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

摘要 美国的黑人社区不成比例地经历了可归因于种族歧视的不利后果。 2019冠状病毒病疫情。虽然COVID-19病例和死亡人数在最近几个月有所下降，但新出现的变异 继续威胁黑人社区和其他人的健康。COVID-19检测最近发生了变化 从最初的即时检测到快速家庭抗原检测的广泛使用。家庭测试可能是 对黑人来说，最好是基于诊所的测试，其中许多人有高度的有根据的， 历史上对医疗系统的不信任，但目前对知识，态度， 以及黑人在COVID-19家庭测试中的行为。除了与以下方面有关的挑战外， 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 监视信息。家庭测试很少报告给公共卫生监督机构， 无法用于基因测序和变异检测。这导致公共卫生方面的巨大差距 关于COVID-19疾病负担和循环变体的知识，这可能特别成问题 对于黑人社区来说，不良后果的风险更高。我们提出了一个基于前干预后研究 在佐治亚州亚特兰大的黑人社区，评估研究参与者使用COVID-19快速 家庭测试，并同时邮寄自我收集的前鼻孔样本到商业实验室， 确认PCR检测。我们将提供文化能力的口头和说明书面沟通 鼓励继续保持对COVID-19的警惕和进行家庭检测，同时自我收集 用于邮寄测试的样本。这些信息将与家庭检测试剂盒一起包装，用于快速检测和自我检测。 收集第二样本并将其邮寄到实验室。如果一部分家庭测试者愿意自己收集 并邮寄样本进行确证性检测，可采用乘数法估算疾病负担 并在家庭测试者中传播变体。然而，对医疗不信任的人可能不会选择分享 用于监视目的的生物样本。我们的目标是了解使用这种方法的动机和障碍。 在黑人社区的测试模式，同时也评估一般知识，态度， 与家庭测试有关的行为。具体目标是：（1）发展文化上适当的、赋予权力的 宣传策略强调家庭COVID-19检测对个人和公众的重要性 健康;（2）评估社会人群对COVID-19快速家庭检测的知识、态度和行为， 人口统计学上多样化的黑人社区;（3）评估提供的意愿，结合快速 居家检测，将自行采集的标本送实验室进行COVID-19确诊检测;（4）深入开展 与完成（N=10）和未完成（N=10）研究提供的家庭测试的人员进行访谈，以进一步 利用参与者对干预措施有效性的开放式思考，改进沟通战略。

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.