COVID-19 Treatment Cascade Optimization Study

项目摘要 2019冠状病毒病影响了美国各地个人和家庭的健康和社会结构; 它不成比例地影响了生活在城市社区的患有合并症的人，那些在高... 风险设置，拒绝或无法遵守CDC指南，等等。健康的社会决定因素，如 由于耻辱、种族歧视、仇外心理、监禁和贫困与日益严重的 暴露于COVID-19和死亡人数增加。边缘化社区，定义为低收入和种族/族裔 少数民族社区，居民遇到越来越多的障碍（例如，住房不足、高风险工作） 预防和治疗，承担不成比例的高比例的并发症与更严重的 COVID-19病例。虽然有效和强效的疫苗越来越容易获得，但需要时间才能达到 目前还不清楚新开发的疫苗提供保护的时间和有效性 对抗新出现的变种因此，疾病控制中心推荐的预防方法 (CDC)- 即，检测、洗手、保持社交距离、追踪接触者、接种疫苗和隔离是必不可少的 降低边缘化社区的COVID-19发病率。关于COVID-19检测和疫苗的研究 在这些社区的吸收必须发生在真实的时间，它必须考虑到快速变化的景观， 大流行，包括疫苗供应对检测吸收的影响。两个具有成本效益的、基于证据的 文化上适当的干预措施在使人们参与艾滋病毒预防和治疗方面是有效的--这些 可以进行调整和测试，以帮助满足COVID-19预防需求。导航服务（NS） 已经表明，在解决阻碍艾滋病毒检测和治疗的结构性障碍的同时， 高风险社区的治疗参与;和简短咨询（BC）已显示增加艾滋病毒治疗 订婚这项研究使用了一项连续、多分配随机试验（SMART），共有1,218名COVID-19患者参加。 19个医疗/社会弱势群体。在COVID-19预防、护理和治疗连续体的指导下， 分析将探索与检测和坚持CDC COVID-19预防和治疗相关的因素 建议.该研究的目的包括：研究适应性干预的有效性，以增加 COVID-19检测和遵守CDC-预防行为建议-社交距离，手- 清洗、接种、戴口罩、接种疫苗-在可比但不同的样本上进行。我们将控制基线， 时间、人口统计和COVID风险;（2）研究适应性政策的即时和中期影响 通过在2、5、12和24日收集随访数据，对COVID检测进行干预并遵守建议 基线后周数。实施目标：收集干预措施实施数据（背景、成本、障碍、 经验教训），并制定实施材料（促进者培训、干预手册、治疗忠实度 措施）。本研究

Project Summary COVID-19 has impacted the health and social fabric of individuals and families living across the United States; and it has disproportionately affected people living in urban communities with co-morbidities, those working in high- risk settings, refusing or unable to adhere to CDC guidelines, and more. Social determinants of health (SDH), such as stigma, racial discrimination, xenophobia, incarceration, and poverty have been associated with increased exposure to COVID-19 and increased deaths. Marginalized communities, defined as low-income and racial/ethnic minority neighborhoods, where residents experience increased barriers (e.g., inadequate housing, high-risk jobs) to prevention and treatment, bear disproportionately higher rates of co-morbidities associated with more severe cases of COVID-19. While effective and potent vaccines are becoming more available, it will take time to reach herd immunity and it is unclear how long newly-developed vaccines provide protection and how effective they are against emerging variants. Therefore, prevention methods recommended by the Centers for Disease Control (CDC) – i.e., testing, hand-washing, social distancing, contact tracing, vaccination, and quarantine -- are essential to reduce the rates of COVID-19 in marginalized communities. Research about COVID-19 testing and vaccine uptake in these communities must occur in real time and it must account for the fast-changing landscape of the pandemic, including the impact of vaccine availability on testing uptake. Two cost-effective, evidence-based, and culturally appropriate interventions have been effective in engaging people in HIV prevention and treatment – these can be adapted and tested to help address COVID-19 prevention needs. Specifically, Navigation Services (NS) have shown to increase HIV testing and adherence to treatment while addressing structural barriers that deter treatment engagement in high-risk communities; and Brief Counseling (BC) has shown to increase HIV treatment engagement. This study uses a Sequential, Multiple Assignment Randomized Trial (SMART) with 1,218 COVID- 19 medically/socially vulnerable people. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, analysis will explore factors associated with testing and adherence to CDC COVID-19 prevention and treatment recommendations. The study aims include: To examine the effectiveness of an adaptive intervention to increase COVID-19 testing and adherence to CDC-recommendations of preventive behaviors – social distancing, hand- washing, inoculation, mask-wearing, vaccination- on comparable but distinct samples. We will control for baseline, time, demographics and COVID risk; (2) To examine the immediate and medium-term impact of the adaptive intervention on COVID testing and adherence to recommendations by collecting follow-up data at 2,5,12 and 24 weeks post baseline. Implementation aim: To collect intervention implementation data (context, cost, barriers, lessons learned) and develop implementation materials (facilitator training, intervention manual, treatment fidelity measure). This study has