Increasing representation of Black communities in COVID-19 home testing and surveillance data

摘要 美国的黑人社区经历了不成比例的不良后果，这可归因于 新冠肺炎大流行。虽然近几个月来新冠肺炎病例和死亡人数有所下降，但新出现的变种 继续对黑人社区和其他人的健康构成威胁。新冠肺炎测试最近发生了变化 从主要的护理点检测到快速家庭抗原检测的广泛使用。家庭测试可能是 对于黑人来说，这比基于临床的检测更可取，因为他们中的许多人都有很高的基础， 历史上对医疗系统的不信任，但目前对知识、态度、 以及围绕新冠肺炎在黑人中进行家庭测试的行为。除了与以下相关的挑战 家庭测试的可负担性和可获得性，家庭测试提供的隐私是以牺牲 监控信息。家庭检测很少向公共卫生监督报告，样本是 不适用于基因测序和变异检测。这导致了公共卫生方面的巨大差距。 关于新冠肺炎的疾病负担和循环中的变异的知识，这可能是特别有问题的 对于不良后果风险较高的黑人社区。我们提出了一项干预前研究，基于 在佐治亚州亚特兰大的黑人社区，评估研究参与者使用新冠肺炎的意愿 家庭化验，并同时邮寄自行收集的前鼻孔样本至商业化验所进行化验 验证性的聚合酶链式反应检测。我们将提供有文化能力的口头和图文并茂的书面交流。 鼓励继续保持新冠肺炎警惕和家庭测试的信息，以及自我收集 用于邮寄测试的样本。这些消息将与家庭测试套件一起打包，以进行快速测试和自我测试 收集第二个样本并将其邮寄到实验室。如果一部分家庭测试员愿意自我收集 并邮寄样本进行验证性检验，乘数法可用于估算疾病负担 以及在家庭测试员中传播变种。然而，医学上不信任的人可能不会选择分享 用于监测目的的生物标本。我们的目标是了解使用这项技术的动机和障碍 黑人社区中的测试模式类型，同时还评估一般知识、态度和 与家庭测试相关的行为。具体目标是：(1)发展适合文化的、赋予能力的 传播策略强调家庭新冠肺炎测试对个人和公众的重要性 健康；(2)评估社会公众对新冠肺炎家庭快速检测的知识、态度和行为 人口结构多样化的黑人社区；(3)评估提供的意愿，与快速 入户检测，自行采集标本到实验室进行确认性新冠肺炎检测；(4)深入开展 对完成(N=10)和未完成(N=10)研究的人的访谈-提供了家庭测试以进一步 利用参与者对干预效果的开放式思考，改进沟通策略。

Abstract Black communities in the U.S. have disproportionately experienced adverse outcomes attributable to the COVID-19 pandemic. While COVID-19 cases and deaths have declined in recent months, emergent variants continue to pose threats to the health of Black communities and others. COVID-19 testing has recently shifted from primarily point-of-care testing to widespread use of rapid home antigen tests. Home testing may be preferable to clinic-based testing for Black persons, many of whom have a high degree of well-founded, historically based mistrust of the medical system, but very little is currently known about knowledge, attitudes, and behaviors surrounding COVID-19 home testing among Black people. In addition to challenges related to affordability and accessibility of home testing, the privacy afforded by home testing comes at the expense of surveillance information. Home tests are rarely reported to public health surveillance, and specimens are unavailable for genetic sequencing and variant detection. This results in a substantial gap in public health knowledge about COVID-19 burden of disease and circulating variants, which may be particularly problematic for Black communities with higher risk for adverse outcomes. We propose a pre-post intervention study based in Black communities in Atlanta, GA to assess willingness of research participants to use a COVID-19 rapid home test and to simultaneously mail a self-collected anterior nares sample to a commercial laboratory for confirmatory PCR testing. We will provide culturally competent oral and illustrated written communication messages encouraging continued COVID-19 vigilance and home testing alongside self-collection of a specimen for mail-off testing. These messages will be packaged with a home test kit for rapid testing and self- collecting and mailing a second specimen to a laboratory. If a subset of home testers were willing to self-collect and mail a specimen for confirmatory testing, multiplier methods could be used to estimate burden of disease and circulating variants among home testers. However, people with medical mistrust may not elect to share biological specimens for surveillance purposes. We aim to understand motivations and barriers for using this type of testing modality in Black communities while also assessing general knowledge, attitudes, and behaviors related to home testing. Specific aims are to: (1) Develop culturally appropriate, empowering communications strategies underscoring the importance of home COVID-19 testing for individual and public health; (2) Assess knowledge, attitudes, and behaviors regarding COVID-19 rapid home testing among socio- demographically diverse Black communities; (3) Assess willingness to provide, in conjunction with a rapid home test, a self-collected specimen to a laboratory for confirmatory COVID-19 testing; (4) Conduct in-depth interviews with persons completing (N=10) and not completing (N=10) the study-provided home test to further improve communications strategies using participants’ open-ended reflections on intervention effectiveness.