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Objectives: In the process of conducting research to understand barriers to colorectal cancer (CRC) screening in underrepresented groups such as Blacks and Hispanics, it became evident that there were also barriers to recruitment in this population. This study assesses the challenges faced in recruitment of focus group participants regarding CRC screening practices among underrepresented groups. Since the COVID-19 pandemic, qualitative research participants have primarily been interviewed through online video or audio interactions. However, as restrictions on in-person interactions have been lifted, in-person focus groups are being increasingly considered. Method(s): The study investigators began recruitment through community health workers in August 2022, when COVID-19 vaccines were available for all adults (age>18 years). Eligible individuals were: age 45-75, Black or Hispanic, with Medicaid or no insurance, and no family history of CRC or diagnosis of certain colon-related diseases. We combined in-person and virtual recruitment strategies, including posting flyers in communities, advertising our study at health fairs, and on social media. Participants would receive a $50 gift card. Result(s): Fifty-five met the eligibility criteria among 144 respondents, and 45 subjects (29 women and 16 men) agreed to be contacted. An average of 2.5 attempts were made per eligible subject. Unfortunately, we were able to recruit only four women (3 Hispanic and one non-Hispanic black). Traveling to the research site was a barrier to participation. Many subjects (49%) requested virtual participation (online video or audio interactions);some declined because the topic was too sensitive (considered taboo), and eligible men were reluctant to participate in-person. Conclusion(s): The requirement of in-person participation affected our recruitment goals, suggesting that COVID-19 has shifted the preferences of research participants to virtual interaction. In response to the eligible participant preferences, the study protocol has been revised to re-contact patients and schedule virtual FG sessions.Copyright © 2023
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Background: The Covid-19 pandemic has hit Western India hard, with Pune district reporting extremely high numbers of cases. During this time, the KEM Hospital Research Centre (KEMHRC), Pune undertook a study determining COVID-19 seropositivity within villages in the Pune district. Aim(s): To engage various stakeholders in establishing sentinel sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in the general population in rural Western India. Method(s): An extensive stakeholder engagement drive was undertaken to drive successful recruitment and implementation of our study. Between February 2021 and May 2021, we conducted 150 meetings with a range of community stakeholders including: village heads;nurses;community health workers and local government representatives, in open-aired community spaces. We advised community members on the purpose and significance of the study, clarified any concerns, and gathered and incorporated their inputs regarding study implementation. Result(s): The team built trust with local communities through these meetings with continued engagement during field work and data collection helping build rapport and create ownership of the study. KEMHRC successfully enrolled 14,500 individuals residing in 150 villages in Pune district. Conclusion(s): The feedback sharing process is important in ensuring that engagement with the community is not limited to a one-time activity but continuous. Training & supplying opportunities can also generate stakeholder engagement champions. Effective communication, active engagement are key elements for effective engagement in research.
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Background: The COVID-19 pandemic poses a threat to everyone, including the healthcare community. The increasing number of incidents against the healthcare providers engaged in COVID-19 response have been reported worldwide, to which India is no exception. India had taken a great initiative by passing the Epidemic Disease (Amendment) Ordinance 2020, to protect healthcare workers and personnel, the most important service providers in the critical time of COVID-19 pandemic. Purpose/objective: To analyze the various incidents of violence against healthcare professionals during the COVID-19 pandemic and to suggest strategies to mitigate this violence. Method(s): All the reported incidents of violence against health care workers or professionals by the print and online media (English) from all states of India, during March-June, 2020, were searched and analyzed. Result(s): We found 31 incidents of violence during this period from 13 states and union territories of India. Majority of these reported violence was in the community (74.2%), followed by hospital (19.4%) and quarantine facility (6.4%). Medical (17), paramedical (10), community health workers (4) and frontline health worker (1) were the target. The majority were verbal (87%) and psychological (13%) violence. We did not find any reported incident of violence in May-June 2020 as Epidemic Disease Ordinance, 2020 was promulgated on April 22, 2020. Conclusion(s): The multipronged approach with introduction of strict policy measures is a need of an hour to mitigate the violence against healthcare professionals. In order to ensure safety, there is also a need to provide right quantity and quality of personal protective equipment along with medical care.
