and insufficient access to financial support for wage replacement. The Test-to-Care Model is a feasible and acceptable intervention for supporting self-isolation and quarantine among newly diagnosed COVID-19 patients and their households by directly addressing key barriers faced by socioeconomically vulnerable populations.
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影响因子：
6.4
作者：
Gil, Raul Macias;Marcelin, Jasmine R.;Piggott, Damani A.
通讯作者：
Piggott, Damani A.
DOI：
10.1186/s13012-017-0605-9
发表时间：
2017-06-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Atkins L;Francis J;Islam R;O'Connor D;Patey A;Ivers N;Foy R;Duncan EM;Colquhoun H;Grimshaw JM;Lawton R;Michie S
通讯作者：
Michie S
影响因子：
5.5
作者：
Bowen, Deborah J.;Kreuter, Matthew;Spring, Bonnie;Cofta-Woerpel, Ludmila;Linnan, Laura;Weiner, Diane;Bakken, Suzanne;Kaplan, Cecilia Patrick;Squiers, Linda;Fabrizio, Cecilia;Fernandez, Maria
通讯作者：
Fernandez, Maria
影响因子：
12.7
作者：
Kangovi, Shreya;Mitra, Nandita;Long, Judith A.
通讯作者：
Long, Judith A.
影响因子：
4.9
作者：
Christopoulos, Katerina A.;Kaplan, Beth;Hare, C. Bradley
通讯作者：
Hare, C. Bradley