Protecting Native Families from COVID-19: Radx Initiative

项目摘要 白色山阿帕奇-纳瓦霍-JHU研究合作伙伴具有独特的地位，并准备推进COVID-19 通过紧急竞争性修订进行预防科学，以促进社区可持续发展COVID-19研究 在服务不足和/或弱势群体中进行检测（NOT-OD-20-121）。自2020年4月以来，我们已实施 与纳瓦霍和白色山区阿帕奇国家开展全面的COVID-19缓解活动，这些国家 美国最高的比率，以及家庭测试和快速获得结果的能力。我们的经验和数据 与部落卫生部门和印度卫生服务部门的审查发现了检测、保护和治疗方面的障碍。 行为，隔离和寻求护理的两个高风险的亚组，必须解决成功的 减灾第一组是年龄>65岁的老年人，他们在两个社区的病死率最高， 深受尊敬的文化习俗和语言的教师。目前，相当一部分老年人拒绝接受 由于文化信仰和恐惧而进行测试，并且在症状恶化时缓慢寻求护理。第二组是年轻人 18-34岁的成年人使用药物，人均病例比例最高，不太可能社会- 他们远离或与世隔绝，而且更短暂，在多代同堂的家庭中流动。该项目将采用2x2 析因设计，以评估这些高风险群体的两种干预措施：1）文化定制，年龄特定 动机性访谈（MI）干预，以促进测试，保护行为和适当的隔离， 2）基于文本的COVID-19症状（CS）监测系统，旨在缩短 症状发作和测试，同时纳入地理信息系统，以协助路线图，以家庭为基础的后续行动。米已 在美国印第安人社区的强有力的证据，包括我们的团队证明MI干预改善STI/艾滋病毒 试验. CS系统基于我们在移动的健康监测和嵌入式GIS/GPS跟踪方面的经验。我们 三个主要目标是：1.利用基于社区的启发性研究来应用相关促进者的知识， 通过随机对照试验创建、试点、实施和评估文化定制的简短MI干预措施的障碍， 出现症状时进行COVID-19检测，采取适当的预防行为， 在老年人（年龄>65岁）和近期有药物滥用史的年轻人中呈阳性; 2：实施和 通过RCT评估每日CS监测系统，包括警报、参与者请求家庭测试的机制 当遇到第一个症状，和GIS路由的那些响应基于文本的警报;和3：评估 MI或CS单独或联合检测的相对优点和出现症状时的检测时间，以及 使用2x2析因设计，当阳性时，坚持隔离和寻求护理的建议。我们的次要 目标将探讨a）文化认同和连通性; B）物质使用或心理健康因素（抑郁， 焦虑、自杀倾向）;以及c）年龄和性别中等干预反应。如果目标实现，我们将迅速 为美国最缺乏服务和高风险人群提供诊断测试策略的进展。

PROJECT SUMMARY White Mountain Apache-Navajo-JHU research partners are uniquely positioned and prepared to advance COVID-19 prevention science through the Emergency Competitive Revisions for Community-Engaged Research on COVID-19 Testing among Underserved and/or Vulnerable Populations (NOT-OD-20-121). Since April 2020, we have implemented comprehensive COVID-19 mitigation activities with Navajo and White Mountain Apache nations, who have had the highest rates in the US, and honed capacity for home-testing and obtaining rapid results. Our experience and data review with tribal divisions of health and the Indian Health Service has uncovered barriers to testing, protective behaviors, isolation and care-seeking among two high risk sub-groups that must be addressed for successful mitigation. The first group are elders, ages >65, who have the highest case fatality rate in both communities and are deeply revered as teachers of cultural practices and languages. A significant portion of elders are currently resistant to testing due to cultural beliefs and fear, and slow to seek care when symptoms worsen. The second group are young adults, ages 18-34, using substances, who have the highest proportion of cases per capita, are less likely to social- distance or isolate, and are more transient, moving among multi-generational households. This project will apply a 2x2 factorial design to evaluate two interventions for these high-risk groups: 1) a culturally tailored, age-specific Motivational Interviewing (MI) intervention to promote testing, protective behaviors and appropriate isolation and care-seeking, and 2) a COVID-19 symptom (CS) text-based monitoring system designed to shorten time between symptom onset and testing, while incorporating GIS to assist with route-mapping for home-based follow-up. MI has strong evidence in American Indian communities, including our team’s proven MI intervention for improved STI/HIV testing. The CS System builds on our experience with mobile health surveillance and embedded GIS/GPS tracking. Our three primary aims are: 1: Use Community Based Participatory Research to apply knowledge of relevant facilitators and barriers to create, pilot, implement, and evaluate through an RCT a culturally tailored brief MI intervention to promote COVID-19 testing when experiencing symptoms, appropriate preventive behaviors, and isolation and care-seeking when positive among elders (ages >65 years) and young adults with a recent history of substance misuse; 2: Implement and evaluate through a RCT a daily CS monitoring system with alerts, mechanisms for participants to request home-testing when experiencing first symptoms, and GIS routing for those responding to text-based alerts; and 3: Evaluate the relative merits of MI or CS alone or combined on testing and time to testing when experiencing symptoms, and adherence to isolation and care-seeking recommendations when positive using a 2x2 factorial design. Our secondary aims will explore if a) cultural identity and connectedness; b) substance use or mental health factors (depression, anxiety, suicidality); and c) age and sex moderate intervention response. If aims are achieved, we will make rapid advances in diagnostic testing strategies for the most underserved and high-risk populations in the US.