A novel community intervention to reduce disparate impact from COVID-19 on vulnerable adolescents

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PROJECT SUMMARY The burden of poor sexual and reproductive health (SRH) and mental health (MH) outcomes among Black adolescents from low-resource communities is substantial. Efforts to mitigate the COVID-19 pandemic have reduced access to care and threaten to worsen existing disparities; thus, research to ameliorate the negative impact of the pandemic on SRH and MH outcomes is desperately needed. Building on previous work and drawing on proven strategies, we propose our novel approach to increasing access to care. We will compare our community-level intervention, TeenHealth Outreach (THO), to our multi-level intervention, TeenHealth Outreach+ (THO+). In THO+, we will provide intervention at the individual (e.g., health system navigation training), interpersonal (e.g., social networks diffuse information), and community (e.g., leaders support care access including telemedicine and mobile health units) levels. We will conduct a cluster randomized controlled trial to evaluate intervention feasibility. Adolescent leaders from our partner community organizations will recruit friends to form small networks (N ~ 96 adolescents aged 14-18 years). We will randomize networks to: (1) THO (trusted community organizations promote health care sources including our MHU, telemedicine, and traditional clinics) or (2) THO+ (peer leaders work with health professionals and trusted adults to curate toolkits containing health materials [e.g., infographics, videos] and strategies for diffusion [e.g., social media, small group sessions] to actively connect adolescents in their friend networks to the same sources for care as THO). We will assess these feasibility constructs using mixed methodology: acceptability, demand, implementation, practicality, integration, expansion, and limited-efficacy. We compare two arms to determine size of effect rates on contraception initiation. At scale, this intervention can be fully integrated into our community and serve as a model for health organizations challenged by the pandemic. Knowledge gained from this research will translate into trusted outreach interventions equipped to respond to rapidly changing health needs, including future vaccination against COVID-19, and delivery environments.