Investigating the effectiveness of COVID-19 testing choices, community engagement, and culturally-embedded mHealth literacy delivery in a medically-underserved, community-based sample

自1月20日在华盛顿和随后不久在芝加哥发现第一例美国病例以来 1月24日，新冠肺炎迅速成为国内最流行、最致命的呼吸道感染 伊利诺伊州，确诊病例总数为220,178例，死亡7,880例(3.6%)。UIC医院与健康 关怀系统(UI Health)，与其14个联邦合格的Mile Square Heath Center合作 实践点(FQHC)(该项目将在那里实施)，在3月期间发生了4000多起此类病例 和2020年6月(6)，指出拉丁裔人群中使用新冠肺炎的比例高得不成比例(47.1%和32.7% 死亡人数中的28.9%)，以及非洲裔美国人或黑人(占死亡人数的43.1%)。在48,111例中 仅在库克县就报告了7231人(15.0%)住院，其中2234人(4.6%)在重症监护病房。 这些与新冠肺炎相关的发病率和死亡率差异伴随着许多其他健康问题 差距。我们的许多FQHC缺乏人员和收入来进行现场测试和提供广泛的跟踪 门诊部对大量涌入的有症状患者关注新冠肺炎。这些挑战 可能导致与新冠肺炎相关的本可以预防的并发症和死亡增加 随着关于新冠肺炎的更清晰、更准确的公共信息，更广泛的检测手段，更早的诊断， 以及越来越多的人认为护理是保密的、可获得的和自我驱动的。该项目将雇用 哨兵和以社区为基础的流行病学监测和参与性研究方法 无论是以人为中心的、快速的新冠肺炎检测干预(居家拭子和送检，还是现场点检 护理测试)，再加上一个新的移动健康新冠肺炎识字和推广套件的应用程序和视频，将 有助于提高用户对新冠肺炎测试的接受度、访问率、覆盖面、接受度和影响力 14个FQHC练习点及其对应的集水区。我们还将分析社会、伦理、 我们的推广和测试方法的经济、行为驱动因素和后果 参与者对共同创建与研究相关的消息的贡献程度。最后，我们将利用 我们现有的基础设施可扩展检测吸收并(通过聚合酶链式反应)分析感染时的病毒载量 发病/暴露和随后的发病/暴露，以确定病毒动态并在早期和 感染的晚期。将使用PhenX措施来测试测试和重新测试的干预效果 吸收、诊断时间、新冠肺炎知识、医疗服务的可获得性和寻求、披露、医疗依从性 并实行居家自我隔离、隔离等传染病控制行为。所有数据采集， 收集和保管方法将由CDCC通知，包括关于ML-知情同意的情况 方法以及其他RADxUP研究和相关联邦机构。

Since the first U.S. cases were identified in Washington on January 20th and soon thereafter in Chicago on January 24th, COVID-19 has rapidly emerged as the most prevalent and deadly respiratory infection within the State of Illinois, with 220,178 total confirmed cases and 7,880 (3.6%) deaths. The UIC Hospital and Health Care System (UI Health), in collaboration with its 14 partnering Federally Qualified Mile Square Heath Center practice sites (FQHCs) (where this project will be implemented), saw over 4,000 of these cases between March and June, 2020 (6), noting the disproportionately higher rates if COVID-19 in Latinx people (47.1% with 32.7% of deaths) and in people identifying as African American or Black (28.9% with 43.1% of deaths). Of 48,111 cases reported in Cook County alone, 7,231 (15.0%) were hospitalized with 2,234 (4.6%) in an intensive care unit. These COVID-19-related morbidity and mortality disparities are accompanied by numerous other health disparities. Many of our FQHCs lack the staffing and revenue to test on-site and provide extensive follow-up outpatient care for the large influxes of symptomatic patients concerned about COVID-19. These challenges have likely resulted in increased COVID-19-related complications and deaths that might have been prevented with clearer and more accurate public messaging about COVID-19, wider access to testing, earlier diagnosis, and an increased perception that care is confidential, accessible, and self-driven. This project will employ sentinel and community-based epidemiological surveillance and participatory research methods to evaluate whether a person-centered, rapid COVID-19 testing intervention (at-home swab and send, or on-site point of care testing), coupled with a novel mHealth COVID-19 Literacy and Outreach Suite of apps and videos, will serve to increase the acceptance, access, reach, uptake, and impact of COVID-19 testing at UI Health and in the 14 FQHC practice sites and their corresponding catchment areas. We will also analyze the social, ethical, economic, and behavioral drivers and consequences of our outreach and testing approaches according to the degree to which participants contribute to the co-creation of study-related messaging. Finally, we will leverage our existing infrastructures to expand testing uptake and analyze (by PCR) viral load at infection onset/exposure and following onset/exposure to determine viral dynamics and identify individuals at early and late stages of infection. PhenX measures will be used to test intervention effects on testing and retesting uptake, time-to-diagnosis, COVID-19 knowledge, healthcare access and seeking, disclosure, medical adherence, and practice of home self-isolation, quarantine, and other infection control behaviors. All data acquisition, collection and curation approaches will be informed by the CDCC, including AboutML-informed consent approaches and with the other RADxUP studies and relevant federal agencies.