RAPID VACCINATION OF HARD TO REACH POPULATI0NS

描述（由申请人提供）：提出的是一个准实验设计，涉及多层次的社区参与性干预，旨在快速免疫困难的少数民族社区（HTR）人群。少数民族和生活在贫困和接近贫困中的人的疫苗接种覆盖率低是一个持续存在的问题，在HTR人群中尤其严重（例如注射毒品使用者、老年人）。免疫接种率受到多种因素的影响，包括人口统计、对疫苗接种的态度、健康规范、获取障碍和免疫接种方法。成功接种HTR人群的努力必须解决这些因素。一个以社区为基础的快速疫苗接种计划可以作为应急准备疫苗接种计划的初始模式，并为未来在弱势城市社区广泛引入艾滋病毒疫苗接种的努力提供参考。该项目将由一个社区公共卫生伙伴关系分三个阶段在哈莱姆和南布朗克斯的八个弱势社区进行。在第一阶段，我们将对指定社区的居民进行简要的调查评估，以确定这些社区的HTR目标人群目前面临的免疫接种的主要障碍。此外，使用几种估计方法，我们将确定研究社区的目标人群的规模，以确定所需的疫苗，并估计疫苗接种率的增长率。在第二阶段，我们将实施两波多层次的社区干预试验（根据调查和社区合作伙伴的投入开发）。在第一波中，四个随机选择的社区将接受干预（即，社区教育、社区组织参与和为符合条件的群体开展的逐户流感疫苗接种计划等）。在四个控制社区，将邀请目标人群到指定地点接种疫苗，作为常规公共卫生工作的一部分。在第二波疫苗接种中，采用交叉设计，根据第一波的经验更新和修改方法后，我们将在四个对照社区实施干预;这一疫苗接种波将进行一周以上，以测试这些人群快速接种疫苗的可行性。该项目的第三阶段将确定该计划的有希望的要素，并开发材料，以便推广到其他城市地区和其他疫苗（例如，HIV、HBV等）。

DESCRIPTION (provided by applicant): Proposed is a quasi-experimental design involving a multilevel community participatory intervention that is designed to rapidly immunize hard-to-reach (HTR) populations in disadvantaged minority communities. Low vaccination coverage among minorities and persons living in and near poverty is a persistent problem that is particularly acute among HTR populations (e.g. injection drug users, elderly shut-ins). Immunization rates are affected by multiple factors including demographics, attitudes about vaccination, health norms, barriers to access, and immunization delivery methods. Efforts to successfully vaccinate HTR populations must address these factors. A community-based program with rapid vaccination can serve as an initial model for emergency preparedness vaccination plans and for future efforts to widely introduce HIV vaccination in disadvantaged urban communities. This project will be conducted by a community-public health partnership in eight disadvantaged neighborhoods within Harlem and the South Bronx in three phases. In Phase 1 we will implement a brief survey assessment of residents in designated neighborhoods to identify current key barriers to immunization faced by the target HTR populations in these neighborhoods. Also, using several estimation methods, we will determine the size of the target populations in the study neighborhoods to establish vaccine needed and to estimate denominators for vaccination rates. In Phase 2, we will implement two waves of a multilevel community intervention trial (developed with input from the survey and community partners). In the first wave, four randomly selected neighborhoods will receive the intervention (i.e., community education, community-organization engagement, and door-to-door influenza vaccination program for eligible groups etc). In the four control communities, target populations will be invited to come for vaccination at specified locations as part of usual public health efforts. In the second vaccination wave, using a crossover design, after updating and revising the approach based on experience from Wave 1, we will implement the intervention in the four control communities; this vaccination wave will be conducted over one week to test the feasibility of rapid vaccination of these populations. Phase 3 of this project will identify the promising elements of the program and develop materials to allow generalizability to other urban areas and to other vaccines (e.g., HIV, HBV, etc).