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

护士-社区卫生工作者-家庭合作模式，以增加城市服务不足和弱势社区的 COVID-19 检测

• 批准号: 10274002
• 负责人: Don C Des Jarlais
• 金额: $ 117.43万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-04-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10274002
• 关键词: 2019-nCoV; Address; Adherence; Adoption; Age; Antibodies; Black Populations; Black race; COVID-19; COVID-19 diagnostic; COVID-19 impact; COVID-19 mortality; COVID-19 pandemic; COVID-19 prevention; COVID-19 risk; COVID-19 screening; COVID-19 test; COVID-19 testing; Cessation of life; Characteristics; Cities; Color; Communities; Community Health Aides; Community Health Nursing; Contact Tracing; Control Groups; County; Crowding; Detection; Development; Diabetes Mellitus; Diagnosis; Diagnostic tests; Disadvantaged; Disease; Epidemiology; Essential worker; Event; Family; Family Nursing; Future; Goals; HIV; Health Services; Health Services Accessibility; Healthcare; Herd Immunity; High Prevalence; Home; Homelessness; Hospitalization; Hospitals; Household; Housing; Hypertension; Immunity; Incidence; Individual; Infection; Influenza vaccination; Infrastructure; Injecting drug user; Intervention; Knowledge; Latinx; Latinx population; Limited English Proficiency; Maternal and Child Health; Measures; Medical; Modeling; Names; Neighborhoods; New York City; Obesity; Outcome; Participant; Patient Self-Report; Personal Space; Persons; Pilot Projects; Population; Poverty; Prevalence; Prevention; Prevention strategy; Public Health; Public Housing; Quarantine; Randomized; Randomized Controlled Trials; SARS-CoV-2 transmission; Social Distance; Social Protection; Testing; Time; Transportation; United States; Vaccination; Wages; Walking; Work; arm; authority; base; burden of illness; community setting; community transmission; coronavirus disease; cost effective; density; effectiveness evaluation; effectiveness testing; ethnic diversity; evidence base; experience; experimental group; face mask; health care availability; health economics; high risk; home test; illicit drug use; improved; indexing; innovation; intergenerational; member; mortality; novel; novel diagnostics; pandemic disease; poor communities; racial and ethnic; racial diversity; research study; residence; social stigma; social vulnerability; socioeconomic disadvantage; socioeconomics; testing access; testing uptake; therapy design; transmission process; treatment as usual; underserved community; uptake; urban underserved; vulnerable community

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.

项目总结/文摘