Optimization of a new adaptive intervention to increase COVID-19 testing among people at high risk in an urban community

项目摘要 新冠肺炎对边缘化城市中的医疗或社会弱势群体产生了不成比例的影响 美国各地的社区(例如，患有共病、在高风险环境中工作的人、 拒绝或无法遵守新泽西州(新泽西州)预防指南)。的社会决定因素 健康(SDH)，如耻辱、监禁和贫困，与接触新冠肺炎的增加有关 死亡人数也在增加。在缺乏有效、有效和广泛可用的疫苗和治疗方法的情况下， 预防--即检测、社交距离、接触者追踪和隔离--至关重要。人们对此知之甚少 新冠肺炎检测在低收入和种族/少数民族社区的可接受性，那里的居民 面临更多的预防障碍(例如，住房不足、高风险工作)。然而，我们有 了解符合成本效益、循证和文化上合适的干预措施 成功地用于让人们参与艾滋病毒的预防和治疗。这些干预措施可以调整和 经测试可帮助解决新冠肺炎问题。导航服务(NS)增加了艾滋病毒检测和治疗依从性 同时解决阻碍高危社区参与治疗的结构性障碍。简短的咨询 增加艾滋病毒治疗参与度。本研究采用序贯、多重分配的随机试验 (SMART)与582名新冠肺炎医疗/社会弱势群体。以《新冠肺炎》为统领 预防、护理和治疗，分析将探索与检测和遵守公众 健康建议。这项研究的目标包括：目标1：优化适应性干预， 提高测试率和新泽西州新冠肺炎建议的遵从率(测试、社交距离、 隔离、住院、接触者追踪和接受新冠肺炎疫苗接种)是高危人群 人口。目标2：确定测试完成和遵守新泽西州建议的预测因素。 这项研究在应用现有的循证干预措施来应对新冠肺炎和 遵循以社区为基础的参与性研究原则。它有

Project Summary COVID-19 has disproportionately impacted medically or socially vulnerable populations in marginalized urban communities across the United States (e.g., people with co-morbidities, working in high risk settings, those refusing or unable to adhere to the State of New Jersey (NJ) prevention guidelines). Social determinants of health (SDH) such as stigma, incarceration, and poverty are associated with increased exposure to COVID-19 and increased deaths. In the absence of effective, potent, and widely available vaccines and treatments, prevention – i.e., testing, social distancing, contact tracing, and quarantine -- is essential. Little is known about acceptability of COVID-19 testing in low-income and racial/ethnic minority neighborhoods, where residents experience increased barriers to prevention (e.g., inadequate housing, high-risk jobs). However, we have knowledge of cost-effective, evidence-based, and culturally appropriate interventions that have been successfully used to engage people in HIV prevention and treatment. These interventions can be adapted and tested to help address COVID-19. Navigation services (NS) increase HIV testing and adherence to treatment while addressing structural barriers that deter treatment engagement in high-risk communities. Brief counseling increases HIV treatment engagement. This study uses a Sequential, Multiple Assignment Randomized Trial (SMART) with 582 COVID-19 medically/socially vulnerable people. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, analysis will explore factors associated with testing and adherence to public health recommendations. The study aims include: Aim 1: To optimize an adaptive intervention that will increase rates of testing and adherence to NJ COVID-19 recommendations (testing, social distancing, quarantine, hospitalization, contact tracing and acceptance of COVID-19 vaccination) among high-risk populations. Aim 2: To identify predictors of testing completion and adherence to NJ recommendations. This study is innovative in its application of existing evidence-based interventions to address COVID-19 and the use of SMART following Community Based Participatory Research principles. It has