Scaling Up SARS-CoV-2 Testing to Serve Latinx Communities

The global SARS-CoV-2 pandemic that causes the severe respiratory illness COVID-19 is the worst health crisis the United States has faced in a century. Although this highly contagious virus has infected millions of Americans, the disease burdens are disproportionately born to historically underserved populations such as Latinx communities. Nationally, Latinx people with COVID-19 are hospitalized at four times the rate of Whites and have much higher rates of morbidity and mortality. This disparity is notable in Oregon, where the 13% of the population that is Latinx represents approximately 44% of COVID-19 cases. An urgent need exists to reach Oregon's Latinx community with public health and prevention messages to increase testing. This project implemented a culturally-tailored community outreach and testing program to increase the reach, access, and uptake of testing in Latinx communities in Oregon. The project brought together a world-class team of prevention scientists, public health experts, Latinx researchers, community partners, and biologists who have been working together to conduct SARS-CoV-2 diagnostic testing since March, soon after the pandemic first arrived in the U.S. This team established a CLIA-certified laboratory and honed molecular testing protocols, hired and trained laboratory personnel and a field research team, procured diagnostic testing equipment and supplies, and partnered with county public health offices and hospitals throughout the state to conduct testing. The team also conducted a comprehensive community assessment using community-based participatory methods to gather Latinx community feedback on modes of communication, health messages, and testing protocols, and staffed multiple county-led testing sites serving Latinx communities. Using these resources and expertise as a foundation, a two-arm randomized controlled trial implemented community-level interventions to increase testing rates and health behaviors. Thirty-nine testing sites across 9 counties were randomized to receive one of two outreach interventions, Basic Outreach versus Promotores de Salud. Promotores de Salud was a culturally-informed intervention that included psychoeducation about COVID-19, motivational strategies, emotional support, and information support to engage individuals to attend a testing site. In addition, the study included a booster intervention for those who attend a Promotoras de Salud testing site. In the booster intervention, participants received an in-person Promotores de Salud intervention and a written pamphlet with information about health behaviors. Participants randomized to the control condition only received the written pamphlet. Participants in the research study were assessed via a survey at the time of testing and 1 month later. Site- and community-level assessments occurred at three timepoints in the study: immediate, mid-term, and primary outcomes, to measure the effects of the randomization and the on-site promotores intervention. Individual-level data were collected from 1,200 participants at two timelines when they were at a testing visit, and approximately one month later. Over time, this project helped communities institutionalize optimal local testing frameworks supported by laboratory facilities for testing capacity, technical support for testing logistics, and collection of data on health behaviors, testing rates, and sustainability. The resulting structures and systems were poised for future scale-up to other vulnerable communities and/or for other public health purposes (e.g., vaccination campaigns). This project aimed for a major reduction in COVID-19 health disparities in underserved populations.

引发重症呼吸道疾病COVID-19的SARS-CoV-2（严重急性呼吸综合征冠状病毒2型）全球大流行，是美国一个世纪以来面临的最严峻公共卫生危机。尽管这种高传染性病毒已感染数百万美国人，但疾病负担却不成比例地落在了历史上服务不足的群体身上，例如拉丁裔（Latinx）社区。从全国范围来看，感染COVID-19的拉丁裔人群的住院率是白人的4倍，其发病率和死亡率也显著更高。这种差异在俄勒冈州尤为突出：该州拉丁裔人口仅占总人口的13%，却占了约44%的COVID-19确诊病例。当前亟需面向俄勒冈州的拉丁裔社区传播公共卫生与预防相关信息，以提升新冠检测覆盖率。本项目针对俄勒冈州拉丁裔社区开展了适配文化背景的社区外展与检测项目，以提升该群体的检测覆盖范围、可及性与参与率。本项目组建了一支由预防科学家、公共卫生专家、拉丁裔研究人员、社区合作伙伴与生物学家组成的世界级团队，自新冠大流行首次登陆美国后的3月起，该团队便携手开展SARS-CoV-2诊断检测工作。该团队搭建了经CLIA（临床实验室改进修正案）认证的实验室，优化了分子检测流程，招聘并培训了实验室人员与现场研究团队，采购了诊断检测设备与耗材，并与全州各郡的公共卫生办公室及医院合作开展检测工作。该团队还采用基于社区的参与式研究方法开展了全面的社区评估，收集拉丁裔社区对传播方式、健康信息及检测流程的反馈，并在多个由郡主导的、服务拉丁裔社区的检测点配备了工作人员。以这些资源与专业能力为基础，本项目开展了双臂随机对照试验，实施社区层面的干预措施以提升检测率与健康行为水平。全州9个郡的39个检测点被随机分配至两种外展干预组之一：基础外展组，或Promotores de Salud（健康推广员）组。Promotores de Salud（健康推广员）组为适配文化背景的干预模式，涵盖COVID-19相关的心理教育、激励策略、情绪支持与信息支持，以引导个体前往检测点接受检测。此外，本研究针对前往健康推广员检测点的参与者设置了强化干预环节，在该环节中，参与者将接受面对面的健康推广员干预，并获得一份包含健康行为相关信息的纸质手册。被随机分配至对照组的参与者仅能获得该纸质手册。本研究中的参与者在检测时及检测后1个月分别接受一次问卷调查评估。本研究在三个时间节点开展检测点与社区层面的评估：即刻评估、中期评估与主要结局评估，以衡量随机分组效果及现场健康推广员干预的成效。研究团队在两个时间节点（检测就诊时及约1个月后）从1200名参与者处收集了个体层面的数据。随着项目推进，本项目协助各社区将最优的本地检测框架制度化：该框架依托具备检测能力的实验室设施、检测后勤技术支持，并收集健康行为、检测率及可持续性相关数据。由此形成的架构与体系可在未来推广至其他弱势社区，或应用于其他公共卫生场景（如疫苗接种活动）。本项目旨在大幅缩减服务不足群体中存在的COVID-19健康差异。