>> WELCOME, EVERYONE.
I'M WITH THE RADX-UP CDC
POPULATION.
AND IT'S GREAT TO WELCOME YOU
HERE TO OUR 2023 RADX-UP
SCIENTIFIC MEETING.
FOR THIS ZOOM, WE WILL BE USING
BREAKOUT ROOMS FOR CONCURRENT
SESSIONS WHEN WE GET TO THAT
POINT.
AND PLEASE FEEL FREE TO POSE
YOUR QUESTIONS IN CHAT.
I'M LOOKING FORWARD TO HEARING
YOUR COMMENTS.
SORRY ABOUT THAT.
THERE WE GO.
AND SO, THIS REALLY IS RADx
FOR UNDER SERVED POPULATIONS.
GROUNDBREAKING PROGRAM CREATED
BY THE NATIONAL INSTITUTES OF
HEALTH IN RESPONSE TO THE
COVID-19 PANDEMIC.
THE NATIONAL INSTITUTES OF
HEALTH WANTED TO ENSURE ALL
AMERICANS HAVE ACCESS TO
COVID-19 TESTING AND SO THEY
FUNDED 138 DIFFERENT PROJECTS
ACROSS THE UNITED STATES IN THE
U.S. TERRITORIES AND TRIBAL
NATIONS.
THE RESEARCH TEAMS AND THE
PEOPLE MOST ASSOCIATED WITH THE
PANDEMIC, IMPROVING THEIR ACCESS
TO COVID-19 TESTING AND LEARNING
WHAT WORKS BEST TO RESPOND TO
THEIR NEEDS.
AND ON BEHALF OF THE CDCC, LET
ME THANKS OUR NIH LEADERS,
PROGRAM OFFICERS AND PROGRAM
SCIENTISTS FOR SUPPORT AND
GUIDANCE THEY HAVE GIVEN TO US
AS WE CARRIED OUT THE RESEARCH.
WE HAVE 138 COVID-19 PROJECTS.
232 COMMUNITY-ENGAGEMENT
RESOURCES THAT ARE AVAILABLE ON
THE RADX-UP.ORG WEBSITE.
WE HAVE 110 PROJECTS SUBMITTING
DATA TO THE CDCC.
WE HAVE MORE THAN 3 UN72,000
ENROLLED PARTICIPANTS.
WE HAVE MORE THAN 424,000 TESTS
THAT HAVE BEEN BEEN THROUGH
RADx FOR UNDER SERVED
POPULATIONS.
WE HAVE 199 PUBLIC RESEARCH
ARTICLES AND 6 WRITING TEAMS FOR
INITIATIVES AND WE HAVE 55
COMMUNITY COLLABORATION
MINIGRANTS.
AND ALL THE TEAMS AND GRANT
RECIPIENTS ARE THROUGH NIH
RADx UNDER SERVED POPULATIONS
DATA ON IT.
AND THAT PROVIDES A STANDARD SET
OF STUDY QUESTIONS FOR COVID-19
TESTING STUDIES.
IT ALLOWS THE CONSORTIUM TO
EDUCATE ALL THE POPULATIONS WE
ARE WORKING IN AND THE
COMMUNITIES OF STUDY TODAY WE
WILL HEAR ABOUT A NUMBER OF
RESEARCH PROJECTS THROUGH THE
COMMUNITY.
THIS YEAR WE RECEIVED 38
PROPOSALS FROM PROJECT TEAMS TO
PRESENT AT THE SCIENTIFIC
MEETING.
WE SELECTED 16 PROJECTS THAT
WILL SHARE THEIR WORK TODAY AS
YOU CAN SEE ON THE MAP, THE
PROJECTS REPRESENT THE WIDE
DIVERSITY OF COMMUNITIES ACROSS
THE COUNTRY.
THEY WILL BE SHARING HIGHLIGHTS
THROUGH SHORT POSTER SESSIONS.
THE THEME OF TODAY'S MEETING,
NEXT SLIDE, PLEASE.
IS ENGAGING COMMUNITIES WITH
ADVANCED HEALTH EQUITIES.
THANK YOU FOR JOINING US TODAY.
WE ARE EAGER TO APPROACH
COMMUNITY ENGAGEMENT.
WE WILL HAVE BILINGUAL
PRESENTATIONS.
FOR THOSE WHO ARE INTERESTED IN
ATTENDING AND GIVING US FEEDBACK
ON HOW THOSE SESSIONS WORK, I
APPRECIATE THAT.
WE WILL HEAR A DIVERSE SET OF
PERSPECTIVES AND INSIGHTS.
I WANT TO THANK MAGDALENE
WELLMAN FROM THE COMMUNITY
CAMPUS PARTNERSHIP FOR HEALTH
FOR BEING OUR MC TODAY.
SHE'LL GUIDE US THROUGH OUR
SESSIONS AND INDIVIDUAL PROJECT
PRESENTATIONS.
THANK YOU FOR BEING HERE FOR
RADX-UP SCIENTIFIC MEETING.
WE LOOK FORWARD SHARING AND
LEARNING DAY TODAY.
AND I LOOK FORWARD TO HEARING
FROM ALL OF YOU.
>> THANK YOU.
WELCOME WE ARE EXCITED TO HAVE
YOU.
I'M MAGDALENE WELLMAN, A PROGRAM
MANAGER WITH COMMUNITY CAMPUS
PARTNERSHIPS FOR HEALTH.
AND I WILL BE SERVING AS YOUR
MEETING HOST TODAY.
SO REALLY QUICK BEFORE WE JUMP
INTO OUR CONCURRENT BREAKOUTS, I
WANTED TO GO OVER A FEW
HOUSEKEEPING THINGS.
SO ONE, THIS IS A ZOOM SESSION.
SO WE'LL BE USING BREAKOUT ROOMS
FOR CONCURRENT SESSIONS AND ALSO
LATER ON FOR THE POSTER SESSION.
BUT WE ASK THAT ALL ATTENDEES
PLEASE KEEP YOUR MICROPHONES
MUTED UNLESS YOU'RE SPEAKING.
WE WILL PROVIDE OPPORTUNITIES TO
ASK QUESTIONS AT THE END OF EACH
PRESENTATION FEEL FREE TO PUT
YOUR QUESTIONS IN THE CHAT AND I
AND THE TEAM WILL TRY TO MAKE
SURE THAT WE GET TO YOUR
QUESTION.
IF YOU HAVE ANY TECHNICAL ISSUES
OR YOU JUST HAVE ANY GENERAL
QUESTIONS ABOUT RADX-UP, PLEASE
FEEL FREE TO USE THE CHAT TO
ALERT OUR TEAM AND SOMEONE WILL
HELP YOU.