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Objective: To share the implementing experience of the May Measure (MMM) campaign in Nepal. Design and Methods: Nepal has been a part of the MMM initiative since its inception. NeDS Nepal, a not-fort profit NGO was responsible for the overall coordination of the campaign. We trained and mobilized community health workers and health science students as volunteers. Although MMM was not executed globally due to the COVID-19 pandemic in 2020, it was conducted in Nepal by following safety measures. Results: The volunteers set up screening sites in supermarkets, temples, colleges, grocery stores, primary health care clinics, banks, government offices, and meeting halls. Some of the volunteers also did house-to-house visits. Between 2017-2021, we screened over 130,000 participants. We identified > 30,000 high blood pressure participants, provided lifestyle counseling, and referred them to the health facility for further diagnosis and treatment. Out of them, ∼18000 were newly identified hypertension. Conclusions: Opportunistic screening like MMM is feasible and needed in the context of Nepal. This could potentially be embedded in the national screening program. It is also important to have a strategy for linking the patients with the health system for further diagnosis and treatment.
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PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHOD(S): We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator;and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test;2) completed test. Results by intervention will be assessed at 12 months. RESULT(S): Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients "engaged" with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening.
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Introductory sentence about purpose of the study: The PRECISE study tests the effectiveness of a targeted patient navigation program for follow-up colonoscopy after abnormal fecal testing in community health centers. We present adaptations of the patient navigation program resulting from the impact of the COVID-19 pandemic. Brief description of pertinent experimental procedures: Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after an abnormal FIT result to prevent CRC or find it in early, treatable forms. Unfortunately, almost half of patients with an abnormal FIT result fail to complete this essential screening component. Patient navigation can provide needed support for patients to complete a follow-up colonoscopy. PRECISE is a collaboration with a large community health center whose patient population is 37% Latino. Eligible patients were aged 50-75, had an abnormal FIT result in the past month, and were due for a follow-up colonoscopy. Patients were randomized to patient navigation or usual care. Patient navigation was delivered by a bilingual (English and Spanish) patient navigator using a six-topic phone-based protocol, adapted from the New Hampshire Colorectal Cancer Screening Program. Summary of new, unpublished data: A total of 985 patients were enrolled in the PRECISE study, 489 randomized to the intervention arm and 496 to the control arm. Due to the COVID-19 pandemic, we made adaptations to the navigator training program and navigation delivery. We converted our in-person training program to a virtual navigation training series combining pre-recorded videos and live webinars. Additionally, we strengthened relationships with GI practices to expedite referrals, improve scheduling processes, and better understand COVID-related policy changes including the conversion of some preprocedure consultations to a phone-based platform and COVID-19 testing requirements prior to the colonoscopy. Finally, we adapted patient navigator messages to address fear and anxiety about getting medical care during the peak COVID-19 pandemic. Preliminary patient navigation outcomes will be available in September 2022. Statement of conclusions: This innovative clinical trial highlights the importance of patient navigation to improve CRC screening in community health centers. Rapid response to COVID-19 provided the opportunity to adapt our navigator program for a virtual setting allowing for 1) the sustainability of patient navigation during the pandemic and 2) the broadening of training resources for patient navigators and community health workers.
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Background. Black Americans have been disproportionately impacted by COVID-19, with systemic inequities contributing to increased incidence and mortality. In Chicago, access to COVID-19 testing was scarce in many predominantly Black neighborhoods early in the pandemic, exacerbating inequities. We aimed to assess uptake and yield of a COVID-19 testing campaign to increase access in high-risk, underserved Chicago communities. Methods. The Alive Church Network (ACN) is a community-driven coalition of Black pastors and public health researchers developed to address health inequities in Chicago. For this initiative, ACN implemented two strategies to improve access to COVID-19 testing in underserved neighborhoods: 1) church-based testing, with nurses and community health workers (CHWs) stationed in churches to perform PCR testing for community members and church staff (Dec 2020-Dec 2021) and 2) community site testing, with nurses and CHWs deployed to 8 local sites (e.g., Salvation Army) to conduct weekly PCR testing for employees and clients (May 2021-Mar 2022). We assessed characteristics of individuals undergoing testing;symptom and exposure history;and COVID-19 positivity. In addition, we compared positivity for ACN sites with Chicago citywide positivity over time. Results. A total of 3420 tests were performed for 1703 individuals. Of those tested, 931 (54.7%) were tested at churches and 772 (45.3%) were tested at community partner sites. Those presenting to churches were older (mean 44.8 vs. 39.1 years), more likely to be female (56.5% vs. 48.5%), and more likely to have a chronic medical condition (37.1% vs. 22.5%, Table). Prevalence of COVID-19 symptoms and exposure history were similar for those presenting to church and community sites (Table). Overall, ACN test positivity was similar to Chicago citywide positivity;however, ACN test positivity was much higher during the Omicron surge (24% vs. 11%, Figure). Characteristics of individuals tested for COVID-19 at church and community sites COVID-19 test positivity, ACN sites vs. Chicago citywide Conclusion. The ACN testing campaign increased access to COVID-19 testing in underserved neighborhoods in Chicago and had high yield during the Omicron surge. Church-based testing was successful for reaching older, medically vulnerable individuals. Ensuring widespread access to testing is essential for health equity and to reduce COVID-19 morbidity and mortality.
