Protecting Native Families from COVID-19: Radx Initiative

项目总结 白山阿帕奇-纳瓦霍-JHU研究合作伙伴处于独特地位，准备推进新冠肺炎 新冠肺炎社区参与研究的紧急竞争性修订中的预防科学 在服务不足和/或脆弱人群中进行测试(非OD-20-121)。自2020年4月以来，我们实施了 与纳瓦霍人和白山阿帕奇国家开展的全面缓解新冠肺炎活动，这些国家 美国最高的比率，以及经过磨练的家庭检测和快速结果的能力。我们的经验和数据 与部落卫生部门和印度卫生服务部门的审查发现了检测、保护性 成功必须解决的两个高危亚群的行为、隔离和寻求关怀 缓解。第一组是65岁的老年人，他们在两个社区的病死率最高，而且 深受尊敬的文化实践和语言教师。相当一部分老年人目前对 由于文化信仰和恐惧而进行测试，当症状恶化时寻求治疗的速度很慢。第二组是年轻人 18-34岁的成年人使用药物，他们的人均患病比例最高，不太可能社交-- 距离或孤立，更多的是暂时性的，在多代家庭之间流动。该项目将应用2x2 为这些高危人群评估两种干预措施的析因设计：1)文化定制的、特定于年龄的 动机访谈(MI)干预，以促进测试、保护行为和适当的隔离 寻求护理，以及2)基于新冠肺炎症状(CS)文本的监测系统，旨在缩短 症状出现和检测，同时结合地理信息系统协助绘制路线图，以便在家中进行后续治疗。我有 在美国印第安人社区有强有力的证据，包括我们团队证实的心肌梗死干预改善STI/HIV 测试。CS系统基于我们在移动健康监测和嵌入式地理信息系统/全球定位系统跟踪方面的经验。我们的 三个主要目标是：1：使用基于社区的参与性研究来应用相关促进者的知识和 通过RCT创建、试行、实施和评估文化定制的简短MI干预以促进 出现症状时进行新冠肺炎检测，采取适当的预防行为，在出现症状时进行隔离就医 在老年人(65岁)和最近有药物滥用史的年轻人中呈阳性；2：执行和 通过RCT评估每日CS监控系统，包括警报、参与者请求上门测试的机制 当出现第一个症状时，并为那些响应基于文本的警报的人提供地理信息系统路由；以及3：评估 当出现症状时，MI或CS单独或组合在测试和测试时间上的相对优点，以及 采用2x2析因设计，积极时坚持隔离和寻求护理的建议。我们的次要 AIMS将探索a)文化认同和联系；b)物质使用或心理健康因素(抑郁， 焦虑、自杀)；以及c)年龄和性别适度的干预反应。如果目标实现，我们将迅速取得进展 针对美国最缺乏服务和高危人群的诊断检测策略的进展。

PROJECT SUMMARY White Mountain Apache-Navajo-JHU research partners are uniquely positioned and prepared to advance COVID-19 prevention science through the Emergency Competitive Revisions for Community-Engaged Research on COVID-19 Testing among Underserved and/or Vulnerable Populations (NOT-OD-20-121). Since April 2020, we have implemented comprehensive COVID-19 mitigation activities with Navajo and White Mountain Apache nations, who have had the highest rates in the US, and honed capacity for home-testing and obtaining rapid results. Our experience and data review with tribal divisions of health and the Indian Health Service has uncovered barriers to testing, protective behaviors, isolation and care-seeking among two high risk sub-groups that must be addressed for successful mitigation. The first group are elders, ages >65, who have the highest case fatality rate in both communities and are deeply revered as teachers of cultural practices and languages. A significant portion of elders are currently resistant to testing due to cultural beliefs and fear, and slow to seek care when symptoms worsen. The second group are young adults, ages 18-34, using substances, who have the highest proportion of cases per capita, are less likely to social- distance or isolate, and are more transient, moving among multi-generational households. This project will apply a 2x2 factorial design to evaluate two interventions for these high-risk groups: 1) a culturally tailored, age-specific Motivational Interviewing (MI) intervention to promote testing, protective behaviors and appropriate isolation and care-seeking, and 2) a COVID-19 symptom (CS) text-based monitoring system designed to shorten time between symptom onset and testing, while incorporating GIS to assist with route-mapping for home-based follow-up. MI has strong evidence in American Indian communities, including our team’s proven MI intervention for improved STI/HIV testing. The CS System builds on our experience with mobile health surveillance and embedded GIS/GPS tracking. Our three primary aims are: 1: Use Community Based Participatory Research to apply knowledge of relevant facilitators and barriers to create, pilot, implement, and evaluate through an RCT a culturally tailored brief MI intervention to promote COVID-19 testing when experiencing symptoms, appropriate preventive behaviors, and isolation and care-seeking when positive among elders (ages >65 years) and young adults with a recent history of substance misuse; 2: Implement and evaluate through a RCT a daily CS monitoring system with alerts, mechanisms for participants to request home-testing when experiencing first symptoms, and GIS routing for those responding to text-based alerts; and 3: Evaluate the relative merits of MI or CS alone or combined on testing and time to testing when experiencing symptoms, and adherence to isolation and care-seeking recommendations when positive using a 2x2 factorial design. Our secondary aims will explore if a) cultural identity and connectedness; b) substance use or mental health factors (depression, anxiety, suicidality); and c) age and sex moderate intervention response. If aims are achieved, we will make rapid advances in diagnostic testing strategies for the most underserved and high-risk populations in the US.