Determinants and Outcomes of Nicotine Metabolite Ratio in HIV + Smokers

HIV 吸烟者尼古丁代谢比率的决定因素和结果

• 批准号: 10254935
• 负责人: ROBERT GROSS
• 金额: $ 144.65万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-11-15 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254935
• 关键词: 2019-nCoV; AIDS prevention; Address; Affect; Area; Behavioral; COVID-19; COVID-19 detection; COVID-19 diagnosis; COVID-19 diagnostic; COVID-19 pandemic; COVID-19 test; COVID-19 testing; Caring; Clinic; Cohort Studies; Collaborations; Communities; Contact Tracing; Containment; Data; Decentralization; Detection; Diagnostic Reagent Kits; Diagnostic tests; Disease; Economics; Epidemic; Ethics; FDA Emergency Use Authorization; FDA approved; Federally Qualified Health Center; Fright; Future; HIV; Health Professional; Health Services Accessibility; Healthcare; Human immunodeficiency virus test; Immigrant; Income; Individual; Infection; Intervention; Intervention Studies; Latinx; Logistics; Low income; Medical; Methods; Misinformation; Modeling; Modification; Nicotine; Outcome; Participant; Philadelphia; Population; Privacy; Process; Public Health; RADx Underserved Populations; Randomized; Randomized Controlled Trials; Research; Research Methodology; Sampling; Secondary to; Sensitivity and Specificity; Services; Severe Acute Respiratory Syndrome; Smoker; Social Network; Substance Use Disorder; System; Technology; Testing; Underserved Population; United States; Viral hepatitis; Virus; Vulnerable Populations; arm; base; community partnership; comorbidity; experience; follow-up; health care availability; health disparity; health inequalities; health management; housing instability; implementation science; literacy; medically underserved; novel; pandemic disease; peer; peer networks; primary care services; randomized trial; response; scale up; self testing; social; social stigma; testing uptake; underserved community; user-friendly

Project Summary COVID-19, the disease caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has led to a global pandemic and has exacerbated existing health inequities among vulnerable populations. Despite higher rates of COVID-19 in Black and Latinx individuals compared to White individuals, rates of testing in predominately non-White, low-income communities are significantly lower than in high-income areas. Strategies to increase COVID-19 testing rates in underserved populations are thus urgently needed. Self-testing, where individuals collect their own samples, is now feasible for the detection of SARS-CoV-2. Self-testing can increase testing convenience and privacy and has been effectively leveraged to expand testing for other infections, such as HIV, in key populations across a broad spectrum of contexts. However, self-testing may be limited to those with access to health services, without reaching individuals underserved by existing medical systems. One promising approach to increase test uptake is the secondary distribution of self-testing kits, where an individual distributes tests to contacts in their social network and encourages them to self-test. A significant advantage of a secondary distribution strategy is that by decentralizing a health care process, individuals may be more likely to access services if delivered by social network peers, rather than health professionals. In addition, secondary distribution can enhance contact tracing efforts, as individuals diagnosed with COVID-19 can distribute self-tests to close contacts to identify additional cases. Given high levels of COVID-19 misinformation, stigma, and medical mistrust among vulnerable populations, this peer-driven test distribution strategy holds significant promise in increasing the reach of COVID-19 testing among underserved populations. In collaboration with our community-based partner, Public Health Management Corporation, we will conduct a 1:1 randomized trial with 1048 individuals cared for at Federally Qualified Health Centers to evaluate whether secondary distribution of SARS-CoV-2 self-tests increases test uptake compared with referrals among underserved populations in Philadelphia (Aim 1). We will also assess whether the secondary distribution of self-tests to close contacts among individuals with COVID-19 facilitates case detection (Aim 2). Additionally, we will use a mixed methods strategy to identify key social, ethical, economic, and behavioral barriers and facilitators to secondary distribution to inform its future modifications, implementation, and scale-up (Aim 3). We will engage our relationship with community partners to reach underserved individuals with housing instability, immigrants, and those with significant medical comorbidities including HIV, viral hepatitis, and substance use disorders, in order to increase COVID-19 test uptake in these populations. As more rapid and user-friendly diagnostic tests emerge, this secondary distribution model may become even more impactful. The proposed project may establish a new paradigm for expanding COVID-19 testing and contact tracing.

项目概要 COVID-19 是由 SARS-CoV-2（严重急性呼吸综合征冠状病毒 2）引起的疾病，已 导致了全球大流行，并加剧了弱势群体之间现有的健康不平等。 尽管与白人相比，黑人和拉丁裔人群的 COVID-19 发病率更高，但 以非白人为主的低收入社区的测试明显低于高收入地区。 因此，迫切需要制定提高服务不足人群的 COVID-19 检测率的策略。 现在可以通过个人收集自己的样本进行自我检测来检测 SARS-CoV-2。 自测试可以增加测试便利性和隐私性，并已有效利用来扩大测试范围 针对广泛背景下的关键人群中的其他感染，例如艾滋病毒。不过自测 可能仅限于那些能够获得卫生服务的人，而没有覆盖到现有医疗服务不足的个人 医疗系统。提高测试采用率的一种有前途的方法是自测的二次分发 工具包，个人向其社交网络中的联系人分发测试并鼓励他们进行自我测试。一个 二次分配策略的显着优势在于，通过分散医疗保健流程， 如果社交网络同伴提供的服务而不是健康服务，个人可能更有可能获得服务 专业人士。此外，二次分发可以加强接触者追踪工作，因为确诊的个人 感染了 COVID-19 的人员可以向密切接触者进行自我测试，以识别其他病例。鉴于高水平 弱势群体中的 COVID-19 错误信息、耻辱和医疗不信任，这项同行驱动的测试 分发策略对于扩大服务不足的地区的 COVID-19 检测范围具有重大前景 人口。 与我们的社区合作伙伴公共卫生管理公司合作，我们将 对在联邦合格健康中心接受护理的 1048 名个人进行 1:1 随机试验进行评估 与转介相比，SARS-CoV-2 自检的二次分发是否会增加测试的采用率 费城服务不足的人群（目标 1）。我们还将评估是否进行二次分配 对 COVID-19 感染者之间的密切接触者进行自我检测有助于病例发现（目标 2）。此外， 我们将使用混合方法策略来识别关键的社会、道德、经济和行为障碍，并 二次分发的促进者告知其未来的修改、实施和扩大（目标 3）。 我们将与社区合作伙伴建立关系，为服务不足的个人提供住房 不稳定、移民以及患有严重合并症（包括艾滋病毒、病毒性肝炎和 物质使用障碍，以增加这些人群中 COVID-19 测试的采用率。随着更加快速和 用户友好的诊断测试的出现，这种二次分配模型可能会变得更有影响力。这 拟议的项目可能会为扩大 COVID-19 测试和接触者追踪建立新的范例。