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Objective: To evaluate the impact of a community-based intervention on perinatal mental health in an urban population during the COVID-19 pandemic Study Design: We performed a prospective cohort study of pregnant and postpartum individuals referred to a new community-based intervention, Helping Us Grow Stronger (HUGS/Abrazos). Participants received four virtual acute behavioral health sessions from a cognitive behavioral therapy (CBT) and trauma-informed care trained social worker, four resource navigation visits with a community health worker, and a care package. Participants completed validated survey instruments assessing mood, anxiety, stress, food insecurity, experience of discrimination, and program satisfaction before and after program completion. Result(s): 103 participants (Table) completed surveys before and after the program. In this urban obstetric population, there were high rates of food insecurity (54%), experiences of discrimination (61%), and COVID-19 infection in pregnancy (62%). Program satisfaction was high (Table). The program was associated with improvement in Edinburgh Postnatal Depression (EPDS) scores (mean 8.3 pre-HUGS vs 6.7 +-5.6 post, p=0.001), with significant reduction in those screened positive for depression (46/103 pre- vs 31/103 post, p< 0.001);improvement in Perceived Stress Scale (PSS) scores (mean 15.4 +- 8.0 (SD) pre vs 13.5+- 7.1 post, p=0.003) with significant reduction in those with moderate or high stress (56/103 pre vs 49/103 post, p< 0.001);and reduction in those screened positive on the PROMIS anxiety scale (46/103 pre vs 40/103 post, p< 0.001). In stratified analyses (Figure), food insecurity, COVID-19 in pregnancy, and experiences of discrimination were associated with improvement in PSS scores and PROMIS anxiety score. Conclusion(s): In a diverse urban cohort, this novel community-based intervention led to improvement in depression, perceived stress, and anxiety, particularly for those with toxic life stressors in pregnancy including food insecurity, discrimination, and COVID-19 infection. [Formula presented] [Formula presented] Copyright © 2022
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Background: Given the ongoing spread of COVID-19 and relatively low uptake of vaccines in Tanzania, there is an opportunity to develop strategies for gathering community input to inform public health responses to disease outbreaks, and vaccine deployment strategies. Objective(s): To provide evidence about COVID-19 to response teams through integration of social science methods in the community engagement strategy to strengthen preventive and control interventions and vaccine deployment in Tanzania. The objectives are: 1) To document knowledge, beliefs, rumours, and discussions related to COVID-19, prevention and control measures, vaccines, and vaccine deployment 2) To identify information that needs action by the COVID-19 response teams at district and national levels 3) To examine the effectiveness of using community health workers in collecting evidence to inform epidemic response teams Methodology: This project trained 22 CHWs in Dar es Salaam, Pwani and Kigoma Regions in social science methods and research ethics. The CHWs then documented the challenges, rumours, beliefs, (mis)information, feelings/emotions, and intentions of community members in their jurisdictions during their routine daily work in health promotion for COVID-19 vaccines. We also conducted semi-structured interviews with village, district, regional and national leaders and health officials on their experience working in COVID-19 vaccine deployment. Result(s): Analysis using the WHO Determinants of Vaccine Hesitancy Matrix showed that while hesitancy in various Tanzanian communities is linked to broader historical and socio-political narratives (e.g., colonialism, racism, national politics), hesitancy around COVID-19 vaccines is overwhelmingly vaccine-specific and confidence in routine vaccinations appears to remain high. Community members, leaders and CHWs themselves have doubts and questions about vaccine safety and efficacy. Conclusions and recommendations: There is an opportunity to implement education campaigns around COVID-19 vaccines that are directly responsive to documented doubts and questions to build vaccine confidence in Tanzania.
