Project IMPROVE: Implementing Community-Engaged Intervention Research to Increase Rapid SARS-CoV-2 Self-Testing Among Diverse Underserved and Vulnerable Asian Americans

项目摘要 英语水平有限的低收入亚裔美国人（AA）占美国人口的很大比例， 基本服务行业的低工资一线工人。许多人还生活在多代同堂的家庭中， 拥挤的条件和他们的老年亲属在民族社区，地区经历了高 COVID-19感染率。不幸的是，AA在COVID-19检测方面遇到了许多障碍 在个人、提供者/卫生系统和社区/社会层面，包括反亚裔种族主义和 歧视，担心考试地点和公共交通的安全，缺乏健康保险，缺乏文化 和语言适当的COVID-19信息和导航，以及对COVID-19测试站点的限制访问。 因此，AA在所有种族/族裔群体中的COVID-19检测率最低。这是特别 鉴于最近由于BA.2变异和取消COVID限制而导致病例激增， 导致COVID-19感染和住院人数增加，特别是在弱势群体中。FDA- 经批准的非处方（OTC）COVID-19诊断测试为以下方面提供了有价值的循证策略： 授权脆弱的AAs（犹豫不决或无法亲自进行PCR检测）完成 自我测试尽管之前的研究已经证明了社区进行COVID-19自我检测的可行性， 由于存在准入障碍，没有干预研究关注弱势的低收入一线工人和老年人 不同AA种族（中国人，越南人，韩国人）的LEP，是美国人口增长最快的群体。 因此，本申请的总体目标是实施社区参与的多方面干预（本文中 称为IMPROVE干预措施），以增加全国各地快速COVID-19自我检测的可及性和使用率 不同的AA人群。在NIMHD研究框架和社会认知理论的指导下， 社会文化/环境和个人/人际关系对COVID自我测试的影响，我们的中心假设 值得信赖的信使（社区健康导航员，健康提供者和同伴倡导者）是必不可少的 减少检测障碍，提高COVID-19自我检测的使用率。具体目标是：（1）参与 社区合作伙伴在12个CBO站点实施一项实用的随机分组试验，以评估 社区参与的循证IMPROVE干预措施在增加获得 和COVID-19自我检测（主要结局）的吸收以及缓解行为的变化，包括 在服务不足和脆弱人群中坚持戴口罩和接种COVID-19疫苗（次要结果） 种族AA（N=1200个AA：400个中国人，400个韩国人和400个越南人）;和（2）评价干预范围， 使用RE-AIM框架促进IMPROVE的有效性、采用、实施和维护 向更多的社区组织传播干预措施，并随着时间的推移增强其可持续性。拟议的项目将是 第一个评估以证据为基础的社区参与方法，以减少系统性障碍， 将填补3个AA族弱势人群中COVID-19自我检测和缓解依从性研究的空白。

Project Summary Low-Income Asian Americans (AA) with limited English proficiency (LEP) represent a meaningful proportion of low-wage frontline workers in essential service industries. Many also live in multigenerational households with crowded conditions and with their elderly relatives in ethnic neighborhoods, areas that have experienced high rates of COVID-19 infection. Unfortunately, AAs have encountered numerous barriers to COVID-19 testing across individual, provider/health system and community/societal levels, including anti-Asian racism and discrimination, fear of safety at test sites and on public transportation, lack of health insurance, lack of culturally and language-appropriate COVID-19 information and navigation, and limited access to COVID-19 testing sites. As a result, AAs have the lowest COVID-19 testing rate across all racial/ethnic groups. This is particularly concerning in light of the recent surge in cases due to the BA.2 variant and lifting of COVID restrictions, which has led to increases in COVID-19 infections and hospitalizations especially among vulnerable populations. FDA- approved over-the-counter (OTC) COVID-19 diagnostic tests offer a valuable evidence-based strategy for empowering vulnerable AAs (who are hesitant or otherwise unable to obtain in-person PCR testing) to complete self-testing. Although prior studies have demonstrated the feasibility of COVID-19 self-testing in communities with access barriers, no intervention study has focused on vulnerable low-income frontline workers and seniors with LEP across diverse AA ethnic groups (Chinese, Vietnamese, Korean), the fastest growing US population. Thus, the overall goal of this application is to implement a community-engaged multifaceted intervention (herein called the IMPROVE intervention) to increase access to and uptake of rapid COVID-19 self-testing across diverse AA populations. Guided by the NIMHD Research Framework and Social Cognitive Theory to address sociocultural/environmental and individual/interpersonal influences for COVID self-testing, our central hypothesis is that trusted messengers (community health navigators, heath providers, and peer advocates) are essential to reducing testing barriers and increasing uptake of COVID-19 self-testing. The Specific Aims are to: (1) Engage community partners to implement a pragmatic cluster-randomized trial in 12 CBO sites to evaluate the effectiveness of the community-engaged and evidence-based IMPROVE intervention in increasing access to and uptake of COVID-19 self-testing (primary outcome) and changes in mitigation behaviors including adherence to mask wearing and COVID-19 vaccination (secondary outcomes) in underserved and vulnerable ethnic AAs (N=1200 AAs: 400 Chinese, 400 Korean and 400 Vietnamese); and (2) Evaluate Intervention Reach, Effectiveness, Adoption, Implementation and Maintenance using the RE-AIM framework to facilitate IMPROVE intervention dissemination to more CBOs and enhance its sustainability over time. The proposed project will be one of the first to evaluate an evidence-based community-engaged approach to reducing systemic barriers and will fill gaps in research on COVID-19 self-testing and mitigation adherence in 3 ethnic AA vulnerable populations.