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

这项提议的长期目标是消除夏威夷种族/民族之间的新冠肺炎差距 然而脆弱的人群，包括夏威夷土著和其他太平洋岛民(NHPI)，生活在农村和 通过将创新的SARS-CoV-2检测能力与新的针对社区的检测能力相结合，实现服务不足的社区 消息传递和教育。再加上长期存在的健康差距和社会经济挑战， 由于新冠肺炎，NHPI的感染率和死亡率都有所增加。到目前为止，NHPI位居 美国感染SARS-CoV-2病毒的最高比例，全国最高的RT，基本的 繁殖指标表明病毒传播的程度，夏威夷的NHPI分类数据进一步显示 差距。我们的合作伙伴怀亚奈海岸综合健康中心收集的初步测试数据 夏威夷最大的由联邦政府资助的社区卫生中心(WCCHC)表示，测试存在重大缺陷 特别是在太平洋岛民中。此外，我们观察到测试的覆盖率不足 在NHPI社区的年轻人(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检测到的无症状病例在内的因素使遏制的努力复杂化 进一步的社区传播。考虑到围绕重新开放企业和学校的公共卫生问题迫在眉睫， 这些差距突显出，迫切需要创新的方法来实现行为改变，同时 新的测试战略，以加强对所有社区成员，包括学龄儿童/青年的接触。 幸运的是，我们在夏威夷文化多元化人群中的合作伙伴关系提供了一个独特的机会来扩大 目前的新冠肺炎应对具有社区知识和韧性。我们提出这样的假设： 由新型医疗保健学校合作伙伴关系传播的社区情景信息，以及 强大的社区和以患者为中心的测试战略将扩大覆盖范围、访问、吸收和影响 新冠肺炎在弱势人群中的测试。为了验证这一假设，我们的多学科团队的目标是(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 提高吸纳能力和(2)优化和实施社区知情的新冠肺炎消息传递和 在夏威夷的NHPI人口中，通过一种新的社区医疗保健-学校网络合作伙伴关系进行教育。 在我们的母公司Ola Hawaii赠款的基础上，该项目利用了我们现有的社区参与， 生物统计和管理核心与NHPI的伙伴关系，以加强RADX-UP协调和数据 新冠肺炎检测相关结果和实施通用评估指标收集中心。 这将为一个积极参与的社区网络奠定基础，为在 夏威夷最危险的人群。鉴于改善公共卫生安全和重新开学的紧迫性， 该项目的结果可能会为卫生诊所和学校提供对综合模型或工具包的见解 在全国各地服务不足和易受伤害的社区，可以积极参与减轻这一流行病。

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.