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BACKGROUND: Due to the novel nature of COVID-19, management strategies are poorly understood by most primary care providers (PCPs), especially in the low-and middle-income countries (LMICs) of the world. If the knowledge of PCPs concerning COVID-19 is enhanced, awareness, perception, and attitude toward patient care will improve. Consequently, maximum prevention and control will be achieved. AIM: This study aims at assessing the awareness, knowledge, and willingness of the PCPs to care for COVID-19 patients in Calabar, Nigeria. METHOD(S): A cross-sectional descriptive study was used to evaluate 1126 PCPs (doctors, nurses, and community health officers) actively working in government primary, secondary, and tertiary health-care facilities in Calabar, Nigeria. A total population sampling method was employed and a validated, semi-structured, 33-item questionnaire was used to explore the objectives of the study. RESULT(S): Majority (99.4%) of the study participants were aware of COVID-19. Most (68.4%) information regarding COVID-19 came from the social media. Bonferroni post hoc test of multiple comparisons revealed that the knowledge score for PCPs in tertiary (11.2 +/- 8) was significantly higher compared to those in secondary (10.6 +/- 1.6) and primary levels of care (10.7 +/- 1.7). Approximately 55.3% of the participants did not want to be involved in the management of COVID-19 patients. CONCLUSION(S): There is the need to focus and intensify training of the PCPs working at the primary and secondary levels of care to increase their awareness, knowledge base, willingness to care for patients and eventually reduce morbidity and mortality associated with COVID-19 in the study setting. Copyright © 2022, Scientific Foundation SPIROSKI. All rights reserved.
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Introduction/ Background: This paper describes the role of Community Health Workers (CHWs) in COVID 19 Response based on the lesson learned from the Partnership for Accelerated COVID-19 Testing (PACT) Initiative implemented by the African Centers for Disease Control and Prevention. Methods: The study is based on field experience and lesson learned from PACT initiative implementation. We analyzed 15 months field reports from PACT supported CHWs who were locally recruited, trained and deployed to support COVID 19 response across 28 African Countries for the period of August 2020 to October 2021. Bi-weekly field reports were received from 28 African countries implementing PACT Initiative and all the countries implementing the initiative were included in the analysis. Over 50 field reports were analyzed using excel. Results: Over 20500 CHWs were trained, deployed and supported with working tools. The deployed CHWs visited over 2.7 million households for community engagement activities, active case search, and contact tracing. They identified over 1.6 million contacts, 941,031 suspect cases and facilitated testing referrals for 571,197 (61%) of suspect cases. The deployed CHWs were also key in Community engagement activities to promote COVID 19 vaccine uptake. Challenges includes low recognition of CHWs, inadequate coordination, insufficient financing and sustainability. Impact: The deployed CHWs were critical in supporting surveillance activities in COVID 19 response including Contact tracing, active case search, Risk communication and community engagement activities to create awareness and promote vaccine uptake. Conclusion: Community health workers represent a crucial asset of African States health system and offers a critical part of human resource for health, when capacitated can offer a range of preventive, promotive and curative health services. There is urgent need for further action to support countryled community health strategies.
