RAPID VACCINATION OF HARD TO REACH POPULATI0NS

描述（由申请人提供）：提议的是一项准实验设计，涉及多层次社区参与性干预，旨在快速免疫弱势少数民族社区中难以到达的人群（HTR）。少数民族和生活在贫困中的及接近贫困的人的疫苗接种覆盖率低是一个长期存在的问题，在HTR人群中尤其严重（例如注射吸毒者、闭门不出的老年人）。免疫接种率受到多种因素的影响，包括人口统计、对疫苗接种的态度、卫生规范、获取障碍和免疫接种提供方法。为HTR人群成功接种疫苗的努力必须解决这些因素。以社区为基础的快速疫苗接种方案可作为应急准备疫苗接种计划的初步模式，并可作为今后在处境不利的城市社区广泛推广艾滋病毒疫苗接种工作的样板。该项目将由一个社区公共卫生伙伴组织分三个阶段在哈莱姆区和南布朗克斯的八个弱势社区实施。在第一阶段，我们将对指定社区的居民进行简短的调查评估，以确定这些社区HTR目标人群目前面临的主要免疫障碍。此外，使用几种估计方法，我们将确定研究社区目标人群的规模，以确定疫苗需求并估计疫苗接种率的分母。在第二阶段，我们将实施两波多层次社区干预试验（根据调查和社区合作伙伴的意见制定）。在第一轮中，随机选择的四个社区将接受干预（即社区教育、社区组织参与和针对符合条件群体的挨家挨户流感疫苗接种计划等）。在四个对照社区，将邀请目标人群到指定地点接种疫苗，作为常规公共卫生工作的一部分。在第二波接种中，采用交叉设计，根据第一波的经验更新和修订方法后，我们将在四个对照社区实施干预；这一轮疫苗接种将在一周内进行，以检验对这些人群快速接种疫苗的可行性。该项目的第三阶段将确定方案中有希望的要素，并编制材料，以便推广到其他城市地区和其他疫苗（例如艾滋病毒、乙型肝炎病毒等）。

DESCRIPTION (provided by applicant): Proposed is a quasi-experimental design involving a multilevel community participatory intervention that is designed to rapidly immunize hard-to-reach (HTR) populations in disadvantaged minority communities. Low vaccination coverage among minorities and persons living in and near poverty is a persistent problem that is particularly acute among HTR populations (e.g. injection drug users, elderly shut-ins). Immunization rates are affected by multiple factors including demographics, attitudes about vaccination, health norms, barriers to access, and immunization delivery methods. Efforts to successfully vaccinate HTR populations must address these factors. A community-based program with rapid vaccination can serve as an initial model for emergency preparedness vaccination plans and for future efforts to widely introduce HIV vaccination in disadvantaged urban communities. This project will be conducted by a community-public health partnership in eight disadvantaged neighborhoods within Harlem and the South Bronx in three phases. In Phase 1 we will implement a brief survey assessment of residents in designated neighborhoods to identify current key barriers to immunization faced by the target HTR populations in these neighborhoods. Also, using several estimation methods, we will determine the size of the target populations in the study neighborhoods to establish vaccine needed and to estimate denominators for vaccination rates. In Phase 2, we will implement two waves of a multilevel community intervention trial (developed with input from the survey and community partners). In the first wave, four randomly selected neighborhoods will receive the intervention (i.e., community education, community-organization engagement, and door-to-door influenza vaccination program for eligible groups etc). In the four control communities, target populations will be invited to come for vaccination at specified locations as part of usual public health efforts. In the second vaccination wave, using a crossover design, after updating and revising the approach based on experience from Wave 1, we will implement the intervention in the four control communities; this vaccination wave will be conducted over one week to test the feasibility of rapid vaccination of these populations. Phase 3 of this project will identify the promising elements of the program and develop materials to allow generalizability to other urban areas and to other vaccines (e.g., HIV, HBV, etc).