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)：迈阿密大学南佛罗里达减少健康差距中心(SUCCESS)旨在通过合作、参与性研究改善南佛罗里达州最脆弱人群的健康。我们的主要重点一直是改进对疾病的早期发现和预防，这些疾病对被剥夺了正式医疗体系权利的社区造成了不成比例的影响。为此，我们测试了多个社区卫生工作者(CHW)领导的干预措施的有效性，以改善对四种优先健康状况的筛查吸收：艾滋病毒、丙型肝炎、结直肠癌(CRC)和宫颈癌。然而，所有这类项目的一个主要限制是，每个项目都是以满足狭隘资格标准的特定社区和/或个人为目标的不同的、独立的倡议。目前的提案将解决这一差距。我们建议开发和实施一项临床试验，在非临床环境下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。我们在这一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--一个由联邦合格健康中心(FQHC)组成的联盟，以及海地研究中心。根据他们的意见，我们建议对900名年龄在50-65岁之间、自认为是西班牙裔、海地人和/或非洲人的人进行一项务实的试验，这些人没有对上述感兴趣的疾病进行适当的筛查。我们的具体目标是确定CHW领导的干预措施是否增加了至少需要这些测试的医疗服务不足的个人的接受情况。CHW领导的干预提供了创新的、基于家庭的筛查。这一多模式的方法将使用口腔拭子检测艾滋病毒，手指棒检测丙型肝炎，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乳头瘤病毒。拟议的务实试验以基于社区的参与性研究(CBPR)的原则为基础，将有助于确定向医疗弱势群体提供预防服务的最佳战略。我们的研究测试了创新的、对成本敏感的方法，这将有助于为卫生改革战略提供信息，这些战略越来越重视人口健康和精准医学。

 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.