Leveraging Social Networks to Increase COVID-19 Testing Uptake: A Comparison of Credible Messenger and Chain Referral Recruitment Approaches

在治疗或疫苗出现之前，我们遏制新冠肺炎的能力必须依赖于广泛的 (无症状)阳性病例的识别、随后的隔离和接触者追踪 可能会暴露出来。因此，检测工作必须针对那些高度脆弱但没有得到服务的人。 人口，包括使用阿片类药物和其他物质的个人。这些人可能有贫穷的 因使用物质(如阿片类药物、甲基苯丙胺)而导致的呼吸或肺健康，这可能会使它们 更容易感染病毒。此外，这些人也更有可能被监禁或居住 在街上、在避难所或在拥挤的住所，进一步使它们面临传播的风险。我们 建议开展研究，以确定社区-社会网络扩展模式的有效性和可持续性 将传染病卫生服务提供者与基于社区的组织合作，成功实施 (覆盖、吸收、交付和维持)新冠肺炎服务点，在高度脆弱的人群中进行快速测试 以及经常得不到充分服务的人群，即那些使用阿片和其他物质的人。两个截然不同的社交网络 已证明有效的招募战略，识别隐藏人群并增加艾滋病毒感染率 测试将被改编和比较。在EPIS框架、社会认知理论和安徒生的指导下 模型方面，本研究分为三个阶段。第一阶段：调整外展招聘战略，我们将 与我们的项目社区咨询委员会(CAB)合作，调整连锁推荐和可信的信使战略 接受新冠肺炎测试，敲定招聘和现场测试方案，并在 新方案和持续质量改进战略(目标1)。阶段2：策略功效试验和 实施评估，我们将在两个社区的交叉设计中比较这两种策略 具有长期服务于社区中难以接触到的人群的历史的组织(CBO)。这个 策略比较并不是为了确定一种抽样策略在提供 人口估计，而不是确定每一种招聘战略达到 目标人群和增加新冠肺炎测试的接受度。我们将研究每种策略对(I)的影响 REACH(招募目标人群)，(Ii)新冠肺炎测试/重复测试，以及(Iii)服务提供(即 隔离、医疗和接触者追踪)新冠肺炎检测呈阳性(探索性)(目标 2)。阶段3：持续，CBO将根据结果实施被证明有效的战略，我们 将审查他们对该计划的维持情况(目标2)。实施情况评估将确定参与者、工作人员、 以及影响每项战略的可行性、可接受性和可持续性的组织级因素 这些CBO。(目标3)。这项调查将提供急需的信息，以改善健康结果和 确定有效的系统级应对措施，以防止或阻止新冠肺炎在社交网络中的传播 在那些使用阿片类药物和其他物质的人中，他们是一个非常脆弱、往往被忽视的群体。

Until the advent of treatment or a vaccine, our ability to contain COVID-19 must rely on widespread identification of (asymptomatic) positive cases, their subsequent quarantine, and contact tracing of those potentially exposed. Therefore testing efforts must be targeted to those highly vulnerable yet unserved populations, including individuals who use opioids and other substances. These individuals may have poor respiratory or pulmonary health due to substance use (e.g. opioids, methamphetamine), which may make them more susceptible to the virus. Also, these individuals are also more likely to have been incarcerated, or reside on the street, in shelters or in crowded accommodation, further placing them at risk for transmission. We propose research to establish efficacy and sustainability of a community-social network outreach model that partners infectious disease health providers with community based organizations to successfully implement (reach, uptake, delivery and sustainment) COVID-19 point of service, rapid-testing among a highly vulnerable and often underserved population, those who use opioids and other substances. Two distinct social network recruitment strategies with demonstrated efficacy identifying hidden populations and increasing uptake of HIV testing will be adapted and compared. Guided by the EPIS framework, social cognitive theory, and Andersen’s model, this study comprises three phases. Phase 1: Adaptation of outreach recruitment strategies, we will work with our project community advisory board (CAB) to adapt chain-referral and credible messenger strategies for uptake of COVID-19 testing, to finalize recruitment and on-site testing protocols, and to train the CAB in the new protocols and in continuous quality improvement strategies (Aim 1). Phase 2: Strategy Efficacy Trial and Implementation Evaluation, we will compare the two strategies in a cross-over design at two community based organizations (CBOs) with long standing history of serving hard-to-reach populations in their communities. The comparison of strategies is not to identify the statistical superiority of one sampling strategy in providing population estimates over the other, but instead to identify the ability of each recruitment strategy to reach the target population and increase uptake of COVID-19 tests. We will examine the impact of each strategy on (i) reach (recruitment of target population), (ii) COVID-19 testing/repeat testing, and (iii) service delivery (i.e. quarantine, medical care and contact tracing) among those who test positive for COVID-19 (exploratory) (Aim 2). Phase 3: Sustainment, CBOs will implement the strategy proven efficacious based on outcomes, and we will examine their sustainment of the program (Aim 2). Implementation evaluation will identify participant-, staff-, and organizational-level factors that influence the feasibility, acceptability, and sustainability of each strategy in these CBOs. (Aim 3). This investigation will provide much needed information to improve health outcomes and to identify effective system-level responses to prevent or arrest the spread of COVID-19 among the social networks of those who use opioids and other substances, a highly vulnerable and often overlooked population.