将公平置于新冠疫情接触者追踪的中心：康涅狄格州的社区外展专家项目。
Centering Health Equity Within COVID-19 Contact Tracing: Connecticut's Community Outreach Specialist Program.
机构信息
Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith).
出版信息
J Public Health Manag Pract. 2022;28(6):728-738. doi: 10.1097/PHH.0000000000001608.
CONTEXT
The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non-English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19-related stigma, and language and cultural barriers between contact tracers and communities are common challenges.
PROGRAM
The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non-English-speaking populations in 11 high-burden jurisdictions in Connecticut.
IMPLEMENTATION
In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non-English speaking populations.
EVALUATION
We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts.
CONCLUSION
A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non-English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.
背景
COVID-19 大流行对弱势群体造成了不成比例的影响，包括那些非英语使用者和社会经济地位较低的人群；然而，这些群体最初参与接触者追踪的比例很低。对政府机构的不信任、对 COVID-19 相关耻辱感的预期，以及接触追踪者和社区之间的语言和文化障碍，是常见的挑战。
项目
康涅狄格州公共卫生部 (DPH) COVID-19 接触者追踪项目内设立了社区外展专家 (COS) 项目，以鼓励参与接触者追踪，并解决在康涅狄格州 11 个高负担司法管辖区中，社会弱势和非英语使用者群体对文化上适宜的护理以及社会和物质支持的需求。
实施
通过与州和地方卫生部门合作，我们从目标社区招募了 25 名具有相关语言技能的 COS 工作人员，并对他们进行培训，以向弱势和非英语使用者群体提供接触者追踪服务。
评估
我们使用 DPH 的企业接触追踪系统 ContaCT 的数据进行了横断面分析。总体而言，COS 项目登记了 1938 例病例和 492 名接触者。在 COS 项目中，与常规接触者追踪项目相比，病例（70%对 57%，P<.001）和接触者（84%对 64%，P<.001）中被联系和访谈的居民比例更高。在调整了客户年龄、性别、种族和民族、语言和司法管辖区后，我们发现 COS 项目与接触者的接触率增加有关（优势比 [OR] = 1.52；95%置信区间 [95%CI]，1.17-1.99），但与病例无关（OR = 0.78；95%CI，0.70-0.88）。对项目方案现场记录和会议报告的快速定性分析提供了证据，表明 COS 项目对客户是可行和可接受的，并有助于 COVID-19 的教育和沟通工作。
结论
采用以客户为中心、以社区为基础的策略来接触弱势和非英语使用者群体的 COS 项目是可行的，与标准 COVID-19 接触者追踪相比，该项目在接触者追踪方面更有效。
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