ALL RIGHT, SO I'M EXCITED TO GET
OUR MEETING STARTED.
WE ARE GOING TO START WITH
CONCURRENT SESSIONS.
THE FIRST WILL FOCUS ON IMPACTS
OF COMMUNITY PARTNER RESEARCH
AND THE SCIENTIFIC PROCESS BEING
LED BY ONE OF OUR WORKING
GROUPS, SOCIAL, ETHICAL AND
BEHAVIOR WORKING GROUPS IF
YOU'RE INTERESTED IN THIS
SESSION, STAY IN THE MAIN ROOM.
OUR SECOND SESSION IS IMPACT OF
COVID-19 AMONG SCHOOL
POPULATIONS.
AND IF YOU'RE INTERESTED IN THAT
SESSION, THEN YOU CAN SELECT
BREAKOUT ROOM 2 - EYE BELIEVE IT
IS STILL BREAKOUT ROOM 2, AND
THAT SESSION IS BEING LED BY OUR
SCHOOL DIAGNOSTIC TESTING
INITIATIVE PROJECTS.
SO, WE WILL BE IN BREAKOUT ROOMS
FOR APPROXIMATELY 35 MINUTES.
YOU WILL CHOOSE THE ROOM OF YOUR
CHOICE AND THEN AT THE END,
YOU'LL COME BACK TO THE MAIN
BREAKOUT ROOM AND WE WILL START
WITH OUR PROJECT PRESENTATIONS
AT THAT TIME.
SO GO AHEAD AND CHOOSE THE ROOM
YOU WOULD LIKE TO JOIN AND I
WILL SEE YOU WHEN YOU RETURN.
>> GOOD AFTERNOON, EVERYBODY.
THANK YOU FOR JOINING US TODAY.
I'M A SOCIAL EPIDEMIOLOGIST AT
EASTERN VIRGINIA MEDICAL SCHOOL
IN NORFOLK, VIRGINIA.
TODAY I'M REPRESENTING THE STUDY
FOR SOCIAL,ECT CALL AND
BEHAVIORAL COHORT WHICH I
CO-CHAIR.
ONE OF OUR GOALS IS TO BUILD
DIALOGUES BETWEEN COMMUNITY
MEMBERS AND RESEARCHERS AROUND
ETHICAL CONCERNS RELATED TO THE
COVID-19 RESPONSE.
WE HEAR THAT LOTS OF PROJECTS
HAVE HAD CONCERNS ABOUT WHETHER
THEY HAVE BEEN ABLE TO LIVE UP
TO WHAT THEY FEEL ARE THEIR
OBLIGATIONS THAT ARE COMMUNITY
PARTNERS.
OUR GOAL ASK TO HAVE A
CONVERSATION ABOUT THAT.
WE WANTED TO MAKE SURE WE
PRIORITIZE OUR PARTNER VOICES
AND HAVE INVITED FOLKS FROM
SEVERAL PROJECTS WITH THE
WORKING GROUP TO DISCUSS HOW WE
DO COMMUNITY ENGAGEMENT.
SO THANKS TO OUR PANEL MEMBERS
FOR JOINING US.
WE HAVE SEVERAL QUESTIONS
PREPARED ON OUR END TO START
WITH WHO ARE REALLY ALSO
INTERESTED IN HEARING WHAT
QUESTIONS THE AUDIENCE MIGHT
HAVE.
SO PLEASE FEEL FREE TO ASK THOSE
IN THE CHAT.
SO TO START, I'M GOING ASK OUR
PANELISTS TO INTRODUCE
THEMSELVES BY STATING THEIR
NAME, THEIR ROLE ON THE PROJECT
THEY ARE WORKING ON, INCLUDING
ANY ORGANIZATIONS THEY REPRES
REPRESENT, AND THE COMMUNITY
ENGAGEMENT.
ANYBODY LIKE TO JUMP IN JAVIER,
WOULD YOU LIKED TO --
>> THANK YOU.
I'M JAVIER GARCIA, I'M WITH THE
REACH OUT.
I'M A COMMUNITY COLLECTOR AND
DATA COLLECTOR AND I WORK FOR 24
YEARS FOR THEM.
AND I WORK WITH THE URBAN LATINX
COMMUNITY.
>> THE GREAT.
THANK YOU.
AND WE'LL GO IN ORDER ON THE
SLIDE HERE.
SO DEBARA?
>> WE'LL GIVE DEBRA A MOMENT TO
UNMUTE HERSELF.
GLEEN ARE YOU THERE?
>> YES, I'M HERE.
MY NAME IS GLEEN TURNER.
I'M HERE IN RICHMOND VIRGINIA
AREA.
I DON'T KNOW -- SORRY.
>> NO WORRIES AT ALL.
THANK YOU, SIR.
DEBRA?
>> GOOD AFTERNOON.
MY NAME IS DEBRA GRANT.
AND I AM ON THE HOUSING
COLLABORATIVE COMMUNITY ADVISORY
BOARD AND I LIVE IN VIRGINIA
BEACH.
AND I REPRESENT OUR COMMUNITY OF
VIRGINIA BEACH.
>> THANK YOU, MA'AM.
MARGUERITE?
ARE YOU THERE MARGUERITE?
WILL YOU INTRODUCE YOURSELF,
PLEASE.
I'M MARGUERITE EDMONGS AND I'M
ALSO ON THE HOUSING
COLLABORATIVE ADVISORY BOARD.
I REPRESENT THE CITY OF NEWPORT
NEWS REDEVELOPMENT AND HOUSING
AUTHORITY WHERE I HAVE BEEN IN
THE ROLE AS COUNCIL PRESIDENT.
>> THANK YOU, MA'AM.
AND EDNY, ARE YOU THERE?
>> CAN YOU HEAR ME?
>> YES WE CAN.
>> SO I'M EDNY GONZALEZ AND I
WORK WITH THE PROJECT THAT IS IT
A TEAM OF COMMUNITY HEALTH
WORKERS WHO DID THE COVID
TESTING ON SITE.
>> THANK YOU.
AND TINA?
>> HI, GOOD MORNING.
IT'S 7:00 A.M HERE IN HONOLULU.
MY NAME IS TINA
TAUASOSI-POSIULAI.
I'M ONE OF THE COINVESTIGATORS
FOR PROTECTING LIFE.
I STUDY AT THE UNIVERSITY OF
HAWAII AND I'M ALSO A EXECUTIVE
DIRECTOR FOR A COMMUNITY
ORGANIZATION CALLED PACIFIC
EMPOWERMENT THAT PARTNER WITH
THE UNIVERSITY IN CONNECTING THE
STUDY.
