Historically, health disparities in the US are concentrated among underserved communitiesand socially vulnerable populations. The disproportionate COVID-19 related morbidity andmortality in communities of color and socioeconomic disadvantage acutely highlight thispersistent public health problem, drawing attention to the urgent need for more equitablereach of testing, prevention, and control measures. The proposed research addresses thisneed using a 2-arm randomized controlled trial (RCT) that will evaluate the effectivenessof the Nurse-Community Health Worker (CHW)-Family Partnership intervention in promotingCOVID-19 testing uptake, adoption of COVID control measures, and mutual aid capacity atthe household level in an underserved and vulnerable population disproportionatelyaffected by COVID-19. Enrolled households will be randomly assigned to either theintervention group where families will receive the Nurse-CHW-Family Partnershipintervention including the offer of in-home testing and referral to seasonal influenzavaccination services, or the treatment-as-usual control group, which will be used tomeasure actual testing rates among public housing residents in relation to participantand household characteristics. The study hypothesis is that the Nurse-CHW-FamilyPartnership intervention will improve household-level COVID-19 testing uptake, adoptionof COVID control measures, and mutual aid capacity relative to the treatment-as-usualcontrol.
The investigators will recruit and follow a randomly-chosen sample of NYCHA public
housing residents in the proposed target community who meet multiple criteria for being
considered vulnerable or underserved. The current study will address knowledge gaps
regarding COVID-19 testing, treatment, and household prevention strategies, and generate
new knowledge related to the epidemiology of COVID-19 in these communities. Working with
community partners, the investigators will create an acceptable and feasible intervention
and testing infrastructure in advance of the influenza season, with a view toward
designing best practices for sustainable COVID-19 testing, prevention, and preparedness
for vaccination trials. The investigators will implement a 2-arm RCT that will evaluate
the effectiveness of the Nurse-CHW-Family Partnership Intervention in promoting COVID
testing uptake, adoption of COVID control measures, and household mutual aid capacity.
The investigators will recruit members of randomly selected households in their homes
using area sampling methods used with excellent results in the investigators' previous
research in the target community. Participants will complete a baseline assessment and
the entire household will be randomized to either the experimental or a
treatment-as-usual control condition, which will be used to measure actual testing rates
among public housing residents in relation to participant and household characteristics.
The baseline sample will include 150 households, and 400 individual household members,
randomized in a 2:1 ratio, intervention:control. Families will complete follow-up
assessments at 6 and 9 months following the baseline. In-home testing and referral to
seasonal influenza vaccination services will be offered to the intervention group;
whereas the control group will receive treatment as usual at multiple NYC Department of
Health COVID-19 testing sites that are within walking distance of each of the three
housing complexes. Test acceptance will be recorded, and incentives will be paid for
study visits, not for testing.
Behavioral: Nurse-Community-Family Partnership Intervention
Nurses conduct home visits on a monthly basis for the first five months post-baseline.
During visits, nurses emphasize the importance of infection control measures and, jointly
with household members, develop and follow-up on the implementation of an infection
control plan tailored to the unique circumstances of the household. Nurses deliver
training on infection control skills necessary for optimal implementation of the plan.
Nurses offer at-home SARS-CoV-2 testing to all members of the household. Nurses conduct
triage, medical case management, monitoring, and follow-up of individuals identified to
have COVID-19 or any other acute health emergencies. CHWs conduct visits on a bi-weekly
basis for the first five months post-baseline. CHWs deliver healthcare information and
medical mistrust counseling in a culturally relevant and linguistically appropriate
fashion; and provide social support, navigate household members to social
welfare/vocational/economic/psychosocial services.
Inclusion Criteria:
- Residence in one of the public housing complexes in Mott Haven, South Bronx
- English or Spanish-speaking
- Age 10 years or older
- Willing and able to provide informed consent or assent
Exclusion Criteria:
- Non-resident of one of the public housing complexes in Mott Haven, South Bronx
- Neither English nor Spanish speaker
- Younger than 10 years old, unless household index case tests antigen positive. In
this instance, all members of family will be included.
- Unwilling or unable to provide informed consent or assent
New York University
New York, New York, United States