Addressing COVID-19 Testing Disparities in Vulnerable Populations Using a Community JITAI (Just in Time Adaptive Intervention) Approach - Phase II

摘要 这个 (阶段 临床与翻译科学中心(CCTS)拟议延续的目标 Ii)RADX-UP 121项目是为了确定SARS-CoV-2检测的趋势和差异， 感染，以及德克萨斯州三个目标地区的新冠肺炎疫苗接种覆盖率：休斯顿/哈里斯 德克萨斯州南部(卡梅伦县和伊达尔戈县)；以及德克萨斯州东北部(7个县 包括泰勒市)。这一努力将导致改进和扩大 时间 相关 将： 近期 结构 和 访问 启用 多层次的，适时的- 帮助遭受不平等的弱势人群的适应性干预策略 敬新冠肺炎。更具体地说，该项目与社区合作伙伴合作， 1)确定SARS-CoV-2检测和感染的差异和动态，考虑到 新冠肺炎疫苗接种数据；2)确定个人、组织、社区和 导致SARS-CoV-2检测和新冠肺炎疫苗接种差异的因素， 3)扩大 多层次干预，以增加对和的动力 在脆弱人群中进行检测和接种疫苗。该项目的努力将是 通过利用长期的社区合作伙伴关系。 S 第二阶段将从第一阶段的工作中吸取经验教训和取得的成就， 其中包括：(1)开发实时数据处理程序并实现 各种本地数据的质量控制措施，包括SARS-CoV-2检测数据，病例 调查和住院记录；(2)处理和分析新冠肺炎病例数据，包括 哈里斯县超过367,000例，卡梅伦县超过40,000例， 德克萨斯州东北部各县--所有数据集现在都有共同的数据元素和一致的格式； (3)开发几个指标来量化总体上的新冠肺炎疾病负担 人口和人口分组；(4)发展人口普查区组(CBG) 贫富差距指数，由美国社区调查中的12个变量构成 (ACS)和；(5)确定受SARS-CoV-2感染影响不成比例的CBG，以及 优先对他们进行干预，以增加检测接受率和新冠肺炎疫苗接种 制定了疾病负担指标和差距指数。 将在第二阶段实施的变化(增强和扩展)，与 第一阶段(基准)，包括：(A)调整第一阶段CHW--培训/外联方案，以包括 关于激励性访谈的培训，并扩大对疫苗接种教育和 激励/促进测试；(B)加强以2-1-1为基础的教育、激励和转介 到检测和疫苗接种，(C)包括基础更广泛的社交媒体推广，如地理- 有针对性的脸书广告，激励用户访问新冠肺炎检测和疫苗接种；(D) 进行小组研究，以比较CHW促进的自我抽样的有效性 干预VS CHW检测导航参与SARS-CoV-2检测的导航干预， (E)评估多层次新冠肺炎通信网络对以下领域的影响和覆盖范围 个人对SARS-CoV-2检测的态度、意图和行为决定 以及在服务不足的社区接种新冠肺炎疫苗。

ABSTRACT The (Phase goal of the Center for Clinical and Translational Science's (CCTS) proposed continuation II) RADx-UP 121 project is todetermine trends and disparities of SARS-CoV-2 testing, infections, and COVID-19 vaccination coverage in threetargeted Texas regions:Houston/Harris County; South Texas (Cameron and Hidalgo Counties; and 3) Northeast TX (seven counties including the city of Tyler). This effort will result in improved and expanded time related will: recent structural and access enabled multilevel, just-in- adaptive intervention trategies to reach vulnerable populations experiencing inequities to COVID-19. More specifically, in collaboration with community partners, this project 1) identify disparities and dynamics of SARS-CoV-2 testing and infections, considering data on COVID-19 vaccination; 2) identify personal, organizational, community, and factors contributing to SARS-CoV-2 testing and COVID-19 vaccination disparities, 3) expand the reach and impact of a multil evel intervention to increase motivation for and to testing and vaccination among vulnerable populations. The project's efforts will be by leveraging long-standing community partnerships. s Phase II will be informed by learnings and accomplishments from the Phase I effort, which have included: (1) Developing real-time data processing procedures and implemented quality control measures for various local data, including SARS-CoV-2 testing data, case investigation and hospital records; (2) Processing and analyzing COVID-19 case data including over 367,000 cases in Harris County, over 40,000 in Cameron County, and over 29,000 cases in Northeast Texas counties - all datasets now have common data elements and consistent formats; (3) Developing several metrics to quantify the COVID-19 disease burden for the overall population and by demographic subgroups; (4) Developing the census block group (CBG)-level disparity index, which is constructed using 12 variables from the American Community Survey (ACS) and; (5) Identifying the CBGs disproportionately affected by SARS-CoV-2 infections and prioritizing them for interventions to increase testing uptake and COVID-19 vaccination using the developed disease burden metrics and disparity index. Changes (enhancements and expansion) to be implemented in Phase II, as compared to Phase I (benchmark), include: (A) Adapting Phase I CHW-training/outreach program to include training on motivational interviewing, and an expanded focus on vaccination education and motivation/promotion of testing; (B) Enhancing 2-1-1-based education, motivation, and referral to testing and vaccination, (C) Including broader-based social media outreach, such as geo- targeted Facebook ads to motivate users to access COVID-19 testing and vaccination; (D) Conducting a panel study to compare the effectiveness of the CHW-Facilitated Self-Sampling Intervention vs. CHW Testing Navigation Intervention on participation in SARS-CoV-2 testing, and; (E) Assessing the impact and reach of multilevel COVID-19 communication networks on individuals' attitudes, intentions, and decisions on behavior surrounding SARS-CoV-2 testing and COVID-19 vaccination in underserved communities.