>> THANK YOU VERY MUCH EVERYBODY
FOR INTRODUCING YOURSELF.
SO THE QUESTION WE WANTED TO GET
STARTED WITH TODAY: WONDERING IF
YOU ALL WOULD DESCRIBE WHAT YOU
SEE AS THE STRENGTHS AND
SUCCESSES OF YOUR PROJECTS,
ESPECIALLY AS IT RELATES IN
COMMUNITY ENGAGEMENT AND
INTERACTING WITH COMMUNITY
PARTNERS.
DO YOU HAVE THOUGHTS ON THAT?
I KNOW SOME OF YOU DO, BECAUSE
WE TALKED ABOUT IT.
ANYBODY WANT TO SHARE THOUGHTS
ON THAT?
>> I WILL GO, FIRST.
ONE OF THE THINGS THAT WE
LEARNED THROUGH CONNECTING THE
COMMUNITY AND WORKING WAT
RESEARCH ENGAGEMENT OF COVID-19.
THE COMMUNITY REALLY WANTS TO BE
INFORMED.
THEY WANTED TO LEARN AND CONNECT
WITH THEM.
SO THAT WAS ONE OF THE BENEFITS
THAT I LEARNED WHILE WORKING ON
THE PROJECT.
>> GREAT.
>> I'LL GO.
FOR THE STUDY, WE DID MAYBE FIVE
THINGS.
WE ESTABLISHED COMMUNITY
ADVISORY BOARD.
WE HIRED, TRAINED, EMPLOYED AND
MENTORED PACIFIC ISLANDERS AND
SPEAKING DIFFERENT LANGUAGES WHO
WORK WITH OUR COMMUNITIES AND
LEADERS.
WE WORKED WITH CULTURAL
COMMUNITY LEADERS.
AND PARTNERED WITH A LOT OF
NONPROFIT COMMUNITY
ORGANIZATIONS THAT WE ARE DOING
A LOT OF OUTREACH TO THE PI
COMMUNITY IN 2022-2023.
THANK YOU.
>> THANK YOU.
HOW ABOUT YOU, EDNY?
>> OUR WORK WAS GETTING PEOPLE
FROM THE COMMUNITY AND HAVING
THEM GET THE INFORMATION OUT TO
THEM AND GIVING THEM TESTING SO
MAKING THEM FEEL COMFORTABLE
LIKE WE WERE, YOU KNOW, ALL
TOGETHER AND JUST BEING ONE OF
THEM.
SO I THINK THAT THAT WAS WHAT WE
SAW WORKED.
>> GREAT.
THANK YOU.
DID YOU WANT TO SAY SOMETHING,
MARGUERITE?
>> YES.
THE ADVISORY PORT ALSO PROVIDED
OUR TECHNOLOGY -- REPORT -- AND
INFORMATION SO THAT WHERE WE
BUILD TRUST IN TOWER COMMUNITIES
BY RELAYING OUR UPDATED
INFORMATION DURING THE COVID-19
PANDEMIC SHUTDOWN.
DEBRA?
DO YOU HAVE ANYTHING YOU WOULD
LIKE TO ADD TO THAT?
OR GLEEN?
>> YES, SO I GATHER A LOT OF
INFO MYSELF BY JUST
PARTICIPATING IN GROUP MEETINGS.
AND A LOT OF GREAT INFO THAT
PEOPLE REALLY NEED ARE LOOKING
FOR.
SO IT'S VERY INTERESTING TO THE
PEOPLE THAT WANT TO HELP AND C
CAN.
THANK YOU.
ANYTHING YOU WOULD LIKE TO ADD
TO THAT, DEBRA?
>> YES, I DO.
WE FELT LIKE THAT AS A
COMMUNITY, WE WERE A FAMILY.
WE WERE LIKE -- WE GOT TO KNOW
ONE ANOTHER AND BEING ABLE TO
HELP ONE ANOTHER IN DOING THE
TESTING, COVID TESTING AND ALSO
GETTING IN OUR COMMUNITY, BEING
ABLE TO LET OUR COMMUNITY KNOW
WHAT IS GOING ON WHEN WE WERE
ABLE TO -- WHEN THE PANDEMIC WAS
OVER WITH.
AND IT WAS VERY INTERESTING.
WE WENT TO A LOT OF SCIENTIFIC
LEAGUES AND MARGUERITE WAS ABLE
TO AND ALSO OUR COMMUNITY MOVED
FORWARD BOARDS THAT WE ARE ON,
NOT ONLY WITH THIS ONE.
>> THANK YOU.
I THINK MAYBE MARGUERITE
MENTIONED THAT BUILDING TRUST
WAS ONE OF THE SUCCESSES.
I WONDER, DID THAT HAPPEN WITH
ANY OF THE OTHER PARTNERS?
THAT TRUST BUILDING?
DO YOU THINK THAT WAS SOMETHING
THAT YOU WERE ABLE TO DO?
>> I THINK SO.
FOR OUR STUDY HERE AND FOR
PACIFIC ISLANDERS, THE TRUST WAS
VERY IMPORTANT.
SO WE DID A LOT OF LEG WORK
BEFORE WE EVEN STARTED OUR
SURVEY.
AND THAT WAS REALLY IMPORTANT
FOR US.
>> SO DOING LEG WORK, GETTING
OUT THERE AND TALKING TO FOLKS?
>> YES, WE DID A LOT OF
PRESENTATIONS ABOUT COVID BEFORE
WE STARTED THE STUDY.
AND THE TRYING TO GET PEOPLE TO
UNDERSTAND AND INTRODUCE THE
STUDY AT THE SAME TIME, BEFORE
WE ACTUALLY STARTED THE FIELD
RESEARCH.
>> OKAY.
HOW DID THAT WORK OUT FOR YOU
ALL, JAVIER?
>> YES, THANK YOU.
SO SOMETHING ELSE THAT WE
LEARNED WHILE BUILDING TRUST,
WAS THE COMMUNITY REALLY TRUSTED
THE PEOPLE THAT WERE DOING DATA
COLLECTION.
BY BEING INFORMED AND I THINK IT
COMES DOWN TO THE RESPONDING THE
TRUSTED MESSENGERS THAT WERE
RELAYING INFORMATION BACK TO THE
COMMUNITY THAT WAS THE CORRECT
INFORMATION.
WE KNOW A LOT OF THE INFORMATION
THAT CAME OUT AT THE BEGINNING
OF COVID WAS BEING SHARED
THROUGH FACEBOOK AND WASN'T
CORRECT INFORMATION.
SO WE LEARNED THE COMMUNITY
REALLY TRUSTED THOSE MESSENGERS
THAT WERE RELAYING THE
INFORMATION.
