Determinants and Outcomes of Nicotine Metabolite Ratio in HIV + Smokers

HIV 吸烟者尼古丁代谢比率的决定因素和结果

• 批准号: 10254935
• 负责人: ROBERT GROSS
• 金额: $ 144.65万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-11-15 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254935
• 关键词: 2019-nCoV; AIDS prevention; Address; Affect; Area; Behavioral; COVID-19; COVID-19 detection; COVID-19 diagnosis; COVID-19 diagnostic; COVID-19 pandemic; COVID-19 test; COVID-19 testing; Caring; Clinic; Cohort Studies; Collaborations; Communities; Contact Tracing; Containment; Data; Decentralization; Detection; Diagnostic Reagent Kits; Diagnostic tests; Disease; Economics; Epidemic; Ethics; FDA Emergency Use Authorization; FDA approved; Federally Qualified Health Center; Fright; Future; HIV; Health Professional; Health Services Accessibility; Healthcare; Human immunodeficiency virus test; Immigrant; Income; Individual; Infection; Intervention; Intervention Studies; Latinx; Logistics; Low income; Medical; Methods; Misinformation; Modeling; Modification; Nicotine; Outcome; Participant; Philadelphia; Population; Privacy; Process; Public Health; RADx Underserved Populations; Randomized; Randomized Controlled Trials; Research; Research Methodology; Sampling; Secondary to; Sensitivity and Specificity; Services; Severe Acute Respiratory Syndrome; Smoker; Social Network; Substance Use Disorder; System; Technology; Testing; Underserved Population; United States; Viral hepatitis; Virus; Vulnerable Populations; arm; base; community partnership; comorbidity; experience; follow-up; health care availability; health disparity; health inequalities; health management; housing instability; implementation science; literacy; medically underserved; novel; pandemic disease; peer; peer networks; primary care services; randomized trial; response; scale up; self testing; social; social stigma; testing uptake; underserved community; user-friendly

Project Summary COVID-19, the disease caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has led to a global pandemic and has exacerbated existing health inequities among vulnerable populations. Despite higher rates of COVID-19 in Black and Latinx individuals compared to White individuals, rates of testing in predominately non-White, low-income communities are significantly lower than in high-income areas. Strategies to increase COVID-19 testing rates in underserved populations are thus urgently needed. Self-testing, where individuals collect their own samples, is now feasible for the detection of SARS-CoV-2. Self-testing can increase testing convenience and privacy and has been effectively leveraged to expand testing for other infections, such as HIV, in key populations across a broad spectrum of contexts. However, self-testing may be limited to those with access to health services, without reaching individuals underserved by existing medical systems. One promising approach to increase test uptake is the secondary distribution of self-testing kits, where an individual distributes tests to contacts in their social network and encourages them to self-test. A significant advantage of a secondary distribution strategy is that by decentralizing a health care process, individuals may be more likely to access services if delivered by social network peers, rather than health professionals. In addition, secondary distribution can enhance contact tracing efforts, as individuals diagnosed with COVID-19 can distribute self-tests to close contacts to identify additional cases. Given high levels of COVID-19 misinformation, stigma, and medical mistrust among vulnerable populations, this peer-driven test distribution strategy holds significant promise in increasing the reach of COVID-19 testing among underserved populations. In collaboration with our community-based partner, Public Health Management Corporation, we will conduct a 1:1 randomized trial with 1048 individuals cared for at Federally Qualified Health Centers to evaluate whether secondary distribution of SARS-CoV-2 self-tests increases test uptake compared with referrals among underserved populations in Philadelphia (Aim 1). We will also assess whether the secondary distribution of self-tests to close contacts among individuals with COVID-19 facilitates case detection (Aim 2). Additionally, we will use a mixed methods strategy to identify key social, ethical, economic, and behavioral barriers and facilitators to secondary distribution to inform its future modifications, implementation, and scale-up (Aim 3). We will engage our relationship with community partners to reach underserved individuals with housing instability, immigrants, and those with significant medical comorbidities including HIV, viral hepatitis, and substance use disorders, in order to increase COVID-19 test uptake in these populations. As more rapid and user-friendly diagnostic tests emerge, this secondary distribution model may become even more impactful. The proposed project may establish a new paradigm for expanding COVID-19 testing and contact tracing.

项目摘要 由SARS-COV-2（严重急性呼吸综合征冠状病毒2）引起的疾病Covid-19具有 导致全球大流行，加剧了弱势群体中现有的健康不平等。 尽管与白人相比，黑人和拉丁裔个体中的共同率更高，但 主要非白人，低收入社区的测试明显低于高收入地区。 因此，迫切需要提高服务不足人群中的共同测试率的策略。 个人收集自己的样本的自我测试现在可用于检测SARS-COV-2。 自我测试可以增加测试的便利性和隐私性，并有效地利用了扩展测试 对于其他各种环境中的关键种群中的其他感染，例如艾滋病毒。但是，自我测试 可能仅限于获得卫生服务的人，而无需接触到现有的个人服务不足 医疗系统。增加测试吸收的一种有希望的方法是自我测试的次要分布 套件，个人在社交网络中向联系人分发测试，并鼓励他们进行自我测试。一个 次要分配策略的重要优势是，通过分散医疗保健过程， 如果由社交网络同行提供，而不是健康，个人可能更有可能访问服务 专业人士。此外，次要分布可以增强接触追踪工作，因为个人被诊断 使用Covid-19可以分发自我测试以关闭联系人以识别其他情况。给定高水平 COVID-19的错误信息，污名和弱势群体的医学不信任，这是同行驱动的测试 分销策略在增加服务不足的COVID-19测试方面具有巨大的希望 人群。 与我们的社区合作伙伴公共卫生管理公司合作，我们将 进行1：1随机试验，并在联邦合格的保健中心接受1048个个人来评估 与转介相比 费城服务不足的人口（AIM 1）。我们还将评估是否的二级分布是否 与COVID-19的个体之间紧密接触的自我测试有助于案例检测（AIM 2）。此外， 我们将使用混合方法策略来确定关键的社会，道德，经济和行为障碍，并 促进者进行次要分配，以告知其未来的修改，实施和扩大规模（AIM 3）。 我们将与社区合作伙伴接触我们的关系，以接触服务不足的住房 不稳定，移民以及具有重大医学合并症的人，包括艾滋病毒，病毒肝炎和 物质使用障碍，以增加这些人群中的Covid-19测试吸收。更快， 出现了用户友好的诊断测试，这种二次分发模型可能会变得更加影响力。这 拟议的项目可能会建立一个新的范式，用于扩展19 Covid-19测试和接触跟踪。