Admin-Core-001

摘要 随着COVID-19大流行蔓延到美国的每一个角落，美国印第安人/阿拉斯加城市的困境 原住民（AI/AN）往往被忽视或忽视。SARS-CoV-2及其引起的疾病COVID-19， 不成比例地影响AI/AN，他们是美国任何种族或族裔群体中患严重 疾病和死于COVID-19。可悲的是，我们没有关于城市感染率、发病率或死亡率的数据， AI/AN占AI/AN总人口的71%。城市AI/AN可以通过城市获得临床护理 印第安人健康计划（UIHP），印第安人健康服务，部落，公共和私人设施。我们的讨论 与UIHP领导人揭示了测试的复杂障碍，例如无法获得测试套件， 病人和外展人员不足。为了在城市AI/AN中增加SARS-CoV-2检测，我们将 利用在6个大型NIH建立的全国卫星中心网络（全部由人工智能/人工智能学者领导）- 赞助的倡议，达到，从事，并确保社区利益攸关方参与研究，在 地方一级我们的卫星中心将与美国6个地理位置相邻的UIHP合作， “社区组织为原住民：COVID-19流行病学，研究，测试和服务”研究 （音乐会）。CONCERTS的目标是消除障碍，增加城市中的SARS-CoV检测。 人工智能/人工神经网络。首先，我们将使用来自这6个UIHP的数据来估计目前SAR-CoV-2检测的使用情况， COVID-19疾病的负担。其次，我们将调查诊所管理人员，提供者和600名患者， 所有6个UIHP了解测试的障碍和促进因素，以及首选的测试选项。第三，通知 这些数据，6个UIHP将实施本地定制的诊所相关（例如，免下车，基于移动的单元 测试）和基于外展的策略（例如，COVID-19导航仪），以增加SAR-CoV-2检测。1日之后 今年，我们将重新检查检测率，进行前后比较，以确定这些策略是否有效。 成功第四，我们将与UIHP合作，制定一份可持续的务实做法清单， 未来的流行病和疫苗接种计划。我们的主要结果是SARS的月检测率- 城市AI/AN中的CoV。具体目的是：1）估计基线SARS-CoV-2检测和感染 确定城市AI/AN中检测和疾病负担差异的比率; 2）调查管理员，提供者， 和100名患者从每个6个UIHP，以确定障碍，促进者，态度，风险因素， 与SARS-CoV-2检测相关的服务; 3）实施与诊所相关和基于外展的策略， 每一个UIHP，以提高检测率，减少SARS-CoV-2的传播，然后比较检测率之前， 实施后;以及4）评估CONCERTS和目录实用的做法，以应用到未来 大流行病和成功的疫苗接种运动中的城市AI/ANs。国家在AI/AN健康方面的努力 护理被描述为“历史性的失败”。在当前的大流行期间，这一历史仍在继续， 强调了服务于美国“最大部落”-城市AI/AN的设施的迫切需求。

ABSTRACT As the COVID-19 pandemic spreads to every corner of the US, the plight of urban American Indian/Alaska Native (AI/AN) people is often overlooked or ignored. SARS-CoV-2 and the disease it causes, COVID-19, disproportionately affect AI/ANs, who are at highest risk of any US racial or ethnic group for developing severe disease and dying from COVID-19. Sadly, we have no data on infection rates, morbidity, or mortality on urban AI/ANs, who comprise 71% of the total AI/AN population. Urban AI/ANs may obtain clinical care through Urban Indian Health Programs (UIHPs), the Indian Health Service, tribal, public, and private facilities. Our discussions with UIHP leaders reveal complex barriers to testing, such as inability to procure test kits, reach homebound patients, and inadequate staffing for outreach. To increase SARS-CoV-2 testing among urban AI/ANs, we will draw on a nationwide network of Satellite Centers (all led by AI/AN scholars) established in 6 large NIH- sponsored initiatives that reach, engage, and ensure participation of community stakeholders in research at the local level. Our Satellite Centers will partner with 6 geographically contiguous UIHPs across the US to launch the “Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services” study (CONCERTS). The goal of CONCERTS is to remove barriers and increase SARS-CoV testing among urban AI/ANs. First, we will use data from these 6 UIHPs to estimate current uptake of SAR-CoV-2 testing and the burden of COVID-19 disease. Second, we will survey clinic administrators, providers, and 600 patients across all 6 UIHPs to understand testing barriers and promoters, and preferred testing options. Third, informed by these data, the 6 UIHPs will implement locally tailored clinic-associated (e.g., drive-through, mobile unit-based testing) and outreach-based strategies (e.g., COVID-19 navigators) to increase SAR-CoV-2 testing. After 1 year, we will re-examine testing rates for a pre-post comparison to establish if these strategies were successful. Fourth, we will collaborate with the UIHPs to produce a list of sustainable, pragmatic practices for future pandemics and vaccination programs. Our primary outcome is the monthly testing rate for SARS- CoV among urban AI/ANs. The Specific Aims are to: 1) Estimate baseline SARS-CoV-2 testing and infection rates to identify disparities in testing and disease burden in urban AI/ANs; 2) Survey administrators, providers, and 100 patients from each of 6 UIHPs to identify barriers, facilitators, attitudes, risk factors, and necessary services pertinent to SARS-CoV-2 testing; 3) Implement clinic-associated and outreach-based strategies at each UIHP to increase testing rates and reduce spread of SARS-CoV-2, then compare testing rates before and after implementation; and 4) Evaluate CONCERTS and catalog pragmatic practices for application to future pandemics and successful vaccination campaigns among urban AI/ANs. The nation's efforts in AI/AN health care have been described as a “historic failure.” This history continues during the current pandemic, underscoring the urgent needs of facilities serving America's “largest tribe” – urban AI/ANs.