Community Driven Approach to Mitigate COVID 19 Disparities in Hawaii's Vulnerable Populations

这项提案的长期目标是消除夏威夷不同种族/民族之间的COVID-19差异 然而，脆弱的人口，包括夏威夷土著人和其他太平洋岛民（NHPI）生活在农村， 通过将创新的SARS-CoV-2检测能力与新的社区特异性 信息传递和教育。再加上长期存在的健康差距和社会经济挑战， 由于COVID-19，NHPI的感染率和死亡率增加。迄今为止，国家卫生机构在 在美国，SARS-CoV-2的负担最重。 生殖指标表明病毒传播的程度，夏威夷的分解NHPI数据进一步揭示了 差距。由我们的合作伙伴，怀亚特海岸综合健康中心收集的初步测试数据 （WCCHC），夏威夷最大的联邦资助的社区卫生中心，表明在测试中存在重大缺陷 特别是在太平洋岛屿居民中。此外，我们观察到测试的覆盖率代表性不足 在国家艾滋病毒/艾滋病方案社区的青年人（5-19岁）中，尽管他们的感染率高于平均水平，其他 包括检测周转时间缓慢和未经检测的无症状病例在内的因素，使遏制 社区进一步扩大。鉴于重新开放企业和学校的公共卫生问题迫在眉睫， 这些差距突出表明，迫切需要创新的方法来实现行为改变， 新的检测战略，以增加所有社区成员，包括学龄儿童/青年的机会。 幸运的是，我们在夏威夷文化多样性人口中的伙伴关系提供了一个独特的机会， 当前的COVID-19应对与社区知识和韧性。我们提出假设， 新的卫生保健-学校伙伴关系传播的社区背景化信息， 强有力的社区和以患者为中心的检测战略将增加覆盖面，访问，吸收和影响， 在脆弱人群中进行COVID-19检测。为了验证这一假设，我们的多学科团队旨在（1） 评估SARS-CoV-2检测数据，确定检测中的差距和障碍，并加强社区检测 提高吸收率的能力，以及（2）优化和实施社区知情的COVID-19信息传递， 在整个夏威夷的NHPI人群中，与一个新的社区卫生保健-学校网络伙伴关系开展教育。 在我们的母公司“奥拉夏威夷”赠款的基础上，该项目利用了我们现有的社区参与， 与NHPI建立伙伴关系，以加强RADx-UP协调和数据 COVID-19检测相关结果和实施的通用评估指标收集中心。 这将为建立一个社区参与网络奠定基础， 夏威夷最危险的人群。鉴于改善公共卫生安全和重新开放学校的紧迫性， 该项目的结果可能会提供一个综合模型或工具包的见解，卫生诊所和学校可以从中受益。 在全国服务不足和脆弱的社区，可以积极参与减少这一流行病。

The long-term goal of this proposal is to eliminate COVID-19 disparities among Hawaii’s racial/ethnically diverse yet vulnerable populations including Native Hawaiian and other Pacific Islanders (NHPI) living in rural and underserved communities by integrating innovative SARS-CoV-2 testing capacity with novel community-specific messaging and education. Compounded by long-standing health disparities and socioeconomic challenges, NHPIs suffer from increased infection and mortality rates attributed to COVID-19. To date, NHPIs rank among the highest disproportionately burdened by SARS-CoV-2 in the U.S. With the nation’s highest Rt, a basic reproductive metric indicating the degree of viral spread, Hawaii’s disaggregated NHPI data reveal further disparities. Preliminary testing data collected by our partner, the Waianae Coast Comprehensive Health Center (WCCHC), Hawaii’s largest federally funded community health center, indicates a significant deficiency in testing uptake, especially among Pacific Islanders. Further, we observed under-representative coverage of testing among youth (ages 5-19 years old) in NHPI communities, despite their higher than average infection rate. Other factors, including slow testing turnaround time and untested asymptomatic cases, complicate efforts to contain further community spread. Given the looming public health concerns around re-opening businesses and schools, these gaps highlight the critical need for innovative approaches of effecting behavioral change coupled with novel testing strategies to enhance access to all community members, including school-aged children/youth. Fortunately, our partnerships in Hawaii’s culturally diverse populations offer a unique opportunity to augment the current COVID-19 response with community knowledge and resilience. We propose the hypothesis that community-contextualized messaging disseminated by novel healthcare-school partnerships coupled with a robust community and patient-centered testing strategy will increase reach, access, uptake, and impact for COVID-19 testing in vulnerable populations. To test this hypothesis, our multidisciplinary team aims to (1) evaluate SARS-CoV-2 testing data, identify gaps and barriers in testing, and augment community testing capacity to increase uptake and (2) optimize and implement community-informed COVID-19 messaging and education with a novel community healthcare-school network partnership in the NHPI population across Hawaii. Building on our parent “Ola HAWAII” grant, this project leverages our existing Community Engagement, Biostatistics, and Administrative Cores with NHPI partnerships to augment the RADx-UP Coordinating and Data Collection Center for common evaluation metrics on COVID-19 testing-related outcomes and implementation. This will lay the foundation for an engaged community network primed for disseminating anticipated vaccines in Hawaii’s highest risk populations. Given the urgency to both improve public health safety and re-opening schools, results from this project may offer insights into an integrated model or toolkit from which health clinics and schools in underserved & vulnerable communities across the country might actively participate in abating this pandemic.