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Introduction/ Background: Rapid, scalable point-of-care COVID-19 testing at community-level may hold the key towards diagnosis and control in resource-limited settings. Our initial door-to-door symptom-based strategy yielded low COVID-19 cases. We therefore investigated COVID19 case detection using a strategy of community hubs in a peri-urban community (~27,000) with high TB/HIV prevalence in Zambia. Methods: COVID19 screening was delivered using “community hubs”, walk-in testing locations staffed by 2 Community Health Workers serving 3000 to 4000 people. Between May-October 2021 4 hubs were operated in high-risk transmission hotspots changing location weekly. All persons attending the hubs were offered COVID-19 testing (Panbio-AgRDT and a PCR (Cepheid-Xpert-Xpress TM or VitaPCRTM RT-PCR assay (Credo Diagnostics Biomedical, Singapore), depending on availability) and symptoms screening;TB/HIV screening and testing;counselling and linkage to routine care. Qualitative methods included: mystery shoppers, focus group discussions with different groups and observations. Results: Over 6 months, 2956 people were screened at the hubs, 1724 (58%) males with median age 30 years. Prevalence of COVID19 suggestive symptoms was 18.3% (540/2956). A total of 2938 antigen tests were done and 168 (5.7%) were positive. For PCR testing, by Xpert Xpress 370/1270 (29.1%) were positive and 113/951 (11.9%) by VitaPCR;157 (5.3%) were positive on both. Test positivity was strongly associated with being symptomatic (p<0.001). Antigen test positivity rate was 1.6% in asymptomatic versus 24.2% in symptomatic;for Xpert-Xpress 20.6% versus 46.5% and for Vita PCR 4.2% versus 30.4% respectively. Qualitative results are available. Impact: This study aims to generate and evaluate models of community-based COVID-19 services to improve the trace-screen-test- isolate cascade and management by overcoming barriers, reducing stigma, and enabling communities to access rapid-testing. Rapid dissemination of key findings will mitigate the impact of the SARS-CoV2 epidemic and to help increase the knowledge. Conclusion: Delivering COVID-19 case-finding using mobile community hubs is feasible and acceptable and contributed towards the district and national COVID19 response in Zambia. Symptomatic persons have a significant higher chance of being detected with SARS-COV-2.
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Introduction/ Background: Health systems in sub-Saharan Africa are strained by communicable diseases, non-communicable diseases, and emerging diseases of pandemic potential. COVID-19 illustrated how shocks disrupt healthcare delivery. To understand factors of health systems resilience, we assessed maintenance of essential health services (EHS) in Uganda, Nigeria, Senegal, and the Democratic Republic of Congo. Methods: Mixed methods were used, including literature review, analysis of routine service data and key informant interviews (KIIs). Indicators including DPT3 coverage, general adult outpatient (OPD) attendance, and diabetes were assessed in 2020 (during the pandemic) and 2019 (baseline) using data from the DHIS2. KIIs were conducted to document EHS maintenance strategies and lessons learned. Key informants included national level policy makers (national task forces and EHS maintenance committee members), regional-level health service directors, district health officers, health facility staff and community health workers. Results: Monthly vaccine disruption ratios for DPT3 remained stable in DRC, but dropped in Uganda (0.7) and Nigeria (0.78), reverting to normal after 1 and 5 months respectively. In Senegal DPT3 dropped (0.65) moderate recovery starting May 2020. In Uganda, OPD visits decreased 10%-22% in three of four geographical regions and increased in one region, diabetes visits decreased by 23% in two regions. EHS maintenance strategies included telemedicine, multi-month drug dispensing, and expanded use of community health workers (CHW). Challenges to maintain EHS included poor dissemination of guidelines across health system levels, poor financing of interventions, and limited tracking of EHS. Impact: These findings highlight gaps in health system resilience with disruptions in essential health service delivery during the COVID-19 pandemic in Africa, and the strategies implemented by countries to mitigate the disruptions. These lessons are important for health systems strengthening and future pandemic preparedness and response. Conclusion: EHS maintenance can be improved through integration into pandemic preparedness and response policies and strengthened data analysis to detect service disruptions. Strategies to mitigate service disruptions such as telemedicine, multimonth drug refills, and community drug distribution via CHWs should be implemented and monitored at the national and subnational levels.
