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Kost GJ, Eng M, Zadran A. Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study. JMIR Public Health Surveill 2024; 10:e47416. [PMID: 39190459 DOI: 10.2196/47416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/06/2024] [Accepted: 06/20/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks. OBJECTIVE The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns. METHODS Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population. RESULTS COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment. CONCLUSIONS Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics.
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Affiliation(s)
- Gerald Joseph Kost
- Point-of-care Testing Center for Teaching and Research (POCT•CTR), School of Medicine, University of California, Davis, Davis, CA, United States
| | - Muyngim Eng
- University of Phutisastra, Phnom Penh, Cambodia
| | - Amanullah Zadran
- Public Health Sciences, POCT•CTR, School of Medicine, University of California, Davis, Davis, CA, United States
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Maughan E, Richardson C, Nazar H. A cross-sectional investigation of a mobile health clinic run by undergraduate pharmacy students providing services to underserved communities. Int J Clin Pharm 2024:10.1007/s11096-024-01783-1. [PMID: 39046691 DOI: 10.1007/s11096-024-01783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Mobile health clinics have been used to provide healthcare to underserved communities, especially during the COVID-19 pandemic. Student-led clinics, operated by undergraduate health students, offer valuable training while serving these populations. AIM This cross-sectional study investigated the demographic characteristics and services provided by a mobile health clinic run by undergraduate pharmacy students, assessing its potential to reach underserved communities. METHOD The mobile health clinic operated from October 2023 to April 2024, staffed by 36 fourth-year pharmacy students. Services included cardiovascular disease risk screening and lifestyle advice. Demographic and service data were collected using an electronic primary care system and analysed with descriptive statistics. RESULTS The clinic served 716 users, with a demographic breakdown of 53.2% female and 46.8% male, predominantly aged 31-60 years. Users were ethnically diverse. Services provided included blood pressure (91.3%), BMI (91.3%), and diabetes risk assessments (54.9%). Many users reported low risk for smoking and alcohol consumption, but varied levels of physical activity. Referrals were made for cardiovascular disease risk and lifestyle support. CONCLUSION The mobile health clinic effectively reached a diverse, underserved population, providing essential health services and facilitating student training. Further research is needed to evaluate the long-term impact and cost-effectiveness of such clinics, and the follow-up care for referred patients.
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Affiliation(s)
- Emily Maughan
- The Grainger Suite, Newcastle GP Services, Dobson House, Newcastle-Upon-Tyne, NE3 3PF, UK
| | | | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle-Upon-Tyne, NE1 7RU, UK.
- Newcastle NIHR Patient Safety Research Collaboration, Newcastle University, Newcastle-Upon-Tyne, NE1 7RU, UK.
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Fruleux A, Gaudart J, Franke F, Nauleau S, Dutrey Kaiser A, Legendre E, Balma D, Lescaudron M, Tamalet L, Malfait P, Chaud P, Rebaudet S. Reviving health mediation during the COVID-19 crisis and beyond: an implementation study in deprived neighbourhoods of Marseille, France. Front Public Health 2024; 12:1313575. [PMID: 39022414 PMCID: PMC11251881 DOI: 10.3389/fpubh.2024.1313575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction In 2020, during France's COVID-19 response, healthcare professionals from a hospital and an association initiated health mediation interventions in Marseille's vulnerable neighbourhoods, funded by the regional health authorities. This mixed method research evaluates the CORHESAN program that lasted until June 2022. Methods We examined CORHESAN documents and reports, conducted interviews, and analysed activity data, comparing it to the COVID-19 hotspots identified on a weekly basis at the neighbourhood level, using generalised linear mixed models (GLMMs). Results CORHESAN was implemented by a team of up to nine health mediators, six private nurses hired on an ad hoc basis, supervised by a general coordinator and two part-time medical and nursing coordinators. Multiple partnerships were established with shelters, associations, social-housing landlords and local institutions. The team accompanied 6,253 people affected by COVID-19 or contact in the practical implementation of their isolation and contact tracing. Of the 5,180 nasopharyngeal samples for RT-PCR and 1,875 for antigenic testing: 12% were taken at home and 27% in partner facilities in the targeted neighbourhoods; 32% were taken from symptomatic patients and 30% in the context of contact tracing; and 40% were positive. Multiple awareness sessions on prevention methods and distributions of personal protection kits and self-diagnostic tests were conducted in the streets, in shelters, in associations or at home. A total of 5,929 doses of COVID-19 vaccine were administered in a walk-in vaccination centre, at temporary street vaccination posts, during operations at partner facilities, or during home-visits to patients with limited autonomy. GLMMs showed that the intervention significantly targeted its testing interventions in neighbourhoods with socioeconomic disadvantage and/or past under-testing (adjusted odds ratio (aOR), 2.75 [1.50-5.00]) and those with high hotspot level (aOR for level-3 versus level-0, 1.83 [1.24-2.71]). Discussion The pandemic emphasised the potential of health mediation interventions to address health disparities. Building on this, a new program began in July 2022, aiming at enhancing cancer screening and vaccinations in deprived areas of Marseille. Evaluations are ongoing to assess its activities and impact, and provide evidence to future implementation initiatives.
