Improving the Response of Local Urban and Rural Communities to Disparities in COVID-19 Testing

Local health departments are employing widely varying approaches to address the dramatic health inequities associated with the COVID-19 pandemic. Learning collaboratives have been effective in other settings for bringing entities together to support joint problem solving and reduce variance in approach. These collaboratives build upon shared experiences to help their members understand not only what to do but how to do it, providing knowledge and skills that are critical to successful implementation of interventions. This study aims to examine the effectiveness of a diverse, regional learning collaborative of health departments that will rapidly adapt, test, and implement community-driven solutions for COVID testing disparities using a pragmatic, hybrid type II trial design. Based on preliminary data from a community-led approach developed in a severely affected Kansas county (Wyandotte), the project will build Local Heath Equity Action Teams in 10 counties (4 urban and 6 rural) disproportionately affected by COVID and provide them with the training and resources needed to achieve COVID testing equity. These Local Health Equity Action Teams will come together into a multi-jurisdictional learning collaborative or ‘Community Partner Program’ (Aim 1) that can share best practices and collaborate on developing, testing and evaluating multi-component intervention packages for addressing COVID. Initial supported interventions will include: community-sponsored pop-up testing events; home-based and worksite testing; community-informed communication strategies; and ‘support packages’ for at-risk individuals and families receiving testing. Additional interventions developed or proposed by our local community partners or identified through national RADx-UP efforts will be continuously considered by the collaborative. Working with the local Action teams, we will conduct a series of semi-structured interviews and surveys within each local community (Aim 2) to better understand common and subgroup (racial, ethnic, geographic, etc.) barriers to and facilitators of testing. We will leverage existing epidemiologic surveillance tools to develop and track a series of county-level metrics of COVID testing inequities. Guided by the RE-AIM framework and the Consolidated Framework for Intervention Research, we will examine the effectiveness (Aim 3) of the collaborative in improving uptake of COVID testing in vulnerable communities and examine the reach, adoption, implementation and maintenance of intervention components within each local community. This study will not only advance our understanding of how to achieve COVID testing equity but will also provide a framework for supporting underserved communities as they respond to future public health emergencies and COVID vaccination challenges.

各地卫生部门正采用差异显著的举措，以应对新冠疫情（COVID-19）引发的严峻健康不平等问题。学习协作共同体在其他场景中已被证实成效显著，可汇聚各方主体以支持协同解决问题、缩小举措差异。此类协作共同体依托共享经验，帮助成员不仅明晰行动方向，更掌握落地方法，为干预措施的成功实施提供关键知识与技能支撑。本研究旨在评估一个多元化区域卫生部门学习协作共同体的成效，该共同体将采用实用型混合II类试验设计，快速适配、测试并落地社区主导的新冠检测不平等问题解决方案。基于在受疫情严重影响的堪萨斯州怀恩多特县（Wyandotte）开发的社区主导模式的初步数据，本项目将在10个受新冠疫情影响尤为严重的县（其中4个为城区县、6个为农村县）组建本地健康公平行动小组（Local Health Equity Action Teams），并为其提供实现新冠检测公平所需的培训与资源。这些本地健康公平行动小组将汇聚为跨辖区学习协作共同体，即"社区伙伴计划"（Aim 1），该共同体可共享最佳实践，并协同开发、测试及评估用于应对新冠疫情的多组分干预方案包。首批获得支持的干预措施包括：社区主办的快闪式检测活动、居家与工作场所检测、社区知情型传播策略，以及为接受检测的高风险个体与家庭提供的"支持包"。协作共同体将持续考量由本地社区伙伴开发或提出的、或通过全国性RADx-UP计划确定的额外干预措施。我们将与本地行动小组合作，在每个本地社区开展一系列半结构化访谈与问卷调查（Aim 2），以更深入地了解检测工作面临的共性障碍与群体特异性障碍（如种族、族裔、地域等维度），以及相应的促进因素。我们将依托现有流行病学监测工具，开发并追踪一系列县级新冠检测不平等相关指标。本研究将以RE-AIM框架（RE-AIM framework）与综合干预研究框架（Consolidated Framework for Intervention Research）为指导，评估该协作共同体在提升弱势社区新冠检测参与率方面的成效（Aim 3），并考察各本地社区内干预组件的覆盖范围、采纳情况、实施过程与维持状态。本研究不仅将增进我们对如何实现新冠检测公平的认知，还将为服务不足社区应对未来公共卫生突发事件及新冠疫苗接种挑战提供参考框架。