IT HELPED TO BUILD THE TRUST
BECAUSE THEY BELIEVED THE STUFF
WE WERE SHARING WAS TO THEIR
BENEFIT.
>> GREAT.
DO YOU ALL HAVE ANY INSIGHT ON
THAT, EDNY?
>> SO THE SAME THING.
WE WOULD CALL EVERYONE AFTER
THEY TESTED, WHETHER THEY WERE
POSITIVE OR NEGATIVE, AND TO ASK
THEM IF THEY WERE OKAY OR NEEDED
ANYTHING, IF THEY HAD NEEDED
RESOURCES.
SO THAT WAS PART OF THE BUILDING
THAT TRUST, BECAUSE THEY GOT TO
SEE US AT THE EVENT WHEN THEY
TESTED AND THEN THEY GOT TO HEAR
FROM US, THE PERSON THAT DID
THEIR TEST AFTERWARDS.
AND THEN GIVING THEM RESOURCES.
SO THAT HELPED BUILD TRUST.
>> SO FOLLOW-UP AND CONTINUING
THE COMMUNICATION AND BUILDING
RELATIONSHIPS?
>> YES, SO THAT -- NOW THEY HAD
OUR NUMBER.
WE WOULD ALWAYS TELL THEM IN
THEY NEEDED SOMETHING ELSE OR IF
THEY NEEDED A RESOURCE -- I MEAN
THERE WERE TIMES WHEN PEOPLE
THAT WERE POSITIVE NEEDED MAYBE
A FOOD BOX SO WE WOULD ORDER OR
DELIVER TO THEIR FRONT DOOR.
SO BUILDING THAT HELPED US
BECAUSE NOW WE HAVE THAT
CONNECTION.
AND TRUSTED INFORMATION.
>> THAT SOUNDS PRETTY GOOD.
THANK YOU FOR ANSWERING TO THAT
QUESTION.
SO ON THE FLIP SIDE, ON -- WERE
THERE ANY BARRIERS AND
CHALLENGES THAT YOU ALL
EXPERIENCED AS COMMUNITY
PARTNERS ON YOUR PROJECTS?
I'M MANAGING SO.
JAVIER, YOU WANTED TO SHARE.
GO AHEAD.
>> YES, THE REASON I WANTED TO
SHARE IS BECAUSE IT CONNECTS
WELL WITH US.
ONE OF THE CHALLENGES WE SEE IN
COMMUNITIES, WHAT HAPPENS WHEN
FUNDING ENDS?
WHAT HAPPENS WHEN THE RESEARCH
IS COMING TO AN END?
WE LEARNED THROUGH WORKING IN
COMMUNITY THAT IT TAKES A LOT OF
TIME AND ENERGY AND EVEN MONEY
TO BUILD SOME OF THOSE
RELATIONSHIPS.
AT LEAST VERY STRONG
RELATIONSHIPS.
BUT THE CHALLENGE THAT WE SEE
IS, THEN WHAT HAPPENS WHEN THERE
IS NO MORE MONEY FOR THAT FUNDED
RESEARCH?
WHO IS GOING -- HOW ARE THEY
GOING TO FUND?
TIME FOR RESEARCHERS TO CONTINUE
TO BUILD THOSE RELATIONSHIPS AND
SHOW UP IN THE COMMUNITY THAT
TOOK TIME TO BUILD.
THAT WAS ONE THE CHALLENGES THAT
PEOPLE WERE ASKING.
ARE YOU COMING BACK?
SO I STAY CONNECTED WELL THEM
AND BUILD THOSE RELATIONSHIPS
AND CONNECTING COMMUNITY
RESOURCES.
>> JAVIER, YOU HAD FOLKS
ASKING -- HOW ARE YOU GOING TO
KEEP THIS GOING?
HOW ARE WE GOING TO IDENTIFY
THIS?
SO WHATNESS IN YOUR BEEN, IF
SOMEONE THAT DOES LAPS AND
YOU'RE UNABLE TO SUSTAIN A
RELATIONSHIP IN THE SAME WAY?
>> I THINK IT TAKES A LOT OF
TIME, PERSONAL TIME AND ENERGY
FROM THE PEOPLE THAT WORK IN THE
COMMUNITY.
BUT OFTEN OTHER THINGS COME UP
AND I FEEL LIKE THAT'S WHERE
COMMUNITY GETS AFFECTED.
I GUESS RESEARCHERS WON'T BE
GOING AS MUCH BACK TO THE
COMMUNITIES AS A RESULT OF
FUNDING.
>> SO MAYBE IT COULD HARM THOSE
RELATIONSHIPS THAT WERE BUILT?
>> CORRECT.
>> COULD WE GO AS FAR AS SAYING
THAT COULD CAUSE DISTRUST TOO?
>> YES, IT COULD CAUSE DISTRUST
BECAUSE WE ARE SHOWING UP AND
THEN ALL OF A SUDDEN, IN A WAY,
LACK OF FUNDING IS BREAKING THIS
RESEARCHER, SO THESE DATA
COLLECTORS THAT WERE GOING INTO
THESE COMMUNITIES AND THEY HAVE
TO START OVER FROM SCRATCH IF
THEY DON'T COME BACK.
AND ALSO, COMMUNITIES NOT GOING
TO TRUST THAT WE'LL COME BACK IF
WE ACTUALLY DON'T SHOW UP.
>> SO FIND A WAY TO BRIDGE THAT
GAP AND KEEP IT GOING SOMEHOW,
SEEMS PRETTY IMPORTANT?
>> I THINK SO, YES.
>> WHAT DO YOU THINK ABOUT THAT,
DEBRA?
>> I AGREE WHOLEHEARTEDLY WITH
JAVIER.
AND WE WERE ABLE TO BRING THAT
CONNECTION THROUGH ZOOM.
SO WE DIDN'T HAVE A LOT OF
PERSONAL CONNECTIONS TWO DID A
LOT OF WORK WHO REALLY HAD
MEETINGS ON ZOOM.
AND WE WERE ABLE TO KIND OF TEST
OURSELVES THE -- LIKE GUINEA PIG
ON OUR OWN SELFS TO FIGURE OUT
HOW WE -- YOU KNOW HOW WE LET
THE COMMUNITY -- WERE ABLE TO
ADMINISTER COVID TO THEMSELVES.
AND IN FACT, WHEN WE WERE ABLE
TO GO OUT IN THE COMMUNITY, WHEN
COVID -- THE PANDEMIC WAS KIND
OF OVER AND EVERYTHING, WE GOT
THE OPPORTUNITY TO GET TO A LOT
OF THE COMMUNITIES, A LOT OF --
WE BUILT A LOT OF TRUST IN
LETTING THEM KNOW THAT WE WERE
THERE FOR THE LONG HAUL.
