Administrative Core

COVID-19在地球仪上造成了一场前所未有的健康危机，严重影响了服务不足和脆弱的人群 美国的人口，包括波多黎各（PR）和美属维尔京群岛（USVI）。而 尽管加勒比地区的COVID-19检测有所增加，但仍然严重不足。美属维尔京群岛和PR 在广泛开展检测方面遇到了障碍，包括检测设备和用品的总体短缺， 导致自7月初以来病例急剧增加。东加勒比健康结果研究的数据 网络队列研究（ECS）表明，我们基于人群的随机样本（n = 3000）中有近61%至少有 一种慢性疾病，使他们面临COVID-19严重并发症的高风险。我们建议加强和 通过利用社区资产，扩大USVI和PR的COVID-19诊断检测级联- 联邦合格的卫生中心（UNAHC）及其社区组织（CBO）合作伙伴-解决障碍 到全面参与从诊断到自我隔离和检疫的检测过程。我们将合作 有3个CNOHC--一个在PR，两个在USVI--和CBO合作伙伴。我们将为这些公司提供协议， 诊断和后续行动，并将采购新的检测技术，使检测更有效率。CBO连接 将有助于接触目前未接受测试的服务不足的社区成员，例如那些 高医疗风险，那些没有家的人，或者那些住在集体环境中的人，如养老院。 在收到阳性结果通知后，我们将支持中心提供门诊护理，以进行积极的临床监测 在家里，并将部署一个筛选健康的社会决定因素。CBO合作伙伴将通过社交网络连接患者 需要资源来支持隔离和自我隔离建议。我们还将评估 在现有和新兴检测中传播和采用FDA授权和批准的检测技术 模型我们将采用严格的准实验方法，重点评估我们的实施情况 结果。具体而言，我们将采用混合III实施效果研究设计。主 实施结果将达到-一个衡量社区中正在进行的测试数量的指标- 中断时间序列设计（ITS）其他感兴趣的结果包括采用新的测试 技术，对干预的忠诚度，可接受性和有效性。我们将部署RE-AIM 指导干预措施评价的框架。在整个项目期间，我们将与 RADx-Up协调和数据收集中心（CDCC），涵盖所有活动，包括协调数据 收集和采购新的COVID-19检测技术。我们亦会与社区紧密合作， 参与领域，以增强我们参与的利益相关方合作伙伴的经验。最后，增强 诊断测试级联将改善服务不足和弱势群体的覆盖率、可及性、吸收率和有效性 这将加强每个利益相关者组织的能力， 现在是流感疫苗分发网络，将来是SARS-CoV-2疫苗。

COVID-19 has created an unparalleled health crisis across the globe that has ravaged underserved and vulnerable populations in the US, including in the territories of Puerto Rico (PR) and the U.S. Virgin Islands (USVI). While testing for COVID-19 has increased in the Caribbean territories, it is still deeply inadequate. The USVI and PR have experienced barriers to wide-spread testing, including an overall shortage of testing equipment and supplies, which has led to a sharp increase in cases since early July. Data from our Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) indicate nearly 61% of our population-based random sample (n=3000) has at least one chronic condition, making them high risk for severe complications from COVID-19. We propose to enhance and amplify the COVID-19 diagnostic testing cascade in the USVI and PR by utilizing community-based assets— Federally Qualified Health Centers (FQHCs) and their community organization (CBO) partners—to address barriers to full participation in the testing continuum from diagnosis through to self-isolation and quarantine. We will partner with 3 FQHCs—one in PR and two in USVI—and CBO partners for each. We will provide FQHCs with protocols for diagnosis and follow-up and will procure new testing technologies to make testing more efficient. CBOs connected to the FQHCs will help reach underserved community members not currently being tested, such as those with elevated medical risk, those living without homes, or those living in congregate settings such as nursing homes. After notification of a positive result, we will support FQHCs to provide ambulatory care for active clinical monitoring at home and will deploy a screener for social determinants of health. CBO partners will connect patients with social needs to resources to support quarantine and self-isolation recommendations. We will additionally assess the diffusion and uptake of FDA authorized and approved testing technologies across existing and emerging testing models. We will utilize a rigorous quasi-experimental approach to focus on assessing our implementation outcomes. Specifically, we will employ a hybrid III implementation-effectiveness study design. The primary implementation outcome will be reach—a measure of the amount of testing that is being done in the community— using an interrupted time series design (ITS). Other outcomes of interest include adoption of new testing technologies, fidelity to the intervention, its acceptability, and its effectiveness. We will deploy the RE-AIM framework to guide the evaluation of the intervention. Throughout the project period, we will collaborate with the RADx-Up Coordination and Data Collection Center (CDCC) across all activities, including harmonizing data collection and procuring new COVID-19 testing technologies. We will also work closely with the Community Engagement domain to enhance the experience of our participating stakeholder partners. Finally, the enhanced diagnostic testing cascade will improve reach, access, uptake, and effectiveness for underserved and vulnerable communities in the USVI and PR. This will strengthen the capacity of each stakeholder organization to contribute to vaccine distribution networks for influenza now and a SARS-CoV-2 vaccine in the future.