SCALE UP Utah II: Community-Academic Partnership to Address COVID-19 Testing and Vaccination Among Utah Community Health Centers

项目总结/摘要 种族/族裔少数、社会经济地位低和农村人口遭受严重的健康不平等， 与各种疾病和状况的联系，以及对健康的负面影响的不成比例的负担， COVID-19疫情的后果。截至2021年6月，犹他州的累计COVID病例率为 10万人是白人中的10,803人，而拉丁美洲人是17,541人。阳性率为14%，白人与 24%为拉丁裔。在全国范围内，城市与城市之间的疫苗接种率存在类似的差距。 农村、高社会经济地位与低社会经济地位、白色与非白色人口。低疫苗接种率导致服务不足的人群- 有可能发生局部疫情，以及更具传染性和严重的变异。因此，针对这些问题的干预措施 检测和疫苗接种之间相互作用的人群对大流行控制至关重要。不仅不- 缺乏服务的人群经历着深刻的健康不平等，但在卫生和医疗服务之间也存在着严重的数字鸿沟。 高和低资源医疗保健系统。低资源环境下采用健康信息的可能性要小得多 技术手段，往往没有能力实施大规模人口健康人- PHM利用数据分析和自动化患者外展工作。社区卫生中心 （社区卫生中心）是实施这些PHM干预措施以增加COVID-19感染的最佳环境 在得不到充分服务的人群中进行检测和接种。11个犹他州CHC系统正在参与 二.按比例扩大我们的38个初级保健诊所每年为112，000多名独特的服务不足的患者提供服务。什么... 通过RADx-UP第一阶段的资助（SCALE-UP犹他州），我们建立了一个灵活的短信服务 和患者导航基础设施与社区卫生中心，以增加测试和疫苗吸收。SCALE-UP II将 消除这一基础设施以及犹他州大学临床和 转化科学研究所，犹他州社区卫生协会，全州的社区卫生中心， 犹他州卫生部。SCALE-UP II将研究三种PHM干预措施， COVID-19疫苗接种和检测：1）文本消息（TM）-一键双向文本消息 响应将患者与疫苗接种或邮寄家庭快速检测试剂盒联系起来，无需支付任何费用，以根据需要使用，2）Con- 自动化代理（CA）-自动化，脚本化和交互式代理，用于模仿人类交互，以提供 获得家庭快速检测试剂盒，3）患者导航（PN）-社区卫生工作者的电话， 帮助解决犹豫和获取障碍，并提供家庭快速检测包。将测试两种类型的PN： 反应性PN（RPN）仅适用于对TM/CA消息回答“是”的患者。主动PN (PPN)将接触所有患者，包括那些不回复TM/CA消息的患者。具体目标 1）进行2（TM vs. CA）× 3（无PN vs. RPN vs. PPN）析因设计，评估干预效果 2）检查与家庭检测和疫苗接种相关的因素， 随着时间的推移，

PROJECT SUMMARY/ABSTRACT Racial/ethnic minority, low socioeconomic status (SES), and rural populations suffer profound health inequi- ties across a wide variety of diseases and conditions, as well as a disproportionate burden of the negative health consequences of the COVID-19 pandemic. As of June 2021, the cumulative COVID case rate in Utah per 100,000 was 10,803 among Whites vs. 17,541 among Latinos. The positivity rate was 14% among Whites vs. 24% among Latinos. Similar disparities persist across the nation regarding vaccination rates between urban vs. rural, high vs. low SES, and White vs. non-White populations. Low vaccination rates leave underserved popula- tions at risk for local outbreaks, and more contagious and severe variants. Thus, interventions targeting these populations at the interplay between testing and vaccination are critical for pandemic control. Not only do un- derserved populations experience profound health inequities, but there is also a critical digital divide between high and low resource healthcare systems. Low resource settings are far less likely to adopt Health Information Technology approaches, and often do not have the capacity to implement large scale population health man- agement (PHM) efforts utilizing data analytics and automated patient outreach. Community Health Centers (CHCs) are optimal settings for implementing these PHM interventions to increase the uptake of COVID-19 testing and vaccination among underserved populations. Eleven Utah CHC systems are participating in SCALE-UP II. Their 38 primary care clinics serve over 112,000 unique underserved patients annually. Sup- ported by a RADx-UP Phase I grant (SCALE-UP Utah), we have established a flexible text messaging outreach and patient navigation infrastructure with CHCs to increase testing and vaccine uptake. SCALE-UP II will lev- erage this infrastructure as well as long standing partnerships among the University of Utah Clinical and Translational Science Institute, Association for Utah Community Health, CHCs across the entire state, and the Utah Department of Health. SCALE-UP II will investigate three PHM interventions at the interplay between COVID-19 vaccination and testing: 1) Text Messaging (TM) – bidirectional text messaging with a one-touch response to connect patients to vaccination or mail at-home rapid test kits at no cost for use as needed, 2) Con- versational Agent (CA) – automated, scripted and interactive agent used to mimic human interaction to offer access to at-home rapid test kits, 3) Patient Navigation (PN) – phone call from a community health worker to help address hesitancy and access barriers, and to offer at-home rapid test kits. Two types of PN will be tested: Reactive PN (RPN) will reach out only to those patients who reply YES to a TM/CA message. Proactive PN (PPN) will reach out to all patients, including those who do not reply to a TM/CA message. The specific aims are to 1) Conduct a 2 (TM vs. CA) X 3 (No PN vs. RPN vs. PPN) factorial design assessing intervention effects on testing uptake among unvaccinated adults 2) Examine factors associated with at-home testing and vaccina- tion uptake over time.