COVID-19 Treatment Cascade Optimization Study

项目概要 COVID-19 影响了美国各地个人和家庭的健康和社会结构； 它对居住在患有合并症的城市社区的人们、在高海拔地区工作的人们造成了不成比例的影响。 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 (SDH)，例如 由于耻辱、种族歧视、仇外心理、监禁和贫困与增加 接触 COVID-19 并增加死亡人数。边缘化社区，定义为低收入和种族/民族 少数族裔社区，居民面临更多障碍（例如住房不足、高风险工作） 为了预防和治疗，与更严重的疾病相关的合并症发生率不成比例地更高 COVID-19 病例。虽然有效和强效的疫苗越来越容易获得，但要达到目标还需要时间 群体免疫，目前尚不清楚新开发的疫苗能提供多长时间的保护以及它们的效果如何 反对新出现的变种。因此，疾病预防控制中心推荐的预防方法 (CDC)——即检测、洗手、社交距离、接触者追踪、疫苗接种和隔离——是必不可少的 降低边缘化社区的 COVID-19 发病率。有关 COVID-19 检测和疫苗的研究 这些社区的吸收必须实时发生，并且必须考虑到快速变化的环境 大流行，包括疫苗供应对检测采用率的影响。两个具有成本效益、基于证据且 文化上适当的干预措施能够有效地让人们参与艾滋病毒预防和治疗——这些 可以进行调整和测试，以帮助满足 COVID-19 预防需求。具体来说，导航服务（NS） 已证明可以增加艾滋病毒检测和治疗依从性，同时解决阻碍艾滋病毒的结构性障碍 高风险社区的治疗参与；短期咨询 (BC) 已被证明可以增加艾滋病毒治疗 参与。本研究采用序贯、多重分配随机试验 (SMART)，对 1,218 名新冠肺炎患者进行了研究 19 名医疗/社会弱势群体。在 COVID-19 预防、护理和治疗连续体的指导下， 分析将探讨与检测和遵守 CDC COVID-19 预防和治疗相关的因素 建议。该研究的目的包括： 检验适应性干预措施的有效性，以提高 COVID-19 检测和遵守 CDC 预防行为建议 – 保持社交距离、手部接触 对可比较但不同的样本进行清洗、接种、戴口罩、接种疫苗。我们将控制基线， 时间、人口统计和新冠病毒风险； (2) 考察适应性措施的近期和中期影响 通过在 2、5、12 和 24 日收集后续数据来干预新冠病毒检测并遵守建议 基线后几周。实施目标：收集干预实施数据（背景、成本、障碍、 经验教训）并制定实施材料（协调员培训、干预手册、治疗保真度 测量）。这项研究有

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