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Introduction/ Background: Community Health Workers (CHWs) have been a cornerstone of health delivery across the globe for over a century. Unfortunately, this vital cadre is often not counted: information on numbers and location of active CHWs is frequently unavailable and/or inaccurate. This undermines health system planning and impedes CHWs' provision of care. Methods: A functional and institutionalized national georeferenced CHW master list (CHWML) closes these gaps. This document was drafted in response to the urgent need to count and identify CHWs as part of the COVID-19 response. It was a collaborative effort by the Clinton Health Access Initiative (CHAI), Community Health Impact Coalition (CHIC), Global Fund, Living Goods, Health GeoLab Collaborative (HGLC), and UNICEF. More than 50 organizations provided technical review, including Africa CDC, USAID and WHO. Representatives from the ministries of health of Ethiopia, Kenya, Mali, Rwanda, Uganda, Sierra Leone, Togo and Zambia inputted their technical expertise and ongoing needs. Results: A CHWML is a single source of truth containing the data elements required to uniquely identify, effectively describe, enumerate, locate, and contact all CHWs in a country. This guidance was developed to support national governments and their technical/financial partners to develop functional, continuously maintained, shared, and institutionalized CHWML hosted in a national registry. It describes a 7-step process for generating, sharing, and maintaining the CHWML in a registry. Each step includes a decision checklist and key considerations for implementation. The guidance also includes a 3-stage maturity continuum, five candid national-level experiences implementing CHWMLs, and practical resources to aid in operationalization. Impact: Accurate, up-to-date, reliable data on CHWs, which captures their location, qualifications and activities, is critical for strategic decision-making. Hosted and kept up to date in a CHWML, these data are vital not only to support existing CHWs, but to identify and close coverage gaps in pursuit of universal health coverage. Conclusion: While one-off georeferenced censuses of CHWs may be effective for establishing a baseline, it is only a first step toward establishing a functional and institutionalized CHWML. Investing in the development and use of a CHWMLs is a fundamental step in maximizing the impact, efficiency, and equity of health service delivery.
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Background: The Hispanic community in the United States has been disproportionately affected by COVID-19. LATIN-19 is an interdisciplinary, multisector coalition formed in March of 2020 and uses innovative approaches to address health disparities in the Hispanic community in North Carolina. One important strategy has been to sponsor vaccination events in partnership with community organizations. We aim to 1) describe the key components of vaccination strategies led by LATIN-19 and 2) evaluate the impact of these strategies on vaccination uptake on the Hispanic community in Durham County, NC. Methods: LATIN-19 partnered with the largest local health system in Durham County to allow Spanish-speaking community health workers to directly register community members at its regular vaccination site. Additionally, from February to June 2021, LATIN-19 organized and participated in multiple vaccination events targeted toward Hispanic communities. Specific engagement strategies included: having known community organizations and leaders reach out to residents directly to inform them about the event and schedule their appointments. Spanish-speaking staff were recruited to work as greeters, vaccinators, observers, and support staff. A quasi-experimental design was used to compare vaccine rates among Hispanic individuals in Durham County compared to two matched communities in North Carolina. Vaccination rates in those 3 different counties from January to June 2021 were reviewed, with % Hispanic residents noted for each one: Durham (12.9 %), Mecklenburg (12.1%), Forsyth (13%). All three counties are urban, and each have a large medical center. LATIN-19 is based in Durham. There was no known similar community coalition-based targeted outreach done in either Mecklenburg or Forsyth. Vaccine rates in Durham were also compared to other racial and ethnic groups in the county. The North Carolina Department of Health and Human Services (NCDHHS) vaccination dashboard reports rates of vaccination by county and includes age, race, and ethnicity qualifiers. Data from the dashboard were reviewed from January to June 2021 to quantify vaccination rates. Results: Vaccination rates among all residents show a sustained upward trend in all three counties for the entire six months. (Table 1). Higher total rates of vaccination among Hispanic residents were noted in Durham County compared to the others. The largest increase in Durham County (15%) occurred from March to April, which corresponds with the beginning of LATIN-19 interventions. Vaccine uptake rates among non-Hispanic, white, and black residents in Durham County appear to plateau from March to June 2021, while they continue to increase among Hispanic residents. Conclusion: Vaccination rates among Hispanic residents in Durham County are higher than in two other matched communities in North Carolina. Innovative coalitions like LATIN-19 can be a successful component of efforts to improve vaccination rates in Hispanic communities. This model can be reproduced and adapted in other counties in North Carolina and in other states. (Table Presented).
