Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations (RESPECT-UP)

我们团队之前的流行病学研究记录了COVID-19中明显的种族和社会经济差异 亚拉巴马的病例流行率、检测率和检测阳性率。在脆弱人群中进行COVID-19检测是 对于当前和未来的大流行控制至关重要，对于减少COVID-19的差异至关重要。减少 COVID-19检测对服务水平低下人群的伦理和社会偏见影响（RESPECT-UP） 了解并解决围绕COVID-19检测的社会、道德和行为因素， 在亚拉巴马的城市和农村非洲裔美国人社区，在社会的前五分之一， 脆弱性指数。杰斐逊县（城市）和达拉斯县（农村）的目标地理区域 一些国家的疫苗接种率最低，使其人口成为未来疾病的极高风险 爆发在目标1中，我们采用顺序解释混合方法设计来评估社会和结构性 COVID-19检测的障碍，同时探索影响COVID-19的污名化、歧视和行为因素， 在疫苗可用性的背景下进行19次试验。在目标2中，我们制定了可操作的战略， COVID-19测试中的不公平现象，并为各种组织和 社区背景。在目标3中，我们部署工具包并评估其在城市和农村的有效性 初级保健环境;将在今后的工作中评价在其他环境中的执行情况。由社会告知 健康的决定因素框架和计划行为理论，这种系统的方法， 了解COVID-19检测的结构、社会、伦理和行为决定因素的完整连续体 产生重要的新科学知识。此外，与社区利益攸关方合作， 该项目以参与的方式产生了具体的多层次解决方案--尊重工具包， 由组织、社区和决策者使用，以改善公平性、获取和吸收当前的 COVID-19检测，并准备在未来提供公平，非污名化和非歧视性的检测 爆发。这些工具包可以适应各种人群和环境，这进一步提高了他们的 价值、可推广性、可持续性和潜在影响。RESPECT-UP由社区支持 与具有长期合作历史的合作伙伴联盟，并协调与其他COVID-19 最大限度地利用资源、社区伙伴关系和收集数据的研究举措。

Prior epidemiologic research by our team documented stark racial and socioeconomic disparities in COVID-19 case prevalence, testing rates, and test positivity in Alabama. COVID-19 testing in vulnerable populations is paramount for current and future pandemic control and critical for reducing COVID-19 disparities. Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations (RESPECT-UP) aims to understand and address the social, ethical, and behavioral factors surrounding COVID-19 testing in highly vulnerable urban and rural African American communities in Alabama, in the top quintile of the Social Vulnerability Index. The targeted geographic areas in Jefferson County (urban) and Dallas County (rural) have some of the lowest vaccination rates in the country, making their population a very high risk for future disease outbreaks. In Aim 1, we employ a sequential explanatory mixed methods design to assess social and structural barriers to COVID-19 testing while exploring stigma, discrimination, and behavioral factors that impact COVID- 19 testing intentions in the context of vaccine availability. In Aim 2, we develop actionable strategies to reduce inequities in COVID-19 testing and produce RESPECT-UP Toolkits tailored to various organizational and community contexts. In Aim 3, we deploy the toolkits and evaluate their effectiveness in urban and rural primary care settings; implementation in other settings will be evaluated in future efforts. Informed by a Social Determinants of Health framework and the Theory of Planned Behavior, this systematic approach to understanding the full continuum of structural, social, ethical, and behavioral determinants of COVID-19 testing generates important new scientific knowledge. Furthermore, working together with community stakeholders in a participatory way, the project produces concrete multi-level solutions – RESPECT-UP Toolkits – that can be used by organizations, communities, and policy makers to improve the equity, access, and uptake of current COVID-19 testing and be ready to deliver equitable, non-stigmatizing, and non-discriminatory testing in future outbreaks. The Toolkits can be adapted to a variety of populations and settings, which further increases their value, generalizability, sustainability, and potential impact. RESPECT-UP is supported by a community coalition of partners with a long-standing history of collaboration, and coordinates efforts with other COVID-19 research initiatives to maximize resources, community partnerships, and collected data.