WHATEVER WE WERE DOING --
WHATEVER NEEDED AND NOT JUST --
WE WERE A PART OF THE COMMUNITY
AND WE WERE ALSO A PART OF THE
COMMUNITY IN VIRGINIA BEACH AND
LETTING PEOPLE KNOW, HEY, THIS
FUNDING IS MEANING MORE TO US
THROUGH THE NATIONAL INSTITUTE
OF HEALTH AND WE THANK THEM FOR
THAT, FOR GIVING -- LETTING US
BE ABLE TO GIVE BACK TO THE
COMMUNITY.
>> I WAS INVITED TO PARTICIPATE
IN A YouTube PARTICIPATION,
ENCOURAGING THE COMMUNITIES WHO
PARTICIPATED IN GETTING THEIR
BOOSTER SHOTS.
THAT BUILT TRUST SHOWING THAT I,
MYSELF HAD ALREADY DONE MINE AND
ENCOURAGED OTHERS TO GET THEIRS.
>> THEY THINK SOUNDS REALLY
HELPFUL.
SO, AS I'M THINKING ABOUT THIS
ISSUE OF TRUST AND ENGAGEMENT,
THE QUESTION I HAVE, THINKING
OUT LOUD HERE -- YOU ALL
PERSONALLY WANT TO KEEP ON
PARTICIPATING IN THE SAME
CAPACITY YOU HAVE BEEN?
WORKING ON RESEARCH, PARTNERING
ON THESE KINDS OF ACTIVITIES
MOVING FORWARD?
>> FOR MYSELF, THIS IS
DIFFERENT.
YES, I DO.
IT WAS VERY EDUCATIONAL BECAUSE
NOT ONLY AM I TEACHING, LEARNING
TO TEACH OTHER PEOPLE HOW TO DO
THE TESTING, BUT ALSO I'M
TEACHING MY FAMILY TOO.
I'M TEACHING NOT ONLY THE
COMMUNITY.
I'M TEACHING MY LOVED ONES ON
HOW TO PROTECT THEMSELVES AND
THEN HOW TO MAKE SURE LIKE WE
SAID, WHEN IT WAS TIME TO GET
THE BOOSTER, TO GO AHEAD ON AND
GET THE BOOSTER, BECAUSE MYSELF,
I HAD THE BOOSTER.
SO I GUESS WE DID -- I DID IT
FIRST HAND AND THEN I SHOWED
THEM THAT IT WAS OKAY FOR THEM
TO DO IT TOO.
>> HOW ABOUT YOU, TINA?
>> OF COURSE.
I THINK FOR THIS STUDY
PARTNERING WITH THE UNIVERSITY
AND KNOWING THAT NIH IS PART OF
THIS STUDY, I THINK IT'S
IMPORTANT THAT WE CONTINUE.
WE CONTINUE BECAUSE FOR US, A
LOT OF PACIFIC ISLANDERS HERE,
THEY ARE NOT REPRESENTING A LOT
OF THOSE CASES WHERE THERE IS
VOICE FOR THEM -- WHERE NIH
NEEDS TO HEAR OUR VOICE.
BUT FOR THIS STUDY, WE ARE AT
THE TABLE.
WE ARE AT THE TABLE TRYING TO
EXPLAIN THE SITUATIONS THAT IS
AFFECTING OUR POPULATION.
FOR THE STUDY, THE BARRIERS WE
FACE, THE SURVEY WAS VERY LONG,
MORE THAN 30 PAGES FOR A
POPULATION THAT IS SO
UNDERREPRESENTED IN COLLEGE
EDUCATION AND HIGH SCHOOL
GRADUATION.
SO WE NEED TO CONTINUE THIS
WORK.
BUT NIH AND THE INSTITUTIONS
HAVE TO SUPPORT.
WE CANNOT JUST LEAD THIS STUDY.
AND A LOT OF THIS WORK FOR THE
NON-PROFIT ORGANIZATIONS OR FOR
COMMUNITY ORGANIZATIONS, BECAUSE
LIKE ONE OF MY COLLEAGUES WAS
SAYING, THAT MEANS WE ARE GOING
TO GO BACK AGAIN.
SOMEBODY HAS TO LIFT US UP.
THESE COMMUNITY ORGANIZATIONS.
BECAUSE FOR US, WE KNEW, WE KNEW
THE SITUATION.
WE KNEW THE PACIFIC ISLANDERS
THAT HAVE INEQUITY IN OUR
POPULATION, WE KNEW IT AS A
COMMUNITY.
BUT THIS HAS ELEVATED OUR VOICE
AND WE ARE GLAD WE ARE PART OF
THIS BECAUSE IT ALLOWS THE
INSTITUTION AND THE STATE AND
EVEN NIH TO KNOW THAT THIS IS
WHAT THE POPULATION KNOWS.
YOU JUST HAVE TO HELP US.
YOU HAVE TO TAKE ACTIONS.
AND WE -- THE OTHER THING
FOLLOWING THIS POPULATION IS
THAT A LOT OF PACIFIC ISLANDERS,
IT WAS A CHALLENGE TRYING TO
TRAIN AND WORKING WITH OUR STAFF
BECAUSE A LOT OF THEM, THIS IS
NEW TO THEM.
BUT NOW WE HAVE THIS RESEARCH
TEAM.
WHAT CAN NIH AND OUR
INSTITUTIONS HELP TO ELEVATE AND
TO CLOSE THIS HEALTH INEQUITY IN
THIS POPULATION?
>> SO YOU MENTIONED YOU HAVING A
VOICE AT THE TABLE.
DO YOU THINK THAT YOUR
COMMUNITIES FELT LIKE THAT WAS
NEW?
>> YES.
DURING COVID -- BECAUSE I WAS
PART OF THE NATIVE HAWAIIAN
PACIFIC ISLANDER COVID RESPONSE
TEAM, IT WAS REALLY, REALLY HARD
FOR US TO -- FOR US TO GET THE
SUPPORT FROM THE STATE.
AND THE LOCAL GOVERNMENT.
BUT I THINK THIS STUDY IS
HIGHLIGHTING THE ISSUES THAT WE
WERE TALKING ABOUT DURING COVID.
SO, WE NOW FEEL -- BECAUSE I
THINK ONE OF THE SUCCESSES FOR
OUR STUDY IS THAT THE
INSTITUTION, ESPECIALLY OUR
FACULTY AT JACKSON -- WE HAD A
MUTUAL UNDERSTANDING.
TRUST AND RESPECT FOR THE VOICE
OF THE COMMUNITY.
