Building on Needle Exchange to Optimize HIV Prevention/Treatment

项目总结 拉美裔是美国受新冠肺炎疫情影响最严重的社区之一，还有更多 这一比例是非西班牙裔白人的3倍多。为了解决这种差异，这支调查团队和 社区合作伙伴已经建立了一种多管齐下的方法，利用受信任的 双语/双文化同行导航员(或推动者)，以解决创造 检测障碍(如缺乏保险、移民身份、污名化或失去工作/收入)和 扩大在社区环境下免费新冠肺炎测试的渠道。我们的初步发现表明，杠杆化 推广者模式，及时交付结果(48小时内)，配合新冠肺炎的快速联动 阳性患者接受危重服务(包括临床随访、送餐、现金援助和/或隔离 酒店)，以及推荐联系人进行测试，提高了对新冠肺炎测试的接受度和接受度 影响了拉美裔社区。这个名为Juntos(一起)的第一阶段测试研究项目的总体目标是 就是与我们的社区合作伙伴密切合作，系统地评估和完善当前的新冠肺炎测试 战略，并实施和评估创新的定制战略，以迅速扩大覆盖范围、获取 接受、吸收和维持FDA授权/批准的诊断(特别是病毒测试) 高度脆弱和医疗保健边缘化的社区。利用社区合作伙伴关系和之前的 实施艾滋病毒检测活动的经验，我们将开发和评估定制的Juntos CoVID- 19测试活动，以解决拉美裔社区的具体共同关切，并将用户与现有用户联系起来 约翰霍普金斯大学新冠肺炎社区测试网站和新的选项，包括基于家庭和/或自我 检测试剂盒和快速检测(目标1)。为了评估Juntos新冠肺炎测试项目的整体影响，我们 将依赖于最新的因果推断方法来评估人口层面的卫生干预措施和 实施一项综合对照分析，以比较巴尔的摩拉丁裔的检测摄取率和阳性率 城市(干预地点)与控制整个马里兰州的邮政编码相比。(目标2)。最后，由以下人员通知 实施研究综合框架(CFIR)和RE-AIM框架，我们将评估 现有和新的Juntos测试干预措施的实施决定因素、机制和结果 通报未来的大规模实施情况(目标3)。我们已经组建了一个多学科的团队， 在实施科学、基于社区的研究和实验室医学方面的方法学专长，以及 与我们在马里兰州卡萨市埃斯佩兰萨中心的合作伙伴进行成熟和长期的合作 市长移民事务办公室和宗教领袖。我们的团队热情地提出了这一点 开展实施研究，以加强拉美裔社区获得检测的机会，并将积极协调和 与其他受赠人、CDCC和RADX-UP支持的其他研究共享数据和协议 程序。

PROJECT SUMMARY Latinos are among the most heavily impacted communities by the COVID-19 pandemic in the US, with more than 3 times higher rate than non-Hispanic whites. To address this disparity, this team of investigators and community partners has established a multi-pronged approach that leverages the skill set of trusted bilingual/bicultural peer navigators (or promotoras) to address social determinants of health (SDOH) that create barriers to testing (such as lack of insurance, immigration status, stigmatization or loss of job/income), and to expand access to free COVID-19 testing in community settings. Our preliminary findings show that leveraging the promotora model for timely delivery of results (within 48 hours), paired with rapid linkage of COVID-19 positive patients to critical services (including clinical follow-up, food delivery, cash assistance, and/or isolation hotel), and referral of contacts for testing, increased acceptability and uptake of COVID-19 testing in a heavily impacted Latino community. The overall goal of this Phase I Testing Research Project called Juntos (Together) is to work closely with our community partners to systematically evaluate and refine current COVID-19 testing strategies, and to implement and evaluate innovative customized strategies to rapidly increase reach, access, acceptance, uptake, and sustainment of FDA-authorized/approved diagnostics (especially viral tests) for this highly vulnerable and health care marginalized community. Leveraging community partnerships and prior experience implementing an HIV testing campaign, we will develop and evaluate a customized Juntos COVID- 19 testing campaign to address specific common concerns in the Latino community and link users to existing Johns Hopkins COVID-19 community testing sites and to new options, including home-based and/or self- testing kits and rapid tests (Aim 1). To assess the overall impact of the Juntos COVID-19 Testing Project, we will rely on the latest in causal inference methods for evaluating population-level health interventions and implement a synthetic control analysis to compare testing uptake and positivity rate among Latinos in Baltimore City (intervention site) as compared to control zip codes across Maryland. (Aim 2). Finally, informed by Consolidated Framework for Implementation Research (CFIR) and RE-AIM framework, we will assess the implementation determinants, mechanisms, and outcomes of existing and novel Juntos testing interventions to inform future broad-scale implementation (Aim 3). We have assembled a multi-disciplinary team with methodological expertise in implementation science, community-based research, and laboratory medicine, and have a mature and long-standing collaboration with our partners at Esperanza Center, Casa de Maryland, the Mayor's Office of Immigrant Affairs, and religious leaders. Our team is enthusiastic to propose this implementation study to enhance access to testing for the Latino community, and will actively coordinate and share data and protocols with other grantees, the CDCC, and other research supported by the RADx-UP program.