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Affiliation(s)
- Alix Fruleux
- Ville de Marseille, Direction de la Santé publique et de l'Inclusion, Marseille, France
| | - Jean Gaudart
- Aix-Marseille Université, Inserm, IRD, UMR1252 SESSTIM, ISSPAM, Marseille, France
- Santé publique France, Saint-Maurice, France
| | | | - Steve Nauleau
- Agence régionale de santé Provence-Alpes-Côte d'Azur (ARS Paca), Marseille, France
| | | | | | | | | | | | | | | | - Stanislas Rebaudet
- Aix-Marseille Université, Inserm, IRD, UMR1252 SESSTIM, ISSPAM, Marseille, France
- Hôpital Européen, Marseille, France
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Martin S, Dill J, Demeritte D, Geressu H, Dahal R, Kirkland C, Hunt S, Parikh R. A Scoping Review of Health Equity Interventions in Governmental Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:479-489. [PMID: 38830006 DOI: 10.1097/phh.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
CONTEXT Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. OBJECTIVE To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. DESIGN This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. ELIGIBILITY CRITERIA The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. MAIN OUTCOME MEASURES This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. RESULTS This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. CONCLUSIONS This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.
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Affiliation(s)
- Skky Martin
- Author Affiliations: Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Gurayah AA, Satish S, Yarborough CC, Perez N, Amin K, Enemchukwu EA, Syan R. Pelvic Floor Disorders Among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs. Urology 2024; 186:147-153. [PMID: 38395073 DOI: 10.1016/j.urology.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To characterize prevalence and severity of pelvic floor disorders (PFDs) in various health care settings and to examine unmet health-related social needs (HRSN) among minority women. MATERIALS AND METHODS Minority women with PFDs were recruited from our academic urogynecology clinic, a general urology clinic at our institution's safety net hospital, and a community outreach mobile clinic. Questions from the Urinary Distress Index-6, Pelvic Organ Prolapse Distress Inventory-6, and Female Genitourinary Pain Index were used to identify patients with stress urinary incontinence, overactive bladder (OAB), and chronic pelvic pain syndrome (CPPS). RESULTS Sixty-one (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Overall, self-reported PFDs included stress urinary incontinence in 45%, OAB in 74.8%, and CPPS in 24.4% of women. Hispanic women were more likely to report OAB symptoms, compared to Black women (odds ratio (OR) 3.4 [1.2-10.2], P = .03) or Other women (OR = 5.1 [1.3-20.4], P = .02). Participants held a median of 5 unmet HRSN. Minority women facing issues with family and community support, transportation, and utilities were more likely to report CPPS symptoms, compared to those without psychosocial issues (support OR: 4.8 [1.7-13.7], P = .002; transportation OR: 2.0 [1.0-8.2], P = .05; utility OR: 7.0 [1.9-28.1], P = .005). CONCLUSION Minority women with PFDs may have several unmet HRSNs which impact their ability to receive appropriate medical care. Our findings may assist in the development of effective strategies to improve health care outcomes for women dealing with PFDs.
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Affiliation(s)
- Aaron A Gurayah
- Weill Cornell Medicine, Department of Urology, New York, NY.
| | - Sanjana Satish
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Christina C Yarborough
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Nathalie Perez
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Katherine Amin
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
| | - Ekene A Enemchukwu
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA.