AND THAT REALLY CONTRIBUTED TO
THE SUCCESS OF THE STUDY.
WE DIDN'T REALLY -- ALL THESE
SCIENTIFIC ISSUES -- I MEAN
RESPONSIBILITIES THAT WE NEEDED
TO FOCUS ON, WE HAVE TO MEET THE
COMMUNITY AT THE LEVEL THEY WERE
AT DURING THE STUDY.
ESPECIALLY THE LIMITATION OF THE
SURVEY, COVID-19 TESTING AND THE
POST-SURVEY.
AND EVEN OUR EDUCATIONAL
SESSIONS.
SO THAT WAS A BIG SUCCESS FOR
US.
IT WAS THE MUTUAL TRUST.
>> SO ONE OF THE QUESTIONS THAT
I JUST GOT SENT -- I THINK IT'S
A PRETTY INTERESTING ONE BECAUSE
IT BUILDS ON THIS IDEA OF -- SO
WE MADE SOME CHANGES.
WE GOT SOME -- WE GOT FOLKS AT
THE TABLE, MAYBE WHO DIDN'T
NECESSARILY HAVE VOICES AND WE
BUILT SOMETHING, RIGHT?
WE CREATED SOMETHING NEW THAT
WAS IMPORTANT.
AND WHAT WOULD KIND OF
UNIVERSITIES OR OTHER
INSTITUTIONS -- WHAT CAN OUR
UNIVERSITIES OR OTHER
INSTITUTIONS DO TO HELP KEEP
THAT GOING?
AND SOME OF US MAY NOT BE
AFFILIATED WITH THE
UNIVERSITIES.
I DON'T KNOW.
DO YOU HAVE ANY THOUGHTS ON
THAT?
>> I THINK THAT ONE OF THE
THINGS WE LEARNED IS THAT PEOPLE
REALLY WANT TO CONTINUE THOSE
RELATIONSHIPS.
SO REALLY UNIVERSITIES OR -- I
WOULD SAY THE PEOPLE THAT
REPRESENT THE UNIVERSITIES, HAVE
TO CONTINUE TO SHOW UP IN THE
COMMUNITY, TO SHOW UP GENERALLY,
HONESTLY, RESPECTFULLY.
I FEEL LIKE UNIVERSITIES HAVE TO
HIRE PEOPLE THAT REPRESENT THE
COMMUNITIES THEY ARE IN.
I DON'T SEE REPRESENTATION OF
THEM FROM MY OWN COMMUNITY.
AT THE UNIVERSITY LEVEL, I THINK
THAT THAT IS DEFINITELY A CHANGE
THAT IS HAPPENING, BUT I THINK
THAT IS ONE OF THE THINGS I
WOULD SUGGEST.
JUST CONTINUE TO SHOW UP AND BE
HONEST WITH THE WORK THAT IS
BEING DONE.
>> WHAT DO YOU THINK, EDNY?
>> I AGREE WITH WHAT HE SAID.
I THINK JUST MEETING COMMUNITY
WHERE THEY ARE AT.
HAVING REPRESENTATION.
AND THEN JUST TAKING INTO
CONSIDERATION WHAT THAT
COMMUNITY HAS TO SAY.
AND I THINK THAT GOES A LONG
WAY.
>> OKAY.
I SEE YOU MUTED YOURSELF, DEBRA.
DID YOU HAVE SOMETHING YOU WOULD
LIKE TO ADD?
>> WELL, AS BEING A PART OF THE
MEDICAL SCHOOL, I FEEL THAT WE
ARE GETTING AN EDUCATION ALL THE
TIME, INFORMATION, ESPECIALLY
ABOUT THE COVID ON THE MEDICAL
SIDE AND GOING INTO OUR
COMMUNITY, IN THE HOUSING
COMMUNITY WHERE A LOT OF PEOPLE
DON'T HAVE A CHANCE TO MAYBE SAY
WHEN COVID WAS GOING ON, AND WE
WERE ABLE TO GET TO THEM BY ZOOM
OR GET TO THEM BY TELEPHONE AND
LETTING THEM KNOW, YOU KNOW,
WHAT IS GOING ON.
AND I THINK THAT WITH US
CONTINUING DOING THIS KIND OF
WORK, IT IS HELPING THE WHOLE
COMMUNITY.
IT'S HELPING THE INCOME-BASED
HOUSING, PUBLIC HOUSING, ANY
PLACE THAT WE NEED TO BE ABLE TO
HELP OUR COMMUNITY.
>> GREAT.
THANK YOU.
I THINK THAT'S PROBABLY GETTING
CLOSE TO WRAPPING US UP.
I'M NOT QUITE SURE HOUSE THIS IS
GOING TO END.
STARTING OFF WITH GREAT
CONVERSATION HERE AND I WISH WE
COULD GO LONGER.
I DO WANT TO THANK EACH AND
EVERY ONE OF THE PANELISTS WHO
JOINED US.
I THINK SUPER IMPORTANT THAT WE
ARE ABLE TO HAVE THIS
CONVERSATION AND THANK YOU VERY
MUCH FOR BEING HERE AND BEING A
PART OF THIS CONVERSATION.
>> YOU'RE WELCOME.
I ENJOYED IT.
>> THANK YOU FOR THE INVITATION.
>> THANK YOU FOR HAVING US.
>> THANK YOU VERY MUCH.
>> THANK YOU THANK YOU FROM THE
WORKING GROUP, FOR ALL OF THE
PANELISTS JOINING US, ESPECIALLY
OUR COMMUNITY PARTNERS.
WE REALLY APPRECIATE ALL THE
WORK YOU DO.
WE KNOW ALL OF THE HARD WORK
THAT YOU WERE DOING O ON THE
GROUND IN YOUR COMMUNITIES.
AND WE OF COURSE WANT ANYONE WHO
IS INTERESTED IN JOINING THE
WORKING GROUP.
I DROPPED THE LINK IN IF YOU
WANT TO JOIN THE WORKING GROUP,
IF YOU WANT TO LEARN MORE ABOUT
THIS PARTICULAR STUDY WORKING
GROUP AND WE HAVE OTHERS AS
WELL.
SOME OF THEM WILL BE
TRANSITIONING TO DIFFERENT GROUP
FORMATS, BUT THEY WILL EXIST IN
THE LONG RUN, OF COURSE, GET IN
TOUCH WITH ME AT CDCC AT DUKE
UNIVERSITY DCRI, AND WE HOPE YOU
ENJOY THE REST OF YOUR TIME WITH
THE REST OF THE SCIENTIFIC
PANELS.
>> ALL RIGHT, WELCOME BACK,
EVERYONE.
