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(WWUD)的女性具有不成比例的高传染性 (例如，艾滋病毒、丙型肝炎)、慢性和肺部疾病，这些疾病会增加他们患新冠肺炎的风险。他们的健康和 疾病概况是由持久的社会条件驱动的(例如，收入匮乏、粮食不安全、获得 卫生服务、住房、歧视)。这些盛行的社会条件也会破坏WWUD 保护自己免受新冠肺炎攻击的能力(例如，洗手、社交距离)。药品采购 和使用，这在很大程度上是社交过程，进一步挑战了这些自我保护措施。测试 而未来的疫苗接种对于减少这一高危人群中的新冠肺炎至关重要，因此有必要 可访问的测试方案。我们提出了一种混合方法研究，借鉴了安徒生的 行为模型10，并以生态社会理论为基础。具体地说，这项位于巴尔的摩的研究旨在： 1)探讨诱因社会因素(如住房、粮食安全)、个人因素(如吸毒、 心理健康)，以及信仰(例如，医疗不信任)是新冠肺炎测试的促进者和障碍 以及通过深入的诊断而产生的感知风险(例如，创收、暴力) WWUD访谈(N=15)和文化领域分析(N=45)；2)了解 促进社区一级的环境(例如，目前提供服务的医疗和社会服务机构 WWUD，现有的全市范围的新冠肺炎测试点)，这可能会促进或阻碍WWUD的CoVID测试 通过观察(N=8-10)和关键线人访谈(N=10)了解情况；并检查诱因 与新冠肺炎测试和重测相关的社会因素、个人因素和信念 在基线和3个月随访的WWUD队列中(N=250)。这两个学校都提供可选测试 研究访问将是一种自我管理的快速抗原测试。我们还将研究医疗服务的作用 对塑造妇女使用医疗保健服务的不信任以及耻辱和 医疗保健环境中的歧视，特别是在黑人参与者中。在巴尔的摩，这种不信任是 尤其明显的是，约翰霍普金斯医院对黑人的不信任由来已久 社区由于实验和研究参与的欺骗。这项研究将由 社区咨询委员会(CAB)将向其设计和实施提供信息，并参与 在社区会议上传播结果，以通知COVID-扩大检测规模。

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.