A Nurse-Community Health Worker-Family Partnership Model to Increase COVID-19 Testing in Urban Underserved and Vulnerable Communities

项目摘要/摘要 纽约市是SARS-CoV2/新冠肺炎大流行的全球震中，有223,000例病例 死亡人数超过25,000人。纽约市病例和死亡的邻里水平差异可以用以下方式解释 社会经济和种族/民族特征，其中拉丁裔和黑人纽约人以及那些生活在 贫困社区检测呈阳性的可能性是前者的1.5倍，因此死亡的可能性是后者的两倍多 新冠肺炎。莫特·黑文社区位于南布朗克斯，是国会中最贫穷的社区之一 美国大陆内的地区。莫特黑文是高度多样化的(73%是拉丁裔，24%是黑人)， 新冠肺炎的死亡率高于整个纽约市--纽约市是震中中的一个中心。然而， 尽管Mott Haven显然是与CoVID相关的预防、检测、疫苗接种和 治疗倡议，到目前为止，只有不到2%的居民接受了测试。 新冠肺炎的二次攻击率在家庭中最高，在12%到38%之间。这让我们找到了 建议在莫特黑文的公共住房家庭中进行新冠肺炎测试和缓解干预，这些干预措施包括 以拥挤、代际共居和低工资比例高为特点 工人“即使在封锁期间也离开家去工作。我们将评估一项 创新护士-社区卫生工作者(CHW)-家庭伙伴关系干预旨在促进 新冠肺炎检测摄取、采取新冠肺炎管控措施、家庭互助能力 水平。我们的干预是从护士-家庭伙伴关系模式改编而来的，该模式已被证明是 在改善高度贫困、种族和贫穷地区的妇幼保健成果方面具有成效和成本效益 种族多元化的社区。社区卫生组织将为家庭提供文化上适当的支持，解决 耻辱、医疗不信任和其他参与医疗保健的常见障碍。 我们建议一项双臂随机对照试验，在该试验中，270个家庭(810个个体)将 随机分配(2：1)到将接受护士-CHW-家庭的试验组家庭 伙伴关系干预和提供家庭检测和流感疫苗接种，或照常治疗 对照组指步行距离内的免费检测和接种流感疫苗。两个项目的参与者 武器将按基准和每月进行评估，为期12个月。 这项研究的发现将为当前和未来的公共卫生倡议提供证据基础。 与其他高风险环境下的新冠肺炎缓解相关。可持续发展将通过建设当地 参与者、社区卫生工作者和政制事务局成员之间的能力和专业知识，并与他们合作开发 社区针对新冠肺炎的最佳实践。如果它被证明是有效的，我们的干预可以量身定做 加大对其他易受攻击和劣势设置的新冠肺炎检测等管控措施。

PROJECT SUMMARY/ABSTRACT New York City (NYC) is a global epicenter of the SARS-CoV2/COVID-19 pandemic, with 223,000 cases and more than 25,000 deaths. Neighborhood-level disparities in cases and deaths in NYC can be explained by socioeconomic and racial/ethnic characteristics, where Latinx and Black New Yorkers and those living in high poverty neighborhoods are 1.5 times more likely to test positive and more than twice as likely to die as a result of COVID-19. The community of Mott Haven is located in the South Bronx – one of the poorest congressional districts within the continental United States. Mott Haven is highly diverse (73% are Latinx and 24% are Black), and the COVID-19 mortality rate is higher than NYC as a whole – an epicenter within an epicenter. Yet, although Mott Haven is clearly a priority community for COVID-related prevention, detection, vaccination, and treatment initiatives, so far fewer than 2% of residents have been tested. COVID-19 secondary attack rates are highest in households, varying between 12 – 38%. This led us to propose a COVID-19 testing and mitigation intervention in public housing households in Mott Haven, which are characterized by crowding, intergenerational co-residence, and a high proportion of low wage “essential workers” who leave the home for work even during lockdown periods. We will evaluate the effectiveness of an innovative Nurse-Community Health Worker (CHW)-Family Partnership intervention designed to promote COVID-19 testing uptake, adoption of COVID-19 control measures, and mutual aid capacity at the household level. Our intervention is adapted from the Nurse-Family Partnership model, which has been shown to be effective and cost-effective in improving maternal and child health outcomes in high-poverty, racially- and ethnically-diverse communities. CHWs will provide culturally-appropriate support to families, addressing stigma, medical mistrust, and other common barriers to engagement in healthcare. We propose a 2-arm randomized controlled trial, in which 270 households (810 individuals) will be randomly assigned (2:1) to either the experimental group of families who will receive the Nurse-CHW-Family Partnership intervention and the offer of in-home testing and influenza vaccination, or the treatment-as-usual control group referred to free testing and flu vaccination located within walking distance. Participants in both arms will be assessed at baseline and monthly for 12 months. Findings from this study will provide an evidence-base to inform current and future public health initiatives related to COVID-19 mitigation in other high-risk settings. Sustainability will be addressed by building local capacity and expertise among participants, CHWs and CAB members, and partnering with them to develop the community’s best practices for COVID-19. Should it prove to be effective, our intervention can be tailored to increase testing and other COVID-19 control measures in other settings of vulnerability and disadvantage.