I HOPE WE HAVE EVERYONE BACK AT
THIS TIME.
WE ARE GOING TO GO AHEAD AND
MOVE FORWARD TO OUR FIRST
PROJECT PRESENTATION.
BUT BEFORE WE DO THAT, I WANTED
TO MAKE A NOTE, IF YOU ARE
HAVING ANY KIND OF TECHNICAL
ISSUES AND YOU NEED TECHNICAL
SUPPORT, PLEASE MESSAGE ALLEY,
AMANDA OR LAUREN AND THEY CAN
HELP YOU WITH THOSE ISSUES.
SO LET'S GET STARTED WITH OUR
FIRST PROJECT TEAM.
WE ARE NOW GOING TO HEAR FROM
THEM.
THE TEAM PROJECT IS ENTITLED.
REACH, ADOPTION, AND
IMPLEMENTATION OF MOBILE HEALTH
FOR MIGRANT HEALTH,
MHEALTH-4-MHEALTH PROGRAM.
PORTIONS OF THIS PROGRAM WILL BE
IN ENGLISH AND SPANISH.
PLEASE PUT QUESTIONS IN THE CHAT
OR IF YOU HAVE QUESTIONS THAT
YOU WOULD LIKE TO ASK AT THE END
OF THE PRESENTATION, WE WILL
PROVIDE TIME FOR YOU ALL TO DO
THAT.
IF THERE IS ENOUGH TIME LEFT AT
THE END.
SO WE'RE GOING TO HOLD ON JUST
ONE SECOND BEFORE WE GET STARTED
I'M GOING TO INVITE THE TEAM TO
SHARE YOUR WORK WITH US.
>> HELLO, EVERYBODY.
THANK YOU VERY MUCH FOR BEING
HERE.
REALLY APPRECIATE YOU TAKING THE
TIME TO LISTEN TO EVERYTHING
THAT WILL BE SHARED TODAY.
SO I WANTED TO START OFF WITH A
INTRODUCTION.
I'M FERNANDO SANCHEZ, RESEARCH
COORDINATOR FOR THE NEBRASKA
MEDICAL CENTER AND I HAVE MY
TEAM WITH ME.
>> GOOD MORNING, MY NAME IS JANA
BROADHURST, A FACULTY MEMBER IN
PATHOLOGY AND MICROBIOLOGY
DEPARTMENT AT THE UNIVERSITY
NEBRASKA MEDICAL CENTER AND
SERVE AS CO-PI.
>> HI, EVERYONE.
THIS IS LISVEY RIVERA, AND I'M
PROVIDER FOR IMMIGRATION PROG
PROGRAM.
>> THANK YOU VERY MUCH.
SO TODAY'S PROJECT IS THE REACH
ADOPTION AND IMPLEMENTATION OF
THE MOBILE HEALTH FOR MIGRANT
HEALTH PROGRAM.
OR MHEALTH-4-MHEALTH PROGRAM.
NEXT SLIDE.
SO HERE IS A QUICK OVERVIEW OF
WHAT ENTAILS FOR OUR PROGRAM.
SO FIRST THING TO NOTE IS WE ARE
WORKING CLOSELY AND PRIMARILY
WITH SPANISH-SPEAKING MIGRANT,
AGRICULTURAL WORKERS BECAUSE WE
NOTICE THAT SOME OF THE SOCIAL
ECONOMICAL DISPARITIES THAT THEY
TEND TO FACE CAN BE A LITTLE BIT
DIFFERENT THAN WHAT SOMEBODY
THAT HAS BEEN HERE FOR
GENERATIONS.
THAT KNOW AND SPEAK THE
LANGUAGE.
THEY KNOW HOW TO WORK THE SYSTEM
AND NAVIGATE THROUGH THESE
CHALLENGES.
SO IT'S EASIER FOR THEM.
SO WE WANT TO BRIDGE THAT GAP.
THEN WE ARE GOING TO OFFER
MOBILE HEALTH TECHNOLOGIES FOR
THEM TO INCREASE THEIR
RESILIENCY AND THIS WILL BE DONE
THROUGH SOME SCREENING TOOLS IN
OUR HEALTH GUIDANCE, SOME
AT-HOME TESTING KITS AND
COMMUNITY RESOURCE NAVIGATION.
THIS IS BEING DONE CLOSELY WITH
WORKING WITH OUR PARTNERS IN
COLLABORATION WITH NEBRASKA
TITLE I C MIGRANT EDUCATION
PROGRAM AND OUR BUFFALO COUNTY
COMMUNITY PARTNERS AND THE
OVERARCHING GOAL IS, OUR BELIEF
AS LONG AS THE FAMILIES ARE
HEALTHY AND THEY HAVE TEST KITS
READY TO TEST, THEY HAVE ACCESS
TO COMMUNITY RESOURCES, IT WILL
KEEP THE FAMILIES HEALTHY AND IT
WILL KEEP ALL THE KIDS HEALTHY
AND BY THAT, KEEPING THEM ALL IN
SCHOOL AND NOT AFFECTING THEIR
SCHOOL ATTENDANCE.
NEXT WE'LL HAVE AN OVERVIEW ON
THE MIGRANT AND EDUCATION
PROGRAM.
>> MIGRANT IMMIGRATION PROGR
PROGRAM --
[ SPEAKING SPANISH ]
>> DID THE INTERPRETER GIVE YOU
REFERENCE?
>> I'LL HAVE TO DEFER TO THE
ORGANIZER.
I THINK WE CAN GO AHEAD AND
CONTINUE.
THANK YOU.
>> FOR THE SAKE OF TIME WE'LL
HAVE TO DO IT IN SPANISH AND
THEN MAYBE SEND OUT NOTES IN
ENGLISH IF ANYONE WANTS SOME
MORE INFORMATION.
[ SPEAKING SPANISH ]
>> I'M THE INTERPRETER.
I HAVE GOT SOME PROBLEMS IN
CONNECTING.
SO I COULDN'T HEAR THE FIRST
PART OF THE PRESENTATION.
>> IT'S OKAY.
I THINK FOR THE SAKE OF TIME,
SHOULD WE JUST CONTINUE?
>> SURE, OF COURSE.
>> OKAY, THANK YOU.
NEXT SLIDE.
NEXT SLIDE, PLEASE.
THANK YOU.
SO HERE IS A LITTLE BIT ABOUT
OUR ENROLLMENT IN THE STUDY
INTERVENTION WE HAVE HERE IN THE
COMMUNITY.
FIRST THING TO NOTE HERE IS THAT
FOR MYSELF AND MY COWORKERS, FOR
THE RESEARCH COORDINATORS, WE
ARE ALL BILINGUAL AND
BICULTURAL, WHICH HAD HAS PLAYED
A HUGE IMPACT IN JUST THE WAY WE
INTERACT WITH FAMILIES.