| | - Raveen Syan
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
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Hamilton-Burgess C, Berkley-Patton J, Allsworth J, Bowe Thompson C, Thompson FE, Burgin T, Williams ED, Derose KP. The Importance of Community-Based and Community-Partnered COVID-19 Testing for Reducing Disparities Among African American Populations. Health Equity 2024; 8:147-156. [PMID: 38505761 PMCID: PMC10949942 DOI: 10.1089/heq.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 03/21/2024] Open
Abstract
Background Health inequalities in African American communities have been further exacerbated by COVID-19. Public health departments and other safety-net providers across the United States have partnered with community-based organizations to address barriers to COVID-19 testing in disproportionately impacted communities. This narrative review summarizes lessons learned from published examples of these community-based COVID-19 testing efforts. Methods We searched online databases for peer-reviewed articles on community-based COVID-19 testing interventions in the United States aimed at increasing COVID-19 testing among African American populations. We abstracted information about each example and synthesized the primary lessons learned and key aspects that contributed to their success. Results Seven examples of community-based COVID-19 testing aimed at increasing testing among African Americans and other underserved populations were identified and described, across various U.S. locations and involving multiple types of partners (1) St. Paul, MN (faith, health centers, Mayo Clinic); (2) Chicago, IL (university hospital and health centers); (3) NC (health centers, Community Advisory Board); (4) Baltimore, MD (hospitals, community clinic, mobile clinic); (5) Marion County, FL (health department and community partners); (6) New Orleans, LA (health department and health system); and (7) New York City, NY health and hospital system, mobile clinic). Discussion Several key aspects of the COVID-19 testing models included the following: (1) close proximity of the testing site to affected communities and availability of walk-up and drive-through testing options; (2) partnerships between safety-net providers and broad community networks, which facilitated outreach and trust; (3) increased resources for safety-net providers; and (4) the use of data to identify areas of need and track impact. The merging of resources and relationships among well-equipped, safety-net providers and other health care institutions and culture-rich, community-centered organizations, to jointly address structural and systemic inequities, is key to cultivating health equity in the distribution of COVID-19 testing and other essential public health services.
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Affiliation(s)
- Chavon Hamilton-Burgess
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri Kansas City (UMKC) School of Medicine, Kansas City, Missouri, USA
| | - Jenifer Allsworth
- Department of Biomedical and Health Informatics, University of Missouri Kansas City (UMKC) School of Medicine, Kansas City, Missouri, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri Kansas City (UMKC) School of Medicine, Kansas City, Missouri, USA
| | | | - Tacia Burgin
- Department of Psychology, University of Missouri Kansas City (UMKC), Kansas City, Missouri, USA
| | - Eric D. Williams
- Calvary Temple Baptist Church, Calvary Community Outreach Network, Kansas City, Missouri, USA
| | - Kathryn P. Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
- RAND Corporation, Santa Monica, California, USA
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Goldstein FC, Hajjar I, Summers A, Truong AD, Lee FFEH, Han JE, Walker TA. Frequency and correlates of subjective cognitive complaints and objective cognitive screening results in African American adults following COVID-19 infection. Brain Behav Immun Health 2023; 34:100691. [PMID: 37842136 PMCID: PMC10569942 DOI: 10.1016/j.bbih.2023.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Background Subjective cognitive complaints are frequent following COVID-19 infection, but assessment of whether these complaints map onto objective cognitive findings may not be routine in busy clinical settings. Consequently, opportunities to confirm these complaints and to provide follow-up referrals and appropriate care may be missed, thereby impacting patients' functional independence and quality of life. African Americans are vulnerable to poor outcomes from COVID-19, and thus represent a minority group in whom subjective concerns are especially important to investigate. Towards this end, we examined the frequency and correlates of subjective complaints and objective screening results of African American patients referred to the Post-Acute Sequelae of SARS-CoV-2 (PASC) Clinic at Grady Memorial Hospital, a large county teaching hospital in Atlanta, Georgia. Methods Eighty seven African American patients (mean age = 52.5, SD = 10.5, range = 30-73) were evaluated between January 28, 2021-October 14, 2021 in the Grady PASC clinic. They ranged from 1 to 17 months post positive SARS-COV-2 antigen testing. Patients were administered a subjective cognitive complaint questionnaire (PROMIS Cognitive Function Scale Short Form 8a) as well as cognitive screening measures including the Mini-Cog (3 item recall, clock) and the Digit Symbol Substitution Test (timed visuomotor sequencing). Mood was assessed via the Patient Health Questionnaire-9, and anxiety via the Generalized Anxiety Disorders Scale. Published norms were used to identify clinically elevated scores. Results Sixty six (76%) patients denied experiencing meaningful cognitive concerns, and of these, 25 (38%) had positive cognitive screens indicating impaired performance on objective testing. Of 21 patients with subjectively elevated cognitive concerns, 17 (81%) also had positive cognitive screens. There were no significant differences in sociodemographic factors (p values = .07-.71), days post-acute positive SARS-COV-2 Antigen Test (p = .99), disease severity (p values = .67-.75), or COVID-19 comorbidity indices (medical conditions (p values = .20-.77), substance abuse (p = .79), psychiatric history (p values = .11-.99) in those with or without subjective complaints and objective cognitive findings. However, patients with subjective complaints and objective cognitive findings reported more post-COVID-19 anxiety (p = .02) and depression (p = .001). Conclusions Findings indicate a high concordance between subjective complaints on the PROMIS Cognitive Scale and objectively confirmed cognitive impairments in African Americans. Further, almost 40% who reported no cognitive complaints screened positive for cognitive impairment. Although depression and anxiety are associated with subjective complaints, they do not account for positive cognitive screening results, as those patients without depressive complaints also had similar rates of positive objective screens. The findings suggest that cognitive screening using assessment tools should be routinely performed in African Americans, especially those reporting cognitive symptoms on outcome scales. While future studies are needed to assess long-term outcomes, we highly recommend follow-ups in those with positive screens to characterize the specific domains that are impacted and that could affect activities of daily living and quality of life.
