Exploring barriers and facilitators to women who use drugs (WWUD) awareness, acceptance and uptake of COVID-19 testing, the CARE study.

CARE 研究探讨了女性吸毒者 (WWUD) 对 COVID-19 检测的认识、接受和采用的障碍和促进因素。

• 批准号: 10259440
• 负责人: Susan G. Sherman
• 金额: $ 65.46万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259440
• 关键词: Action Research; Attention; Awareness; Baltimore; Behavioral; Belief; COVID testing; COVID-19; COVID-19 diagnosis; COVID-19 testing; Caring; Chronic Disease; Cities; Clinical; Collaborations; Communities; Community Services; Data Collection; Deception; Development; Diagnosis; Diagnostic tests; Discrimination; Disease; Drops; Drug usage; Environment; Ethics; Evaluation; Foundations; Future; Generations; HIV; HIV/STD; Handwashing; Health; Health Services; Health Services Accessibility; Healthcare; Hepatitis C virus; High Risk Woman; Hospitals; Housing; Income; Individual; Infrastructure; Interview; Lung diseases; Measures; Medical; Medical Research; Mental Health; Methods; Modeling; Outcome; Overdose; Participant; Pharmaceutical Preparations; Provider; Recording of previous events; Research; Risk; Role; Scheme; Seasons; Self Administration; Shapes; Site; Social Conditions; Social Distance; Social Processes; Social Work; Sorting - Cell Movement; Testing; Theoretical Studies; Training; Trust; Underserved Population; Vaccination; Violence; Visit; Vulnerable Populations; Woman; antigen test; base; black women; cohort; community based research; community engagement; community partnership; coronavirus disease; demographics; design; experience; follow-up; food insecurity; food security; health belief; health care service utilization; health care settings; high risk population; housing instability; illicit drug use; informant; meetings; point of care; racism; recruit; scale up; service providers; sex; sexual violence; social; social factors; social stigma; stem; testing uptake; theories; transportation access; uptake

Project Summary In the U.S. women who use illicit drugs (WWUD) have disproportionately high rates of infectious (e.g., HIV, HCV), chronic, and pulmonary diseases that elevate their risk for COVID-19. Their health and disease profile is driven by enduring social conditions (e.g., scarcity of income, food insecurity, access to health services, housing, discrimination). These prevailing social conditions can also undermine WWUDs’ ability to protect themselves from COVID-19 (e.g., washing hands, social distancing). Drug procurement and use, which are largely social processes, further challenge these self-protection measures. Testing and future vaccination is vital to reducing COVID-19 among this high-risk population, necessitating accessible testing schemes. We propose a mixed methods study that draws upon the Andersen Behavioral Model10 and is grounded in eco-social theory. Specifically, the Baltimore-based study aims to: 1) explore predisposing social factors (e.g., housing, food security), individual-level factors (e.g., drug use, mental health), and beliefs (e.g., medical mistrust) that are facilitators and barriers of COVID-19 testing and perceived risks (e.g., income generation, violence) resulting from a diagnosis through in-depth interviews among WWUD (N=15) and a cultural domain analysis (N=45); 2) gain an understanding of the enabling community-level environment (e.g., medical and social service agencies that currently serve WWUD, existing city-wide COVID-19 testing sites) that could facilitate or hinder WWUDs’ COVID-testing uptake through observations (N=8-10) and key informant interviews (N=10); and examine predisposing social factors, individual-level factors, and beliefs that are associated with COVID-19 testing and retesting among a cohort (N=250) of WWUD at baseline and 3-month follow-up. Optional testing offered at both study visits will be a self-administered, rapid antigen test. We will also examine the role of medical mistrust in shaping women’s use of healthcare services as well as experiences of stigma and discrimination in healthcare settings, particularly among Black participants. In Baltimore, this mistrust is particularly pronounced, with Johns Hopkins Hospital having a long history of mistrust in the Black community owing to experimentation and deception of research engagement. The study will be guided by a community advisory board (CAB) who will inform its design and implementation as well as engage in disseminating the results at community meetings to inform COVID-testing scale up.

项目概要 在美国，使用非法药物 (WWUD) 的女性感染率极高 （例如 HIV、HCV）、慢性疾病和肺部疾病会增加其感染 COVID-19 的风险。 疾病概况是由持久的社会条件（例如收入稀缺、粮食不安全、获得食物的机会）驱动的 医疗服务、住房、歧视）。这些普遍的社会条件也会损害 WWUD 的作用。 保护自己免受 COVID-19 感染的能力（例如洗手、保持社交距离）。 和使用主要是社会过程，进一步挑战了这些自我保护措施。 未来的疫苗接种对于减少这一高危人群中的 COVID-19 至关重要，因此有必要 我们提出了一种借鉴安徒生方法的混合方法研究。 具体来说，这项位于巴尔的摩的研究旨在： 1）探索诱发社会因素（例如住房、粮食安全）、个人因素（例如吸毒、 心理健康）和信念（例如医疗不信任）是 COVID-19 检测的促进因素和障碍 以及通过深入诊断而产生的感知风险（例如，创收、暴力） WWUD 访谈（N=15）和文化领域分析（N=45）；2）了解 有利的社区环境（例如目前提供服务的医疗和社会服务机构 WWUD（现有的全市范围内的 COVID-19 检测点）可能会促进或阻碍 WWUD 的 COVID-19 检测 通过观察 (N=8-10) 和关键知情人访谈 (N=10) 进行吸收并检查易感性； 与 COVID-19 检测和重新检测相关的社会因素、个人因素和信念 在基线和 3 个月随访时进行的 WWUD 队列（N=250）中进行了研究。 研究访问将是一种自我管理的快速抗原测试，我们还将检查医疗的作用。 对塑造妇女使用医疗保健服务的不信任以及耻辱和歧视的经历 医疗机构中的歧视，尤其是在巴尔的摩的黑人参与者中，这种不信任是存在的。 尤其明显的是，约翰·霍普金斯医院长期以来对黑人不信任 由于实验和研究参与的欺骗而导致的社区本研究将受到以下指导： 社区咨询委员会（CAB）将为其设计和实施提供信息并参与 在社区会议上传播结果，为扩大新冠病毒检测规模提供信息。