Cherokee Nation Native AmericanResearch Center for Health

项目摘要 通过RADx-UP计划，切罗基国家社区驱动的测试和联系计划 追踪（切罗基族）团结部落，学术和社区合作伙伴的领导下， 切罗基民族（CN）解决对COVID-19检测、接触者追踪和文化信息的迫切需求 为得不到充分服务的弱势农村人口提供教育。截至8月4日，切罗基民族卫生服务 （CNHS）已在主要为农村地区服务的部落人口中确认了>850例COVID-19病例 俄克拉荷马州东北部。2019冠状病毒病在中国所有14个县都存在社区传播 保留，但由于CN的社区检测，筛查和接触者追踪能力有限， COVID-19的影响尚不清楚。大约34%的18-64岁的美国印第安人/阿拉斯加原住民（AI/AN）成年人 由于合并症，50岁以上的人面临严重COVID-19的风险，超过美国任何其他种族/族裔群体。 CN的五个县在美国县中处于严重COVID-19风险成人患病率的前20% 由于基本的医疗条件，这种脆弱性因高贫困率和地理位置而加剧 隔栏.居住在CN农村地区的人可能需要往返60英里进行病毒检测。 迄今为止，CN的大多数COVID-19检测都是通过CNHS进行的，CNHS是最大的部落压实健康 在美国的系统，服务于所有AI/AN人生活在CN保留。虽然CNHS占 大约8.5%的IHS活跃用户群和38%的俄克拉荷马州服务活跃用户群 地区，不是所有部落成员居住在保留访问CNHS，因此，可能不会被测试， CNHS。除了CNHS诊所外，该地区14个县中有7个只有一个公共检测点，结果可能 2-3周内不能返回。CNHS及其紧密结合的CN公共卫生计划具有示范性 20-提供公共卫生干预措施的一年记录，包括突破性的丙型肝炎病毒 消除计划与俄克拉荷马州健康科学中心的大学，和正在进行的项目，>40 农村K-12学校通过合作临床研究和分子研究，CN和俄克拉荷马州 医学研究基金会在部落人群中发现了新的免疫生物标志物。根据这些 现有的优势和基础设施，切罗基切诺基将（1）建立基础设施，并增加FDA-EUA CNHS临床护理的COVID-19病毒和抗体检测;（2）启用基于社区的COVID-19检测， 与CN公共卫生部门的接触者追踪和教育;（3）确定COVID-19检测的障碍和促进因素 在CN保留区，为量身定制的教育活动提供信息，以增加检测和接触者追踪， （4）实施严格的评估，以确保质量的改进和可持续性。

PROJECT SUMMARY Through the RADx-UP program, the Cherokee Nation Community-Driven Program for Testing and Contact Tracing (Cherokee PROTECT) unites tribal, academic, and community partners under the leadership of Cherokee Nation (CN) to solve a dire need for COVID-19 testing, contact tracing, and culturally informed education in underserved and vulnerable rural populations. As of August 4, Cherokee Nation Health Services (CNHS) has confirmed >850 cases of COVID-19 in the tribal populations served across mainly rural northeastern Oklahoma. Community spread of COVID-19 exists throughout all 14 counties in the CN reservation, but with CN’s limited capacity for community testing, screening, and contact tracing, the true impact of COVID-19 is unknown. Roughly 34% of American Indian/Alaska Native (AI/AN) adults aged 18-64 years are at risk of severe COVID-19 due to comorbidities, more than any other racial/ethnic group in the US. Five counties in CN are in the top 20% of US counties for the prevalence of adults at risk of severe COVID-19 due to underlying medical conditions; this vulnerability is compounded by high poverty rates and geographic barriers. People living in rural areas of CN may have to travel as many as 60 miles round-trip for viral testing. Most COVID-19 testing in CN to date has been conducted through CNHS, the largest tribally compacted health system in the US that serves all AI/AN people living within the CN reservation. Although CNHS accounts for approximately 8.5% of all IHS active user population and 38% of active user population of Oklahoma service area, not all tribal members residing in the reservation access CNHS, and therefore, may not be tested by CNHS. Other than CNHS clinics, 7 of 14 counties in this area have only one public testing site, and results may not be returned for 2-3 weeks. CNHS and its closely integrated CN Public Health program have an exemplary 20-year record of delivering public health interventions, including a groundbreaking Hepatitis C Virus elimination program with the University of Oklahoma Health Sciences Center, and ongoing projects with >40 rural K-12 schools. Through collaborative clinical research and molecular studies, CN and the Oklahoma Medical Research Foundation have identified new immune biomarkers in tribal populations. Drawing on these existing strengths and infrastructure, Cherokee PROTECT will (1) Build infrastructure and increase FDA-EUA COVID-19 viral and antibody testing for clinical care in CNHS; (2) Enable community-based COVID-19 testing, contact tracing, and education with CN Public Health; (3) Identify barriers and facilitators to COVID-19 testing in the CN reservation to inform a tailored educational campaign to increase testing and contact tracing, and decrease spread; and (4) Implement a rigorous evaluation to ensure quality improvement and sustainability.