CRISOL: Building Community Resilience and Integrating Efforts to Understand and Address Syndemic Health Conditions Afflicting Young LatinoImmigrants

本次竞争性修订的目标是扩展我们的原始项目，以适应、实施和评估一个多 一级干预，以减轻COVID 19在拉丁美洲移民社区中的多方面费用， 费城有证据表明有有效战略来遏制这一流行病，减少差距，减轻其影响 缺乏，而且非常紧迫。在美国，拉丁裔移民是受这一流行病影响最严重的群体之一， 最近这一群体中COVID-19死亡人数的急剧增加证实了他们的风险持续增加 感染和易感性增加。拉丁裔移民长期以来在糖尿病、肥胖症、 和高血压，已知会增加COVID-19相关严重程度的因素，以及物质滥用， 暴力暴露、艾滋病毒/艾滋病和心理健康（SAVAME）综合征。这些综合症已经 在COVID-19的背景下恶化。拉丁裔移民代表着一个难以接触和边缘化的群体， 人口中的大多数人获得适当保健和安全网的机会极为有限。该组织面临许多 结构性障碍和社会脆弱性，阻碍了他们获得COVID-19检测的能力， 治疗服务，并坚持公共卫生干预措施和措施，以减少 2019冠状病毒病。拉丁美洲人往往依赖于一个薄弱而分散的卫生和社会服务组织网络。 减轻COVID-19对这一人群影响的干预措施需要有广泛的利益相关者 参与和解决广泛的健康决定因素。同侪驱动的干预措施是有效的 预防和控制拉丁美洲人口中的艾滋病毒、性传播感染等传染病。 加强社区成员与这些组织之间的联系， 组织协调，以满足拉丁美洲人的综合健康，行为，经济和法律的需求 社区是减轻COVID-19对这一低资源人群影响的重要因素。在 直接响应NOT-MD-20-022/PAR PA-18-935，我们正在进行的社区-学术合作伙伴关系 建议评估“CRISOL控制”，一个多层次的干预，以解决创造或放大的需求 新冠肺炎疫情在费城的拉丁裔社区蔓延。CRISOL连接器包括一个同行- 推动计划和动员拉丁美洲服务组织。在目标1中，我们将调整一个正在进行的流行 意见领袖（POL）计划，以解决与COVID-19相关的独特健康，社会和经济需求 和SAVAME综合征在目标2中，我们将评估CRISOL Concrete在改善COVID-19方面的有效性 相关的预防性健康行为以及使用和获得COVID-19相关的检测和护理（共同初级 成果）。在目标3中，我们将研究CRISOL咨询对社区资产、机构间 费城拉丁裔服务组织之间的合作和协调。差不多有20个 在美国有数百万拉丁裔移民，他们在维持美国经济的重要部分方面发挥着核心作用 迫切需要考虑到拉丁美洲人独特需求的量身定制的多层次干预措施，以减轻 本次及未来COVID-19疫情对弱势群体的影响。

This goal of this competitive revision is to expand our original project to adapt, implement and evaluate a multi- level intervention to mitigate the multi-dimensional toll of COVID19 among Latino immigrant communities in Philadelphia. Evidence of effective strategies to curb the pandemic, reduce disparities and mitigate its impact is lacking and very urgent. In the US, Latino immigrants are one of the groups hardest hit by this pandemic, with recent steep increases in COVID-19 deaths among this group corroborating their continued increased risk of infection and increased susceptibility. Latino immigrants have long exhibited disparities in diabetes, obesity and hypertension, factors known to increase COVID-19 related severity, and also in Substance Abuse, Violence exposure, HIV/AIDS, and MEntal health (SAVAME) syndemic. These syndemic conditions have been worsened in the context of COVID-19. Latino immigrants represent a hard-to-reach and marginalized population, with extremely limited access to adequate health care and safety nets. This group faces many structural barriers, and social vulnerabilities, that hinder their capacity to access COVID-19 testing and treatment services and to adhere to public health interventions and measures to decrease the spread of COVID-19. Latinos often rely on a thin and fragmented network of health and social services organizations. Intervention to mitigate the impact of COVID-19 on this population will need to have a broad stakeholder engagement and address a wide range of health determinants. Peer-driven interventions have been effective for the prevention and control of infectious diseases such as HIV, STIs among Latino populations. Strengthening the links between community members and these organizations and promoting inter- organizational coordination to meet syndemic health, behavioral, economic, and legal needs of Latino communities are essential elements to mitigate the impact of COVID-19 on this low-resource population. In direct response to the NOT-MD-20-022/PAR PA-18-935, our ongoing community-academic partnership proposes to evaluate “CRISOL Contigo,” a multi-level intervention to address the needs created or magnified by the COVID-19 pandemic among Latino communities in Philadelphia. CRISOL Contigo includes a peer- driven program and mobilization of Latino-serving organizations. In aim 1, we will adapt an ongoing Popular Opinion Leader (POL) program to address the unique health, social, and economic needs related to COVID-19 and the SAVAME syndemic. In aim 2, we will assess the efficacy of CRISOL Contigo to improve COVID-19 related preventive health behaviors and use and access to COVID-19 related testing and care (co-primary outcomes). In aim 3, we will examine the impact of CRISOL Contigo on community assets, interagency collaborations and coordination among the Latino-serving organizations in Philadelphia. There are almost 20 million Latino immigrants in the US, and they play a central role in sustaining the vital parts of the US economy Tailored, multi-level interventions that consider the unique needs of Latinos are urgently needed to mitigate the impact of this and future outbreaks of COVID-19 on this disadvantaged population.