Increasing Uptake of Evidence Based Screening Services though a CHW-led multi-modality program: The South Florida Center for Reducing Health Disparities

 描述（由申请人提供）：迈阿密大学的南佛罗里达中心减少健康差距（成功）旨在通过合作，参与性研究，改善南佛罗里达最脆弱人群的健康。我们的主要重点是改善早期发现和预防疾病，这些疾病不成比例地影响社区，被剥夺了正规医疗保健系统的权利。为此，我们测试了多种社区卫生工作者（CHW）主导的干预措施的有效性，以提高四种优先健康状况的筛查率：艾滋病毒，丙型肝炎，结直肠癌（CRC）和宫颈癌。然而，所有这些项目的一个主要局限性是，每个项目都是针对特定社区和/或符合狭窄资格标准的个人的独特、独立的举措。目前的建议将弥补这一差距。我们建议开发和实施一项临床试验，在非临床环境中对所有四种健康状况进行筛查，绕过已知的结构和获得护理的障碍。我们在此应用程序中的合作伙伴是我们的长期合作伙伴：健康选择网络-联邦合格的健康中心（CAHCs）和海地研究中心的联盟。根据他们的意见，我们提出了一个务实的试验，900人年龄在50-65谁自我认同为西班牙裔，海地，和/或非洲人，并没有适当的筛选上述疾病的利益。我们的具体目标是确定CHW主导的干预措施是否提供了创新的家庭筛查，增加了至少需要这些测试的医疗服务不足的个人的摄入量。这种多模态方法将使用口腔拭子检测HIV，手指针刺检测丙型肝炎，粪便免疫化学检测（FIT）检测CRC，以及自我采样检测宫颈癌的主要原因人类乳头状瘤病毒。拟议的务实试验，基于社区参与式研究（CBPR）的原则，将有助于确定最佳战略，提供预防服务的医疗弱势群体。我们的研究测试创新的，成本敏感的方法将有助于为卫生改革战略提供信息，这些战略越来越优先考虑人口健康和精准医疗。

 DESCRIPTION (provided by applicant): The University of Miami's South Florida Center for Reducing Health Disparities (SUCCESS) aims to improve the health of South Florida's most vulnerable populations through collaborative, participatory research. Our primary focus has been to improve early detection and prevention of diseases that disproportionately affect communities, disenfranchised from the formal healthcare system. Towards this end, we have tested the effectiveness of multiple Community Health Worker (CHW)-led interventions to improve screening uptake for four priority health conditions: HIV, Hepatitis C, Colorectal Cancer (CRC), and cervical cancer. However, a major limitation of all such projects is that each has existed as distinct, standalone initiative targeting a specific community and/or individuals who meet narrow eligibility criteria. The current proposal will address this gap. We propose to develop and implement a clinical trial that offers screening for all four health conditions in a no-clinical setting, circumventing known structural and access barriers to care. Our partners in this application are our longstanding collaborators: the Health Choice Network- a consortium of Federally Qualified Health Centers (FQHCs), and the Center for Haitian Studies. Based on their input, we propose a pragmatic trial of 900 people ages 50-65 who self-identify as Hispanic, Haitian, and/or African and have not been appropriately screened for the aforementioned diseases of interest. Our specific aim is to determine whether a CHW led intervention, which provides innovative, home based screening increases uptake among medically underserved individuals who are in need of at least of these tests. This multi-modality approach will use oral swabs for HIV, finger stick testing for Hepatitis C, Fecal Immunochemical Testing (FIT) for CRC, and self- sampling for Human Papilloma Virus, the primary cause of cervical cancer. The proposed pragmatic trial, grounded in the tenets of community-based participatory research (CBPR), will help identify optimal strategies for delivering prevention services to medically-vulnerable population sub-groups. Our study testing innovative, cost sensitive approaches will help inform health reform strategies that increasingly prioritize population health and precision medicine.