Exploring barriers and facilitators to women who use drugs (WWUD) awareness, acceptance and uptake of COVID-19 testing, the CARE study.

项目摘要 在美国，使用非法药物的妇女（WWUD）的感染率不成比例地高， (e.g., HIV、HCV）、慢性和肺部疾病，这些疾病会增加他们感染COVID-19的风险。他们的健康和 疾病谱由持久的社会条件驱动（例如，收入匮乏、粮食无保障、获得 卫生服务、住房、歧视）。这些普遍存在的社会条件也会破坏WWUD的 保护自己免受COVID-19感染的能力（例如，洗手，社交距离）。药品采购 使用这些基本上属于社会进程的药物，进一步挑战了这些自我保护措施。测试 未来的疫苗接种对于减少高风险人群中的COVID-19至关重要， 可访问的测试方案。我们提出了一个混合方法的研究，借鉴安徒生 行为模式10，并以生态社会理论为基础。具体而言，巴尔的摩的研究旨在： 1)探索诱发社会因素（例如，住房、粮食安全），个人层面的因素（例如，吸毒， 心理健康），和信仰（例如，医学上的不信任）是COVID-19检测的促进者和障碍 和感知的风险（例如，创收、暴力），这是通过深入分析 WWUD访谈（N=15）和文化领域分析（N=45）; 2）了解 有利的社区一级环境（例如，医疗和社会服务机构，目前服务 WWUD，现有的全市COVID-19检测点），可能会促进或阻碍WWUD的COVID检测 通过观察（N=8-10）和关键线人访谈（N=10）进行吸收;并检查易感性 与COVID-19检测和复检相关的社会因素、个人因素和信念 在基线和3个月随访时，WWUD队列（N=250）中。在两个地点提供可选测试 研究访视将是自我管理的快速抗原检测。我们还将研究医疗的作用 不信任影响了妇女对医疗保健服务的使用， 医疗机构的歧视，特别是黑人参与者。在巴尔的摩，这种不信任是 尤其是约翰霍普金斯医院在黑人中有着长期的不信任历史， 社区由于实验和欺骗的研究参与。该研究将遵循 一个社区咨询委员会（CAB），将告知其设计和实施，并参与 在社区会议上传播结果，为扩大COVID检测提供信息。

Project Summary In the U.S. women who use illicit drugs (WWUD) have disproportionately high rates of infectious (e.g., HIV, HCV), chronic, and pulmonary diseases that elevate their risk for COVID-19. Their health and disease profile is driven by enduring social conditions (e.g., scarcity of income, food insecurity, access to health services, housing, discrimination). These prevailing social conditions can also undermine WWUDs’ ability to protect themselves from COVID-19 (e.g., washing hands, social distancing). Drug procurement and use, which are largely social processes, further challenge these self-protection measures. Testing and future vaccination is vital to reducing COVID-19 among this high-risk population, necessitating accessible testing schemes. We propose a mixed methods study that draws upon the Andersen Behavioral Model10 and is grounded in eco-social theory. Specifically, the Baltimore-based study aims to: 1) explore predisposing social factors (e.g., housing, food security), individual-level factors (e.g., drug use, mental health), and beliefs (e.g., medical mistrust) that are facilitators and barriers of COVID-19 testing and perceived risks (e.g., income generation, violence) resulting from a diagnosis through in-depth interviews among WWUD (N=15) and a cultural domain analysis (N=45); 2) gain an understanding of the enabling community-level environment (e.g., medical and social service agencies that currently serve WWUD, existing city-wide COVID-19 testing sites) that could facilitate or hinder WWUDs’ COVID-testing uptake through observations (N=8-10) and key informant interviews (N=10); and examine predisposing social factors, individual-level factors, and beliefs that are associated with COVID-19 testing and retesting among a cohort (N=250) of WWUD at baseline and 3-month follow-up. Optional testing offered at both study visits will be a self-administered, rapid antigen test. We will also examine the role of medical mistrust in shaping women’s use of healthcare services as well as experiences of stigma and discrimination in healthcare settings, particularly among Black participants. In Baltimore, this mistrust is particularly pronounced, with Johns Hopkins Hospital having a long history of mistrust in the Black community owing to experimentation and deception of research engagement. The study will be guided by a community advisory board (CAB) who will inform its design and implementation as well as engage in disseminating the results at community meetings to inform COVID-testing scale up.