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Affiliation(s)
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Aerica Summers
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
| | - Alexander D. Truong
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - F. Frances Eun-Hyung Lee
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jenny E. Han
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiffany A. Walker
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Boivin P, Coulibaly A, Richard Z, Gomes de Medeiros S, Dutra Da Nóbrega RE, de Araujo Oliveira SR, Cloos P, Chabrol F, Ridde V, Zinszer K. Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali. Soc Sci Med 2023; 335:116230. [PMID: 37716184 DOI: 10.1016/j.socscimed.2023.116230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Lara Gautier
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Camille Beaujoin
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada.
| | - Pauline Boivin
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Abdourahmane Coulibaly
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Zoé Richard
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Stéphanie Gomes de Medeiros
- Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife PE 50670-901, Brazil.
| | - Raylson Emanuel Dutra Da Nóbrega
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Sydia Rosana de Araujo Oliveira
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Patrick Cloos
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada; School of Social Work, University of Montréal, 3150 Rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada.
| | - Fanny Chabrol
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Valéry Ridde
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Kate Zinszer
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
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Lane-Barlow C, Thomas I, Horter L, Green J, Byrkit R, Juluru K, Weitz A, Ricaldi JN, Fleurence R, Valencia D. Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:539-546. [PMID: 36729971 PMCID: PMC10198798 DOI: 10.1097/phh.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT Health departments (HDs) work on the front lines to ensure the health of their communities, providing a unique perspective to public health response activities. Say Yes! COVID Test (SYCT) is a US federally funded program providing free COVID-19 self-tests to communities with high COVID-19 transmission, low vaccination rates, and high social vulnerability. The collaboration with 9 HDs was key for the program distribution of 5.8 million COVID-19 self-tests between March 31 and November 30, 2021. OBJECTIVE The objective of this study was to gather qualitative in-depth information on the experiences of HDs with the SYCT program to better understand the successes and barriers to implementing community-focused self-testing programs. DESIGN Key informant (KI) interviews. SETTING Online interviews conducted between November and December 2021. PARTICIPANTS Sixteen program leads representing 9 HDs were purposefully sampled as KIs. KIs completed 60-minute structured interviews conducted by one trained facilitator and recorded. MAIN OUTCOME MEASURES Key themes and lessons learned were identified using grounded theory. RESULTS Based on perceptions of KIs, HDs that maximized community partnerships for test distribution were more certain that populations at a higher risk for COVID-19 were reached. Where the HD relied predominantly on direct-to-consumer distribution, KIs were less certain that communities at higher risk were served. Privacy and anonymity in testing were themes linked to higher perceived community acceptance. KIs reported that self-test demand and distribution levels increased during higher COVID-19 transmission levels. CONCLUSION HDs that build bridges and engage with community partners and trusted leaders are better prepared to identify and link high-risk populations with health services and resources. When collaborating with trusted community organizations, KIs perceived that the SYCT program overcame barriers such as mistrust of government intervention and desire for privacy and motivated community members to utilize this resource to protect themselves against COVID-19.
