Prevention Science Institute, University of Oregon, Eugene.
Department of Counseling Psychology and Human Services, University of Oregon, Eugene.
JAMA Netw Open. 2022 Jun 1;5(6):e2216796. doi: 10.1001/jamanetworkopen.2022.16796.
Latinx individuals have been disproportionately affected during the COVID-19 pandemic caused by the spread of SARS-CoV-2. It is imperative to evaluate newly developed preventive interventions to assess their effect on COVID-19 health disparities.
To examine the effectiveness of a culturally tailored outreach intervention designed to increase SARS-CoV-2 testing rates among Latinx populations.
DESIGN, SETTING, AND PARTICIPANTS: In this cluster randomized trial performed from February 1 to August 31, 2021, in community settings in 9 Oregon counties, 38 sites were randomized a priori (19 to the community health promoters intervention and 19 to outreach as usual wait-listed controls). Thirty-three sites were activated. A total of 394 SARS-CoV-2 testing events were held and 1851 diagnostic samples collected, of which 919 were from Latinx persons.
A culturally informed outreach program was developed that made use of promotores de salud (community health promoters) to increase Latinx SARS-CoV-2 testing. Strategies addressed barriers by disseminating information on testing events in English and Spanish, mitigating misinformation, and increasing trust.
The primary outcomes were the count of sample tests from Latinx persons and the sampled proportion of the Latinx populace. Site-level covariates included census tract Latinx populace, nativity (number of US-born individuals per 100 population), median age, and income inequality. Time-varying covariates included number of new weekly SARS-CoV-2-positive cases and percentage of vaccine coverage at the county level.
A total of 15 clusters (sites) were randomized to the control group and 18 to the community health promoters group. A total of 1851 test samples were collected, of which 995 (53.8%) were from female participants and 919 (49.6%) were from Latinx individuals. The intervention tested 3.84 (95% CI, 2.47-5.97) times more Latinx individuals per event than controls (incident rate ratio, 0.79; 95% CI, 0.46-1.34; Cohen d = 0.74; P < .001). The intervention was associated with a 0.28 increase in the proportion of Latinx populace being tested compared with control sites for the dependent variable scaled as the proportion of the Latinx populace ×100, or a 0.003 proportion of the raw populace count. The use of a standardized scaling of the proportion of Latinx individuals showed that the relative percentage increase was 0.53 (95% CI, 0.21-0.86) in the intervention sites compared with controls, representing a medium effect size.
To our knowledge, this was the first randomized evaluation of an outreach intervention designed to increase SARS-CoV-2 testing among Latinx populations. Findings could be used to implement strategies to reduce other health disparities experienced by these groups.
ClinicalTrials.gov Identifier: NCT04793464.
在由 SARS-CoV-2 传播引起的 COVID-19 大流行中，拉丁裔个体受到了不成比例的影响。评估新开发的预防干预措施以评估其对 COVID-19 健康差异的影响至关重要。
评估一种文化上合适的外展干预措施，旨在提高拉丁裔人群的 SARS-CoV-2 检测率。
设计、地点和参与者：在这项于 2021 年 2 月 1 日至 8 月 31 日在俄勒冈州 9 个县的社区环境中进行的聚类随机试验中，38 个站点预先随机化（19 个分配给社区健康促进者干预组，19 个分配给常规等待的对照组）。有 33 个站点被激活。共进行了 394 次 SARS-CoV-2 检测活动，并采集了 1851 份诊断样本，其中 919 份来自拉丁裔人群。
制定了一项文化知情的外展计划，利用 promotores de salud（社区健康促进者）来增加拉丁裔的 SARS-CoV-2 检测。策略通过以英语和西班牙语传播检测事件信息、减轻错误信息和增加信任来解决障碍。
主要结果是拉丁裔个体的样本检测次数和拉丁裔人群的抽样比例。站点级别的协变量包括人口普查区的拉丁裔人口、出生地（每 100 人口中美国出生的人数）、中位年龄和收入不平等。时间变化的协变量包括县一级每周新的 SARS-CoV-2 阳性病例数和疫苗接种覆盖率百分比。
共有 15 个（站点）被随机分配到对照组，18 个被分配到社区健康促进者组。共采集了 1851 个测试样本，其中 995 个（53.8%）来自女性参与者，919 个（49.6%）来自拉丁裔个体。与对照组相比，干预组每检测事件检测到的拉丁裔个体多 3.84 倍（发病率比，0.79；95%置信区间，0.46-1.34；Cohen d = 0.74；P <.001）。与对照组相比，干预组检测到的拉丁裔人群比例增加了 0.28 个百分点，用于依赖变量，即拉丁裔人群比例×100 的比例，或原始人群计数的 0.003 个百分点。使用拉丁裔个体比例的标准化比例进行缩放表明，与对照组相比，干预组的相对百分比增加了 0.53（95%置信区间，0.21-0.86），这代表了中等效应大小。
据我们所知，这是首次对旨在提高拉丁裔人群中 SARS-CoV-2 检测率的外展干预措施进行随机评估。研究结果可用于实施策略，以减少这些群体所经历的其他健康差异。
ClinicalTrials.gov 标识符：NCT04793464。
