Addressing COVID-19 Testing Disparities in Vulnerable Populations Using a Community JITAI (Just in Time Adaptive Intervention) Approach - Phase II

摘要 的 （阶段 临床和转化科学中心（CCTS）的目标 II）RADx-UP 121项目旨在确定SARS-CoV-2检测的趋势和差异， 感染，以及德克萨斯州三个目标地区的COVID-19疫苗接种覆盖率：休斯顿/哈里斯 县;德克萨斯州南部（卡梅隆县和伊达尔戈县; 3）德克萨斯州东北部（7个县 包括泰勒市）。这一努力将改善和扩大 时间 相关 威尔： 最近 结构 和 接入 启用 多层次的，刚刚在- 适应性干预战略，以帮助经历不平等的弱势群体 新冠肺炎更具体地说，通过与社区伙伴合作，该项目 1)确定SARS-CoV-2检测和感染的差异和动态，考虑 关于COVID-19疫苗接种的数据; 2）识别个人、组织、社区和 导致SARS-CoV-2检测和COVID-19疫苗接种差异的因素， 3)扩大一个 多层次的干预，以增加动力， 在弱势群体中进行检测和接种疫苗。该项目的努力将是 通过利用长期的社区合作伙伴关系。 S 第二阶段将借鉴第一阶段工作的经验和成就， 包括：（1）开发实时数据处理程序， 各种本地数据的质量控制措施，包括SARS-CoV-2检测数据、病例 调查和医院记录;（2）处理和分析COVID-19病例数据，包括 哈里斯县超过367，000例，卡梅隆县超过40，000例， 德克萨斯州东北部各县-所有数据集现在都有共同的数据元素和一致的格式; (3)制定几个指标来量化整体COVID-19疾病负担 （4）发展人口普查区组-一级 差距指数，它是由美国社区调查的12个变量构成的 (ACS)和;（5）确定受SARS-CoV-2感染不成比例影响的CBG， 优先考虑他们的干预措施，以增加检测和COVID-19疫苗接种， 发达国家的疾病负担指标和差距指数。 与第二阶段相比，第二阶段将实施的变更（增强和扩展） 第一阶段（基准），包括：（A）调整第一阶段CHW培训/推广方案， 关于动机访谈的培训，以及扩大对疫苗接种教育的关注， 激励/促进测试;（B）加强基于2-1-1的教育、激励和转诊 （C）包括基础更广泛的社会媒体外联，如地理信息系统， 有针对性的Facebook广告，以激励用户获得COVID-19检测和疫苗接种;（D） 进行一项小组研究，以比较CHW促进的自我采样的有效性 参与SARS-CoV-2检测的干预与CHW检测导航干预， 及;（E）评估COVID-19多层次传播网络的影响和范围， 个人对SARS-CoV-2检测的态度、意图和行为决定 以及在服务不足的社区接种新冠疫苗。

ABSTRACT The (Phase goal of the Center for Clinical and Translational Science's (CCTS) proposed continuation II) RADx-UP 121 project is todetermine trends and disparities of SARS-CoV-2 testing, infections, and COVID-19 vaccination coverage in threetargeted Texas regions:Houston/Harris County; South Texas (Cameron and Hidalgo Counties; and 3) Northeast TX (seven counties including the city of Tyler). This effort will result in improved and expanded time related will: recent structural and access enabled multilevel, just-in- adaptive intervention trategies to reach vulnerable populations experiencing inequities to COVID-19. More specifically, in collaboration with community partners, this project 1) identify disparities and dynamics of SARS-CoV-2 testing and infections, considering data on COVID-19 vaccination; 2) identify personal, organizational, community, and factors contributing to SARS-CoV-2 testing and COVID-19 vaccination disparities, 3) expand the reach and impact of a multil evel intervention to increase motivation for and to testing and vaccination among vulnerable populations. The project's efforts will be by leveraging long-standing community partnerships. s Phase II will be informed by learnings and accomplishments from the Phase I effort, which have included: (1) Developing real-time data processing procedures and implemented quality control measures for various local data, including SARS-CoV-2 testing data, case investigation and hospital records; (2) Processing and analyzing COVID-19 case data including over 367,000 cases in Harris County, over 40,000 in Cameron County, and over 29,000 cases in Northeast Texas counties - all datasets now have common data elements and consistent formats; (3) Developing several metrics to quantify the COVID-19 disease burden for the overall population and by demographic subgroups; (4) Developing the census block group (CBG)-level disparity index, which is constructed using 12 variables from the American Community Survey (ACS) and; (5) Identifying the CBGs disproportionately affected by SARS-CoV-2 infections and prioritizing them for interventions to increase testing uptake and COVID-19 vaccination using the developed disease burden metrics and disparity index. Changes (enhancements and expansion) to be implemented in Phase II, as compared to Phase I (benchmark), include: (A) Adapting Phase I CHW-training/outreach program to include training on motivational interviewing, and an expanded focus on vaccination education and motivation/promotion of testing; (B) Enhancing 2-1-1-based education, motivation, and referral to testing and vaccination, (C) Including broader-based social media outreach, such as geo- targeted Facebook ads to motivate users to access COVID-19 testing and vaccination; (D) Conducting a panel study to compare the effectiveness of the CHW-Facilitated Self-Sampling Intervention vs. CHW Testing Navigation Intervention on participation in SARS-CoV-2 testing, and; (E) Assessing the impact and reach of multilevel COVID-19 communication networks on individuals' attitudes, intentions, and decisions on behavior surrounding SARS-CoV-2 testing and COVID-19 vaccination in underserved communities.