Understanding Factors Influencing COVID-19 Testing and Vaccination in Immigrant Low-income and Homeless Populations and Testing Targeted Interventions

COVID-19大流行对弱势群体和弱势群体的影响尤为严重 社区.迄今为止的研究强调了造成这些差异的因素，包括 在医疗保健和研究环境中对边缘化群体的差别待遇和经验， 获得检测和护理，生活在集体或多代同堂的家庭中， 被诊断出患有COVID-19并被排除在外，对COVID-19的不同理解和态度 大流行，以及对接触者追踪的担忧。移民和低收入人口，以及 经历无家可归，许多患有精神疾病，和/或最近被监禁， 参加检测，接受COVID-19检测和疫苗接种。迫切需要 了解如何提供有关检测和疫苗接种的信息，这些信息是可以理解的， 文化和社会背景下的高风险社区。有效的公共卫生战略， 信息必须包括社区投入和伙伴关系。与社区合作伙伴密切合作， 深入了解文化，行为，经济和影响人们对测试决策的因素 接受疫苗对于制定有效的宣传和推广战略至关重要， 让个人参与检测、接种疫苗和护理。与我们的社区合作伙伴合作，我们将创建和 评估缅因州坎伯兰县公共卫生干预措施的影响， 对来自撒哈拉以南非洲的大型移民社区进行宣传、检测和疫苗接种教育， 中东和中美洲，高风险低收入人群使用公共卫生设施（ 性传播感染诊所、针具交换和免费诊所），以及 无家可归这将是一项纵向研究，以了解对COVID-19的信念和知识， 关于检测和疫苗接种的障碍和信念。结果将告知一个社区开发和基于 采取干预措施，使这些人群中的其他成员参与检测和疫苗教育， 并评估这种干预措施对我们的移民，低收入， 无家可归的社区。具体目标：1）了解患者对以下问题的看法、恐惧和 新冠病毒检测和疫苗接种的经验，包括在我们的移民，低- 收入和无家可归的人。2)利用目标1的数据制定和试点测试公共卫生 信息传递和测试计划，以增加我们感兴趣的人群的疫苗和测试吸收。3)到 评估目标2中制定的公共卫生信息和检测计划对快速应对COVID-19的影响 检测和疫苗接种。虽然需要根据当地社区的文化和需要加以调整， 这项工作可以为制定和维持公共卫生措施奠定基础， 控制疫情及减少美国弱势群体与COVID-19相关的差异。

The COVID-19 pandemic has disproportionately affected people from vulnerable and disadvantaged communities. Research to date has highlighted the factors that contribute to these disparities including differential treatment and experience of marginalized populations in healthcare and research settings, reduced access to testing and care, living in congregate or multigenerational households, the economic consequences of being diagnosed with COVID-19 and quarantining, differing understanding of and attitudes towards the pandemic, and concerns about contact tracing. Immigrant and low income populations, and people experiencing homelessness, many with mental illnesses, and/or have been recently incarcerated, are hesitant to participate in testing and to accept COVID-19 testing and vaccination. There is an urgent need to understand how to deliver information about testing and vaccination that is understandable and resonates with higher risk communities in their cultural and social contexts. Effective public health strategies for delivering this information must include community input and partnerships. Working closely with community partners who have insight into cultural, behavioral, economic, and factors impacting people’s decision making about testing and vaccine acceptance is essential to developing effective communication and outreach strategies for engaging individuals in testing, vaccination, and care. Working with our community partners, we will create and evaluate the impact of a public health intervention in the area of Cumberland County, Maine, to provide outreach, testing, and vaccination education to a large community of immigrants from sub-Saharan Africa, the Middle East, and Central America, higher-risk low-income people accessing a public health facility (with a sexually transmitted infections clinic, needle exchange, and a free clinic), and individuals experiencing homelessness. This will be a longitudinal study to understand beliefs about and knowledge of COVID-19, and barriers and beliefs about testing and vaccination. Results will inform a community-developed and based intervention to engage the cohort and other members of these populations in testing and vaccine education, and evaluate the impact of this intervention on testing and vaccination uptake in our immigrant, low-income, and homeless communities. Specific Aims: 1) To understand patient perceptions of, fears about, and experiences with COVID-19 testing and vaccination, including booster vaccination in our immigrant, low- income, and homeless populations. 2) To use the data from Aim 1 to develop and pilot test a public health messaging and testing program to increase vaccine and testing uptake in our populations of interest. 3) To evaluate the impact of a public health messaging and testing program developed in Aim 2 on rapid COVID-19 testing and vaccine uptake. While it will need to be adapted based on local communities’ cultures and needs, this work could be foundational for creating and sustaining public health measures that will contribute to the control of the pandemic and reducing the COVID-19 related disparities of vulnerable populations in the US.