Protecting Native Families from COVID-19: Radx Initiative

保护原住民家庭免受 COVID-19 侵害：Radx Initiative

• 批准号: 10746221
• 负责人: Mary Allison Barlow
• 金额: $ 108.88万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-20 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10746221
• 关键词: Address; Adherence; Affect; Age; American Indians; Anxiety; Apache; Behavior; Belief; COVID testing; COVID-19; COVID-19 mortality; COVID-19 prevention; COVID-19 testing; Caregivers; Case Fatality Rates; Cessation of life; Cherokee Indian; Child; Clinical; Communicable Diseases; Communities; Contact Tracing; Data; Diagnostic tests; Disease; Elderly; Emergency Situation; Evaluation; Family; Food; Fright; Fund Raising; Funding; Geography; Goals; HIV/STD; Health; Home; Household; Housing; Hualapai; Human immunodeficiency virus test; Intervention; Knowledge; Language; Link; Maps; Mental Depression; Mental Health; Monitor; Morbidity - disease rate; Motivation; National Institute of Mental Health; Navajo; Outcome; Participant; Policies; Population; Positioning Attribute; Positive Test Result; Prevention Research; Preventive; Privatization; Quarantine; RADx; Recommendation; Recording of previous events; Research; Research Personnel; Resistance; Role; Route; Science; Self Efficacy; Social Distance; Speed; Subgroup; Suicide prevention; Symptoms; System; Testing; Text; Time; Trauma; Tribes; Underserved Population; United States Indian Health Service; Vulnerable Populations; Water; White Mountain Apache; Work; Youth; age group; barrier to testing; behavior change; behavior test; care seeking; community based participatory research; community engaged research; coronavirus disease; cost effective intervention; design; experience; follow-up; high risk; high risk population; home test; human old age (65+); improved; mHealth; motivational enhancement therapy; outbreak control; protective behavior; rapid testing; response; severe COVID-19; sex; staff intervention; substance misuse; substance use; suicidal; teacher; tribal Nation; young adult

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.

项目摘要 白山apache-navajo-jhu研究合作伙伴是独特的位置，并准备好促进Covid-19 预防科学通过紧急竞争修订，用于社区参与的COVID-19 在服务不足和/或弱势群体中进行测试（非OD-20-121）。自2020年4月以来，我们已经实施 与纳瓦霍人和白山阿帕奇国家一起进行的全面的共同减轻活动，他们拥有 美国的最高比率，以及诚实的家庭测试和取得快速结果的能力。我们的经验和数据 卫生部落和印度卫生服务部的审查发现了测试的障碍，受到保护 在两个高风险子组中，必须解决的行为，隔离和寻求护理 减轻。第一组是老年人，年龄> 65岁，他们在两个社区中的死亡率最高，并且是 作为文化实践和语言的老师，深受尊敬。目前很大一部分长者对 由于文化信仰和恐惧而引起的测试，并在症状恶化时寻求护理缓慢。第二组年轻 18-34岁的成年人使用的物质（人均案例比例最高），社会不太可能 距离或分离株，并且更短暂地在多代家庭中移动。该项目将应用2x2 评估这些高风险组的两种干预措施的阶乘设计：1）经过文化量身定制的特定年龄 动机访谈（MI）干预措施以促进测试，保护行为和适当的隔离和 寻求护理，以及2）基于文本的监控系统的Covid-19症状（CS）旨在缩短时间 症状发作和测试，同时编码GIS来协助基于家庭的随访路线映射。 Mi有 美洲印第安人社区的强有力证据，包括我们团队经过验证的MI干预，以改善性传播感染/艾滋病毒 测试。 CS系统基于我们在移动健康监视和嵌入式GIS/GPS跟踪方面的经验。我们的 三个主要目的是：1：使用基于社区的参与研究来应用相关促进者的知识和 通过RCT进行创建，试行，实施和评估的障碍 COVID-19在经历症状，适当的预防性行为以及隔离和护理时进行测试 长者（65岁）和年轻人的近期滥用史的成年人之间的积极影响； 2：实施和 通过RCT进行每日CS监视系统评估，并具有警报，参与者要求进行家庭测试的机制 在经历首次症状时，以及对基于文本的警报的人的GIS路由；和3：评估 单独或CS的相对优点，或在经历症状时进行测试和测试时间合并的相对优点，并且 使用2x2阶乘设计阳性时，遵守隔离和寻求护理建议。我们的次要 目的将探讨a）文化身份和联系； b）药物使用或心理健康因素（抑郁症， 动画，自杀）； c）年龄和性别中等干预反应。如果实现目标，我们将迅速 在美国，服务最低迷和高风险人群的诊断测试策略进展。