A Nurse-Community Health Worker-Family Partnership Model: Addressing Uptake of COVID-19 Testing and Control Measures

New York City (NYC) is a global epicenter of the SARS-CoV2/COVID-19 pandemic, with 222,000 cases and more than 25,000 deaths. Neighborhood-level disparities in cases and deaths in NYC can be explained by socioeconomic and racial/ethnic characteristics, where Latinx and Black New Yorkers and those living in high poverty neighborhoods are 1.5 times more likely to test positive and more than twice as likely to die as a result of COVID-19. The community of Mott Haven is located the South Bronx – the poorest congressional district within the continental United States. Mott Haven is highly diverse (73% are Latinx and 24% are Black), and COVID-19 mortality is among the highest NYC and higher than in NYC as a whole – an epicenter within an epicenter. Yet, although Mott Haven is clearly a priority community for COVID-related prevention, detection, vaccination, and treatment initiatives, so far fewer than 2% of residents have been tested.

COVID-19 secondary attack rates are highest in households, varying between 12 – 38%. This led us to propose a COVID-19 testing and mitigation intervention in public housing households in Mott Haven, which are characterized by crowding, intergenerational co-residence, and a high proportion of low wage “essential workers” who leave the home for work even during lockdown periods. We will evaluate the effectiveness of an innovative Nurse-Community Health Worker (CHW)-Family Partnership intervention designed to promote COVID-19 testing uptake, adoption of COVID-19 control measures, and mutual aid capacity at the household level. Our intervention is adapted from the Nurse-Family Partnership model, which has been shown to be effective and cost-effective in improving maternal and child health outcomes in high-poverty, racially- and ethnically-diverse communities. CHWs will provide culturally-appropriate support to families, addressing stigma, medical mistrust, and other common barriers to engagement in healthcare.

We propose a 2-arm randomized controlled trial, in which 270 households (810 individuals) will be randomly assigned (2:1) to either the experimental group of families who will receive the Nurse-CHW-Family Partnership intervention and the offer of in-home testing, or the treatment-as-usual control group referred to free testing located within walking distance. Participants in both arms will be assessed at baseline and monthly for 9 months.

The findings from this study will provide an evidence-base to inform current and future public health initiatives related to COVID-19 mitigation in other high-risk settings. Sustainability will be addressed by building local capacity and expertise among participants, CHWs and CAB members, and partnering with them to develop the community’s best practices for COVID-19. Should it prove to be effective, our intervention can be tailored to increase testing and other COVID-19 control measures in other settings of vulnerability and disadvantage.