Admin-Core-001

摘要 随着新冠肺炎疫情蔓延到美国的每个角落，美国印第安人/阿拉斯加城市居民的困境 原住民(人工智能/人工智能)经常被忽视或忽视。SARS-CoV-2及其引起的疾病，COVID-19， 对人工智能/AN的影响不成比例，他们是美国任何种族或民族中患严重疾病的风险最高的人 疾病和死于新冠肺炎。不幸的是，我们没有关于城市的感染率、发病率和死亡率的数据。 人工智能/人工智能，占人工智能/人工智能总人口的71%。城市人工智能/人工智能可能通过城市获得临床护理 印度卫生计划(UIHP)、印度卫生服务、部落、公共和私人设施。我们的讨论 与UIHP合作，领导人揭示了测试的复杂障碍，例如无法采购检测试剂盒、无法到达家中 病人，以及外展工作人员不足。为加强在市区人工感染/非典型肺炎患者中检测SARS-CoV-2，我们将 利用在6个大型NIH建立的全国性卫星中心网络(均由AI/AN学者领导)- 受赞助的计划，达到、吸引并确保社区利益相关者参与在 地方层面。我们的卫星中心将与美国各地6个地理上相邻的UIHP合作发射 《原住民社区组织：新冠肺炎流行病学、研究、测试和服务》研究 (音乐会)。音乐会的目标是消除障碍，增加城市中SARS冠状病毒的检测 AI/ANS。首先，我们将使用这6个UIHP的数据来估计SAR-CoV-2检测的电流吸收和 新冠肺炎病的负担。其次，我们将对诊所管理人员、提供者和600名患者进行调查 所有6个UIHP都了解测试障碍和推动者，以及首选的测试选项。第三，消息来源 这些数据，6个UIHP将实施当地定制的诊所关联(例如，免下车、基于移动单元的 (例如，“新冠肺炎”导航员)和以外联为基础的战略(例如，“新冠肺炎”导航员)，以增加对SARS-CoV-2的检测。在1之后 年，我们将重新检查检测率以进行事后比较，以确定这些策略是否 成功。第四，我们将与研究所合作，制定一份可持续、务实的做法清单， 未来的流行病和疫苗接种计划。我们的主要结果是每月对SARS的检测率- 城市人工智能/人工智能的覆盖范围。具体目标是：1)评估SARS-CoV-2检测和感染的基线 比率以确定城市人工智能/ANS在检测和疾病负担方面的差异；2)调查管理员、提供者、 并从6个UIHP中各抽取100名患者，以确定障碍、促进者、态度、危险因素和必要的 与SARS-CoV-2检测相关的服务；3)在 每个UIHP都要提高检测率，减少SARS-CoV-2的传播，然后比较前后的检测率 实施后；以及4)评估演唱会并将实用做法分类以供将来应用 在城市禽流感/ANs中的流行病和成功的疫苗接种运动。国家在人工智能/AN健康方面的努力 CARE被描述为“历史性的失败”。在当前的大流行期间，这一历史仍在继续， 强调了为美国“最大部落”--城市人工智能/人工智能--服务的设施的迫切需求。

ABSTRACT As the COVID-19 pandemic spreads to every corner of the US, the plight of urban American Indian/Alaska Native (AI/AN) people is often overlooked or ignored. SARS-CoV-2 and the disease it causes, COVID-19, disproportionately affect AI/ANs, who are at highest risk of any US racial or ethnic group for developing severe disease and dying from COVID-19. Sadly, we have no data on infection rates, morbidity, or mortality on urban AI/ANs, who comprise 71% of the total AI/AN population. Urban AI/ANs may obtain clinical care through Urban Indian Health Programs (UIHPs), the Indian Health Service, tribal, public, and private facilities. Our discussions with UIHP leaders reveal complex barriers to testing, such as inability to procure test kits, reach homebound patients, and inadequate staffing for outreach. To increase SARS-CoV-2 testing among urban AI/ANs, we will draw on a nationwide network of Satellite Centers (all led by AI/AN scholars) established in 6 large NIH- sponsored initiatives that reach, engage, and ensure participation of community stakeholders in research at the local level. Our Satellite Centers will partner with 6 geographically contiguous UIHPs across the US to launch the “Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services” study (CONCERTS). The goal of CONCERTS is to remove barriers and increase SARS-CoV testing among urban AI/ANs. First, we will use data from these 6 UIHPs to estimate current uptake of SAR-CoV-2 testing and the burden of COVID-19 disease. Second, we will survey clinic administrators, providers, and 600 patients across all 6 UIHPs to understand testing barriers and promoters, and preferred testing options. Third, informed by these data, the 6 UIHPs will implement locally tailored clinic-associated (e.g., drive-through, mobile unit-based testing) and outreach-based strategies (e.g., COVID-19 navigators) to increase SAR-CoV-2 testing. After 1 year, we will re-examine testing rates for a pre-post comparison to establish if these strategies were successful. Fourth, we will collaborate with the UIHPs to produce a list of sustainable, pragmatic practices for future pandemics and vaccination programs. Our primary outcome is the monthly testing rate for SARS- CoV among urban AI/ANs. The Specific Aims are to: 1) Estimate baseline SARS-CoV-2 testing and infection rates to identify disparities in testing and disease burden in urban AI/ANs; 2) Survey administrators, providers, and 100 patients from each of 6 UIHPs to identify barriers, facilitators, attitudes, risk factors, and necessary services pertinent to SARS-CoV-2 testing; 3) Implement clinic-associated and outreach-based strategies at each UIHP to increase testing rates and reduce spread of SARS-CoV-2, then compare testing rates before and after implementation; and 4) Evaluate CONCERTS and catalog pragmatic practices for application to future pandemics and successful vaccination campaigns among urban AI/ANs. The nation's efforts in AI/AN health care have been described as a “historic failure.” This history continues during the current pandemic, underscoring the urgent needs of facilities serving America's “largest tribe” – urban AI/ANs.