Optimization of a new adaptive intervention to increase COVID-19 testing among people at high risk in an urban community

项目摘要 COVID-19对边缘化城市中的医疗或社会弱势群体造成了不成比例的影响 美国各地的社区（例如，患有合并症的人，在高风险环境中工作， 拒绝或不能遵守新泽西州（NJ）预防指南）。问题社会决定因素 健康（SDH），如耻辱，监禁和贫困与COVID-19暴露增加有关 增加死亡人数。在缺乏有效、强效和广泛可用的疫苗和治疗方法的情况下， 预防-即，检测、社交距离、接触者追踪和隔离是必不可少的。知之甚少 在低收入和种族/少数民族社区进行COVID-19检测的可接受性， 在预防方面遇到越来越多的障碍（例如，住房不足、高风险工作）。但我们 具有成本效益的，基于证据的和文化上适当的干预措施的知识， 成功地用于让人们参与艾滋病毒预防和治疗。这些干预措施可以调整， 帮助应对COVID-19。导航服务（NS）增加了艾滋病毒检测和治疗依从性 同时解决阻碍高危社区参与治疗的结构性障碍。短期心理咨询 增加艾滋病毒治疗的参与。本研究采用序贯、多重分配随机试验 （SMART）与582名COVID-19医疗/社会弱势群体合作。在2019冠状病毒病连续体的指导下， 预防，护理和治疗，分析将探讨与测试和遵守公共 健康建议。研究目的包括：目的1：优化适应性干预， 提高检测率和遵守新泽西州COVID-19建议（检测，社交距离， 隔离、住院、追踪接触者和接受COVID-19疫苗接种） 人口。目的2：确定测试完成和遵守NJ建议的预测因素。 这项研究在应用现有的循证干预措施应对COVID-19方面具有创新性， SMART的使用遵循基于社区的前瞻性研究原则。它有

Project Summary COVID-19 has disproportionately impacted medically or socially vulnerable populations in marginalized urban communities across the United States (e.g., people with co-morbidities, working in high risk settings, those refusing or unable to adhere to the State of New Jersey (NJ) prevention guidelines). Social determinants of health (SDH) such as stigma, incarceration, and poverty are associated with increased exposure to COVID-19 and increased deaths. In the absence of effective, potent, and widely available vaccines and treatments, prevention – i.e., testing, social distancing, contact tracing, and quarantine -- is essential. Little is known about acceptability of COVID-19 testing in low-income and racial/ethnic minority neighborhoods, where residents experience increased barriers to prevention (e.g., inadequate housing, high-risk jobs). However, we have knowledge of cost-effective, evidence-based, and culturally appropriate interventions that have been successfully used to engage people in HIV prevention and treatment. These interventions can be adapted and tested to help address COVID-19. Navigation services (NS) increase HIV testing and adherence to treatment while addressing structural barriers that deter treatment engagement in high-risk communities. Brief counseling increases HIV treatment engagement. This study uses a Sequential, Multiple Assignment Randomized Trial (SMART) with 582 COVID-19 medically/socially vulnerable people. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, analysis will explore factors associated with testing and adherence to public health recommendations. The study aims include: Aim 1: To optimize an adaptive intervention that will increase rates of testing and adherence to NJ COVID-19 recommendations (testing, social distancing, quarantine, hospitalization, contact tracing and acceptance of COVID-19 vaccination) among high-risk populations. Aim 2: To identify predictors of testing completion and adherence to NJ recommendations. This study is innovative in its application of existing evidence-based interventions to address COVID-19 and the use of SMART following Community Based Participatory Research principles. It has