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Affiliation(s)
| | - Isabel Thomas
- CDC COVID-19 Response Team
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Libby Horter
- CDC COVID-19 Response Team
- Goldbelt C6, LTD, Chesapeake, Virginia
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10
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DeGarmo DS, De Anda S, Cioffi CC, Tavalire HF, Searcy JA, Budd EL, Hawley McWhirter E, Mauricio AM, Halvorson S, Beck EA, Fernandes L, Currey MC, Ramírez García J, Cresko WA, Leve LD. Effectiveness of a COVID-19 Testing Outreach Intervention for Latinx Communities: A Cluster Randomized Trial. JAMA Netw Open 2022; 5:e2216796. [PMID: 35708690 PMCID: PMC9204550 DOI: 10.1001/jamanetworkopen.2022.16796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023] Open
Abstract
Importance 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. Objective 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. Interventions 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. Main Outcomes and Measures 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. Results 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. Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT04793464.
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Affiliation(s)
- David S. DeGarmo
- Prevention Science Institute, University of Oregon, Eugene
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene
| | - Stephanie De Anda
- Prevention Science Institute, University of Oregon, Eugene
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene
| | | | | | - Jacob A. Searcy
- Presidential Initiative in Data Science, University of Oregon, Eugene
| | - Elizabeth L. Budd
- Prevention Science Institute, University of Oregon, Eugene
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene
| | | | | | - Sven Halvorson
- Prevention Science Institute, University of Oregon, Eugene
| | - Emily A. Beck
- Presidential Initiative in Data Science, University of Oregon, Eugene
- Institute of Ecology and Evolution, University of Oregon, Eugene
| | | | - Mark C. Currey
- Institute of Ecology and Evolution, University of Oregon, Eugene
| | - Jorge Ramírez García
- Prevention Science Institute, University of Oregon, Eugene
- Oregon Research Institute, Eugene
| | - William A. Cresko
- Presidential Initiative in Data Science, University of Oregon, Eugene
- Institute of Ecology and Evolution, University of Oregon, Eugene
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene
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11
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Lamothe AS, Mikanagu R, Cloos P, Ridde V, Zinszer K. Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study. BMC Public Health 2022; 22:749. [PMID: 35422030 PMCID: PMC9008388 DOI: 10.1186/s12889-022-13163-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). METHODS Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. RESULTS Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. CONCLUSIONS These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada.
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada.
| | - Lara Gautier
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- Department of health management, evaluation and policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Camille Beaujoin
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Ashley Savard Lamothe
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Rachel Mikanagu
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Patrick Cloos
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- School of Social Work, University of Montréal, Montréal, Canada
| | - Valéry Ridde
- Centre Population et Développement, Institut de recherche pour le développement (IRD), Université de Paris, Paris, France
| | - Kate Zinszer
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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Petrova E, Farinholt T, Joshi TP, Moreno H, Al Mohajer M, Patel SM, Petrosino J, Anandasabapathy S. A Community-Based Management of COVID-19 in a Mobile Container Unit. Vaccines (Basel) 2021; 9:1362. [PMID: 34835293 PMCID: PMC8624920 DOI: 10.3390/vaccines9111362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection control and biological decontamination of the Smart Pod by testing surfaces and the air-filtration system for the COVID-19 virus and bacterial pathogens. We show the Smart Pod to be efficacious in providing a safe clinical environment for vaccine delivery. Moreover, in the Smart Pod, up-to-date education of community healthcare workers was provided to reduce vaccine hesitancy and improve COVID-19 vaccine uptake. The proposed solution has the potential to augment existing hospital capacity and combat the COVID-19 pandemic locally and globally.
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Affiliation(s)
- Elena Petrova
- Baylor Global Health, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Medicine—Gastroenterology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Timothy Farinholt
- Alkek Center for Metagenomics and Microbiome Research, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA; (T.F.); (H.M.); (J.P.)
| | - Tejas P. Joshi
- Baylor Global Health, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Hannah Moreno
- Alkek Center for Metagenomics and Microbiome Research, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA; (T.F.); (H.M.); (J.P.)
| | - Mayar Al Mohajer
- Department of Medicine—Infectious Disease, Baylor College of Medicine, Houston, TX 77030, USA; (M.A.M.); (S.M.P.)
| | - Shital M. Patel
- Department of Medicine—Infectious Disease, Baylor College of Medicine, Houston, TX 77030, USA; (M.A.M.); (S.M.P.)
| | - Joseph Petrosino
- Alkek Center for Metagenomics and Microbiome Research, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA; (T.F.); (H.M.); (J.P.)
| | - Sharmila Anandasabapathy
- Baylor Global Health, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Medicine—Gastroenterology, Baylor College of Medicine, Houston, TX 77030, USA
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