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STATEMENT OF PROBLEM/QUESTION: When COVID-19 vaccine notification and scheduling is largely driven by patient portals, how can clinics and health systems ensure that vaccine distribution is equitable? DESCRIPTION OF PROGRAM/INTERVENTION: The COVID-19 pandemic has disproportionately impacted minority communities, evidenced by higher rates of infection, hospitalization, and mortality. Elderly, minority, and socially vulnerable populations are less likely to enroll in patient portals. Our urban academic General Internal Medicine (GIM) practice serves a high proportion of Black and socially vulnerable patients. For patients 65 and older in our clinic, significant disparities exist in patient portal access between white and Black patients (85.3% versus 35.3%) and those living in high versus low social vulnerability zip codes (45.3% versus 82.1%). The larger health system deployed a method of patient outreach largely driven by patient portal notification and scheduling. Our GIM practice mobilized community health workers and students to engage in telephonic outreach to patients aged 65 and older without patient portal access. Our team provided outreach to 1575 GIM clinic patients from February 5 to March 10, 2021. During that time, 903 GIM patients completed their first dose of the COVID-19 vaccine;51.9% had been contacted through our outreach. MEASURES OF SUCCESS: A pre-post analysis of demographics of patients receiving vaccination from the GIM clinic was completed to understand rates of vaccination by race/ethnicity, social vulnerability, and portal access with a sub-analysis of those who received outreach. A more robust comparative analysis is being completed to understand the impact compared to other health system internal medicine clinics where additional outreach was not completed to understand differences in relation to race/ethnicity, social vulnerability, and portal access. This analysis will be available by the time of presentation. FINDINGS TO DATE: Compared to the first week of vaccine availability when no outreach was conducted, the intervention resulted in significant increases in the vaccination rates among vulnerable populations. After 4 weeks of telephone outreach, the proportion of vaccine recipients who were nonHispanic Black increased from 7.1% to 43%, the proportion with inactive EMR status increased from 2.8% to 36.4%, and the proportion from high social vulnerability zip codes increased from 13.9% to 44.7%. For the subset of patients for which outreach resulted in vaccination, 65% were Black, 69.9% had an inactive EMR, and 64.2% lived in a high social vulnerability zip code. KEY LESSONS FOR DISSEMINATION: This intervention has shown that a telephonic outreach program targeting elderly individuals without patient portal access can measurably improve not only access to vaccine for those without patient portals but equity in COVID-19 vaccine access for Black and socially vulnerable communities. This type of population management strategy will be important to ensure equity in access to not only vaccines but other preventative services for vulnerable communities.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION: We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS: This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE: The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories: 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION: This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic highlights the disproportionate burden of disease on communities made vulnerable by structural inequities. The pandemic has increased economic hardship, including housing instability, food insecurity and ability to pay bills. Hospitalization for COVID-19 is an opportunity to address unmet healthrelated social needs (HRSNs) and connect patients with community resources. DESCRIPTION OF PROGRAM/INTERVENTION: Community health workers (CHWs) play a critical role in response to public health crises. To address the inequitable burden of COVID-19 on Austin's Latinx population, we implemented a pilot program at an academic hospital where a CHW helps patients navigate care transitions and address unmet HRSNs. The care team referred patients with COVID-19 to the CHW, who met with patients to establish rapport, provide language-concordant communication between the care team and patient/family, deliver health promotion education, and assess HRSNs. MEASURES OF SUCCESS: This includes three typical cases describing key components of the CHW pilot program. CHWs connected patients and families to community resources and facilitated discharge planning and connection with primary care providers. The CHWs continued to follow patients for at least 45 days after discharge to assist with care coordination. We provide qualitative data from patients and healthcare professionals. FINDINGS TO DATE: Patient 1 is a 38-year-old day laborer with hypertension hospitalized with COVID-19 pneumonia. His family of four is undocumented and faced economic insecurity due to loss of work from the pandemic. The CHW assisted with utilities, bills, food and rent through coordination with local organizations to provide direct financial assistance to the family. Patient 2 is a 45-year-old woman with diabetes hospitalized with COVID-19 pneumonia. She is a mother of three children, two with disabilities. In addition to financial insecurity, she identified transportation as a primary HRSN. The CHW arranged financial resources to fix their car, which allowed the family to access school and clinic resources. Patient 3 is a 36-year-old man hospitalized with COVID-19 pneumonia. The CHW connected the family, including three children, with their school social worker, enabling access to financial support for utilities, food and clothes. The CHW arranged free food delivery to their home for four months. The CHW also secured county-based indigent care coverage for the patient, enabling hospital follow-up with a primary care provider. The patient's wife noted, because of the CHW, “We never felt alone” and now feel “capable of navigating a health system that we never felt we had access to.” KEY LESSONS FOR DISSEMINATION: CHWs, as patient advocates and skilled care navigators, build trust, establish longitudinal relationships with patients and address unmet HRSNs that can enable successful care transitions. CHWs can alleviate the disproportionate burden of COVID-19 on individuals with unmet HRSNs. Supporting the work of CHWs within hospital care teams can improve care transitions.