Alive Church Network: Increasing COVID-19 Testing in Chicago's African American Testing Deserts

摘要 2019年新型冠状病毒病（COVID-19）的流行引发了前所未有的公共卫生危机 在美国非裔美国人（AA）受到了不成比例的影响，因为系统性的不平等 增加了对COVID-19的暴露和脆弱性。有证据表明，AA正在推迟 检测和护理COVID-19，这会增加传播风险和不良结果。在芝加哥，种族隔离 AA社区经历了该市一些最高的COVID-19死亡率，但大部分地区 这些社区的一部分仍然在测试沙漠。提供可信、可访问、基于社区的测试， 服务不足的AA社区对于确保AA获得早期诊断至关重要，从而减少 进一步传播的风险和改善临床结果。这项研究利用了Alive Church Network (ACN)这是一个由非裔美国人牧师和公共卫生研究人员组成的长期社区联盟 这是一个可持续的基础设施，以解决隔离的慢性病中的卫生不平等问题。 芝加哥的AA社区。该战略旨在解决缺乏获得保健、文化和社会服务的机会的问题。 不敏感和缺乏信任，这是慢性病和传染病差异的根本原因。 疾病，包括COVID-19。拟议的项目利用ACN基础设施建立一个教会网络， 位于芝加哥一个隔离和服务不足的AA社区的测试点，将提供COVID-19 测试和教育以及与医疗保健和社会资源的联系。13名ACN牧师服务 芝加哥西区的AA教会将组成一个联盟， 在当地教会进行COVID-19检测。所有年龄段的居民都将获得COVID-19教育和免费的SARS-CoV- 2 PCR检测，由现场临床团队快速提供结果，并与当地 解决社会需求的资源，包括食物、住房和医疗。我们的具体目标是：（1）行为 快速需求评估，以确定COVID-19检测的障碍和促进因素，为量身定制的外展提供信息 和干预策略，以增加高风险AA中的COVID-19检测;（2）（主要目的）评估 ACN COVID-19检测干预措施对目标高度贫困AA居民接受检测的影响 社区在芝加哥;（3）使用RE-AIM框架，以评估的范围，采用，实施， ACN COVID-19检测干预的维护和成本。我们的初步分析使用了一个中断的时间 系列框架，这是一个准实验的方法，以测试是否ACN测试干预， 成功地将目标社区居民中至少20%的检测率提高。 这些目标的实现将为这种方法的公共卫生效用提供关键证据，并为人们提供信息。 努力扩大这一干预措施的规模，以增加芝加哥其他脆弱城市地区的检测率， 全国范围内。

ABSTRACT The epidemic of novel coronavirus disease 2019 (COVID-19) has caused an unprecedented public health crisis in the United States. African Americans (AA) have been disproportionately impacted, as systemic inequities have contributed to increased exposure and vulnerability to COVID-19. Evidence suggests that AAs are delaying testing and care for COVID-19, which increases risk of transmission and poor outcomes. In Chicago, segregated AA neighborhoods have experienced some of the highest COVID-19 mortality rates in the city, yet large portions of these neighborhoods remain testing deserts. Providing trusted, accessible, community-based testing in underserved AA communities is critical to ensuring that AAs receive an early diagnosis, thereby reducing the risk of further transmission and improving clinical outcomes. This study leverages the Alive Church Network (ACN), a long-standing, community-driven coalition of African American pastors and public health researchers that was developed as a sustainable infrastructure to address health inequities in chronic disease in segregated AA neighborhoods in Chicago. The ACN was designed to address lack of access to health care, cultural insensitivity, and lack of trust, which are the root cause of disparities in chronic disease as well as infectious disease, including COVID-19. The proposed project utilizes the ACN infrastructure to create a network of church- based testing sites in a segregated and underserved AA neighborhood in Chicago that will provide COVID-19 testing and education as well as linkage to healthcare and social resources. Thirteen ACN pastors who serve predominantly AA congregations in the West Side of Chicago will form a coalition to promote community-wide COVID-19 testing in local churches. Residents of all ages will receive COVID-19 education and free SARS-CoV- 2 PCR testing with rapid turn-around of results from an on-site clinical team, as well as connection to local resources to address social needs, including food, housing, and medical care. Our specific aims are: (1) Conduct a rapid needs assessment to identify barriers to and facilitators of COVID-19 testing to inform a tailored outreach and intervention strategy to increase COVID-19 testing among high-risk AAs; (2) (Primary Aim) Evaluate the impact of the ACN COVID-19 testing intervention on uptake of testing among residents of target high poverty AA neighborhoods in Chicago; (3) Use the RE-AIM framework to assess the reach, adoption, implementation, maintenance and cost of the ACN COVID-19 testing intervention. Our primary analysis uses an interrupted time series framework, which is a quasi-experimental approach, to test whether the ACN testing intervention is successful at increasing uptake of testing by at least 20% among residents in the target neighborhoods. Completion of these aims will provide crucial evidence about the public health utility of this approach and inform efforts to scale this intervention to increase testing uptake in other vulnerable urban areas in Chicago and nationally.