COVID-19 Treatment Cascade Optimization Study

项目摘要 新冠肺炎已经影响了生活在美国各地的个人和家庭的健康和社会结构； 它对生活在城市社区的人造成了不成比例的影响，这些人患有共病，工作在高危人群中。 风险设置，拒绝或无法遵守疾控中心的指导方针，等等。社会健康决定因素(SDH)，如 因为耻辱、种族歧视、仇外心理、监禁和贫穷与越来越多的 接触新冠肺炎，死亡人数增加。被边缘化的社区，定义为低收入和种族/民族 少数族裔社区，那里的居民遇到了更多的障碍(例如，住房不足，高风险工作) 在预防和治疗方面，与更严重的疾病相关的不成比例的高并存率 新冠肺炎的案例。虽然有效和强大的疫苗正在变得更加可用，但要达到这一目标还需要时间 群体免疫和新开发的疫苗提供多长时间的保护以及它们的有效性尚不清楚 对抗新兴的变种。因此，疾病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、接种疫苗和隔离--是必不可少的 降低边缘化社区新冠肺炎使用率。新冠肺炎检测与疫苗的研究 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 大流行，包括疫苗可获得性对检测摄入量的影响。两个经济高效、以证据为基础的 在让人们参与艾滋病毒预防和治疗方面，文化上适当的干预措施是有效的--这些 可以进行调整和测试，以帮助满足新冠肺炎预防需求。具体而言，导航服务(NS) 已经表明，在解决阻碍艾滋病毒检测和坚持治疗的结构性障碍的同时， 在高危社区参与治疗；和短暂咨询(BC)已表明增加艾滋病毒治疗 订婚。这项研究使用了序贯多分配随机试验(SMART)，共1218个COVID- 19名医疗/社会弱势群体。在新冠肺炎预防、关怀和治疗连续体的指导下， 分析将探索与检测和坚持疾控中心新冠肺炎防治相关的因素 建议。这项研究的目的包括：检查适应性干预的有效性，以增加 新冠肺炎检测和对疾病预防控制中心的依从性.预防行为建议.社交距离，手 洗涤、接种、戴口罩、接种--在可比较但不同的样本上。我们将控制基线， 时间、人口结构和COVID风险；(2)检查适应性疾病的直接和中期影响 通过收集第2、5、12和24天的随访数据，对COVID检测的干预和对建议的遵守情况进行调查 基线后数周。实施目标：收集干预实施数据(背景、成本、障碍、 经验教训)并编写执行材料(促进员培训、干预手册、治疗忠诚度 措施)。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