Leveraging Social Networks to Increase COVID-19 Testing Uptake: A Comparison of Credible Messenger and Chain Referral Recruitment Approaches

在治疗方法或疫苗出现之前，我们遏制COVID-19的能力必须依赖于广泛的 确定（无症状）阳性病例，随后对其进行隔离，并追踪这些病例的接触者 可能暴露。因此，测试工作必须针对那些高度脆弱但得不到服务的人。 包括使用类阿片和其他物质的个人。这些人可能是穷人。 呼吸或肺部健康由于物质的使用（如阿片类药物，甲基苯丙胺），这可能使他们 更容易感染病毒此外，这些人也更有可能被监禁，或居住在 在街上、收容所或拥挤的住所，进一步使他们面临传播的风险。我们 建议开展研究，以确定社区-社会网络外联模式的有效性和可持续性， 传染病卫生提供者与社区组织合作，成功实施 （覆盖、吸收、交付和维持）COVID-19服务点，在高度脆弱的人群中快速检测 这些人往往是得不到充分服务的人，即使用阿片类药物和其他药物的人。两个不同的社交网络 招募战略，经证明具有查明隐藏人口和增加艾滋病毒感染率的功效 测试将进行调整和比较。在EPIS框架、社会认知理论和安徒生的 模型，这项研究包括三个阶段。第一阶段：调整外联征聘战略，我们将 与我们的项目社区咨询委员会（CAB）合作，调整连锁推荐和可信信使策略 进行COVID-19检测，最终确定招募和现场检测方案，并对CAB进行 新的协议和持续质量改进战略（目标1）。II期：策略有效性试验和 实施评估，我们将在两个基于社区的交叉设计中比较两种策略 长期以来一直为社区中难以接触到的人群提供服务的组织（CBO）。的 策略的比较不是为了确定一种抽样策略在提供 人口估计数，而是确定每一个招聘战略的能力， 目标人群和增加COVID-19检测的使用。我们将研究每项战略对以下方面的影响： 覆盖范围（招募目标人群），（ii）COVID-19检测/重复检测，及（iii）服务提供（即 隔离、医疗护理和接触者追踪）（Aim 2）。第3阶段：持续，社区组织将根据结果实施经证明有效的战略，我们 将检查他们对该计划的支持（目标2）。执行情况评价将确定参与者、工作人员、 以及影响每个战略的可行性、可接受性和可持续性的组织层面因素， 这些CBO (Aim 3）。这项调查将提供急需的信息，以改善健康结果， 确定有效的系统级应对措施，以防止或遏制COVID-19在社交网络中的传播 在使用类阿片和其他药物的人中，这是一个高度脆弱和经常被忽视的群体。

Until the advent of treatment or a vaccine, our ability to contain COVID-19 must rely on widespread identification of (asymptomatic) positive cases, their subsequent quarantine, and contact tracing of those potentially exposed. Therefore testing efforts must be targeted to those highly vulnerable yet unserved populations, including individuals who use opioids and other substances. These individuals may have poor respiratory or pulmonary health due to substance use (e.g. opioids, methamphetamine), which may make them more susceptible to the virus. Also, these individuals are also more likely to have been incarcerated, or reside on the street, in shelters or in crowded accommodation, further placing them at risk for transmission. We propose research to establish efficacy and sustainability of a community-social network outreach model that partners infectious disease health providers with community based organizations to successfully implement (reach, uptake, delivery and sustainment) COVID-19 point of service, rapid-testing among a highly vulnerable and often underserved population, those who use opioids and other substances. Two distinct social network recruitment strategies with demonstrated efficacy identifying hidden populations and increasing uptake of HIV testing will be adapted and compared. Guided by the EPIS framework, social cognitive theory, and Andersen’s model, this study comprises three phases. Phase 1: Adaptation of outreach recruitment strategies, we will work with our project community advisory board (CAB) to adapt chain-referral and credible messenger strategies for uptake of COVID-19 testing, to finalize recruitment and on-site testing protocols, and to train the CAB in the new protocols and in continuous quality improvement strategies (Aim 1). Phase 2: Strategy Efficacy Trial and Implementation Evaluation, we will compare the two strategies in a cross-over design at two community based organizations (CBOs) with long standing history of serving hard-to-reach populations in their communities. The comparison of strategies is not to identify the statistical superiority of one sampling strategy in providing population estimates over the other, but instead to identify the ability of each recruitment strategy to reach the target population and increase uptake of COVID-19 tests. We will examine the impact of each strategy on (i) reach (recruitment of target population), (ii) COVID-19 testing/repeat testing, and (iii) service delivery (i.e. quarantine, medical care and contact tracing) among those who test positive for COVID-19 (exploratory) (Aim 2). Phase 3: Sustainment, CBOs will implement the strategy proven efficacious based on outcomes, and we will examine their sustainment of the program (Aim 2). Implementation evaluation will identify participant-, staff-, and organizational-level factors that influence the feasibility, acceptability, and sustainability of each strategy in these CBOs. (Aim 3). This investigation will provide much needed information to improve health outcomes and to identify effective system-level responses to prevent or arrest the spread of COVID-19 among the social networks of those who use opioids and other substances, a highly vulnerable and often overlooked population.