SOME OF OUR CONNECTIONS ARE WE
HAVE BEEN ABLE TO ESTABLISH WITH
THEM HAS MADE IT PRETTY QUICK.
I KNOW THERE ARE TIMES WHERE
MYSELF AND COWORKERS, WE'VE HAD
THE OPPORTUNITY TO HAVE OR GO
VISIT FAMILIES AND THEY INVITE
US OVER FOR A MEAL.
THEY WANT US TO BE THERE.
I THEY SHARE THEIR LIFE STORIES
AND HAVE THAT RAPPORT HAS BEEN
HUGE.
ALL THE STUDY MATERIALS WE HAVE
ARE AVAILABLE IN ENGLISH AND
SPANISH.
AND I TELL YOU WHAT, WHAT WE
HAVE IN ENGLISH, WE MAINLY USE
MATERIALS THAT IS IN SPANISH FOR
OUR FAMILIES.
AND THEN AS FAR AS INTERVENTION
WE HAVE, SO THE FIRST STEP HERE
IS ONCE THEY CONSENT, WE HELP
THEM DOWNLOAD THE TOOL AND THEN
COVID TESTS ARE SHIPPED OUT TO
THEIR HOME AND RECEIVED IN A FEW
DAYS.
FROM THIS CONNECTING HEALTH
KOREANING ON THEIR HEALTH
TOOL -- SCREENING -- TO ASSESS
THE RISK OF COVID.
RISK AND EXPOSURE AND THEN IF
THEY WERE TO RECEIVE A POSITIVE
COVID TEST, IT PROMPTS ALL THE
HOUSEHOLD TO CONDUCT THE TEST AS
WELL.
THEN WE ARE ALSO SCREENING FOR
HOUSEHOLD CHALLENGES.
SO THIS IS WHERE OUR FAMILY
NAVIGATOR WOULD COME IN.
IN THE IVENT THEY NEED HELP WITH
LIGHT BILL, HAVE TO CUT BACK ON
MEALS, CAN'T AFFORD CLOTHES, ANY
TYPE OF NEED LIKE THAT, THEY
HAVE THE OPTION IF THEY SELECT
ONE, THEY HAVE TWOY REQUESTS
AFTER THAT.
ONE IF, THERE WAS A RESOURCE
AVAILABLE AND IF THEY WANT TO BE
CONTACTED BY OUR FAMILY NURSE
NAVIGATOR IF THEY SELECT YES
THEY WANT TO BE CONTACTED, THEN
OUR NURSE NAVIGATOR SPECIALIZING
ACROSS THE STATE OF NEBRASKA,
SHE REACHES OUT TO THEM AND
HELPS THEM FIND THAT RESOURCE
THAT WILL HELP THEM WITH THAT
NEED.
AND LASTLY, WE CONDUCT INTRODUCE
TO ENSURE THE QUALITY AND
SUCCESS OF THE PROGRAM ALONG
WITH CONSISTENT COMMUNICATION SO
THEY ALSO DON'T FEEL LIKE A
NUMBER ADDEDDED TO OUR PROJECT.
WE ENSURE COMMUNICATION IS OPEN
BOTH WAYS.
NEXT SLIDE.
>> THANK YOU.
SO WE HAVE ORGANIZED THE
EVALUATION OF OUR PROGRAM
PERFORMANCE ACCORDING TO THE
RE-AIM FRAMEWORK WITH EFFICACY
ADOPTION, IMPLEMENTATION AND
MAINTENANCE.
WE WILL TALK ABOUT OUTCOMES
RELATED TO REACH, ADOPTION AND
IMPLEMENTATION.
NEXT SLIDE.
I'LL MOVE QUICKLY THROUGH DATA
OUTPOINTS SO WE CAN CONTINUE TO
FOCUS ON OUR COMMUNITY
ENGAGEMENT PIECE.
BUT TO SUMMARIZE, WE HAVE CHOSEN
METRICS FOR REACH AND ADOPTION
THAT SPEAK TO OUR ENROLLMENTS
AND OUR REPRESENTATION OF
FAMILIES AND STUDENTS ACROSS THE
MIGRANT EDUCATION PROGRAM.
TO DATE, WE HAVE ENROLLED 69
HOUSEHOLDS WITH 266
PARTICIPANTS.
SO OUR ENROLLMENT STRATEGY IS
HOUSEHOLD-BASED.
AND THOSE FAMILIES AND
HOUSEHOLDS REPRESENT 14 RURAL
COUNTS AND 18 SCHOOL DISTRICTS
ACROSS THE STATE OF NEBRASKA.
JUST OVER HALF OF OUR
PARTICIPANTS ARE CHILDREN AND
THEY REPRESENT GRADES ACROSS
KINDERGARTEN THROUGH 12th
GRADE.
OUR REPRESENTATIVENESS OF THE
MIGRANT EDUCATION PROGRAM WITH
RESPECT TO IDENTIFICATION TO
HISPANIC/LATINO AND SPANISH
ORIGIN, AS WELL AS SPANISH AS A
PREFERRED LANGUAGE FOR THE HEAD
OF HOUSEHOLD AS SHOWN IN THE
TABLE HERE.
SO IN FACT WE ARE CURRENTLY
OVERREPRESENTED FOR THESE
DEMOGRAPHICS AND OUR
PARTICIPANTS.
AND WE HAVE HAD SUCCESS IN
HAVING 100% OF OUR HOUSEHOLDS
SUCCESSFULLY DOWNLOAD THE
MHEALTH TOOL AND RECEIVE
ANTIGEN KITS.
THESE ARE REALLY THE BASIC TOOLS
FOR ADOPTING THE
MHEALTH-4-MHEALTH PROGRAM.
NEXT SLIDE, PLEASE.
WITH RESPECT TO IMPLEMENTATION,
WE HAVE BEEN TRACKING THE USE OF
THE mHEALTH TOOL FOR BOTH
HOUSEHOLD SYMPTOM SCREENING AS
WELL AS HOUSEHOLD CHALLENGES
SCREENING THAT FERNANDO
DESCRIBED.
WE SEEN ROBUST UPTAKE IN
UTILIZATION OF THESE TOOLS WITH
MORE THAN 4000 HOUSEHOLD SYMPTOM
SCREENINGS TAKING PLACE, WHICH
IS JUST ABOUT TWO SCREENING
EVENTS PER HOUSEHOLD PER WEEK,
WHICH WE THINK IS A GREAT
OUTCOME.
SO WHEN HOUSEHOLD SYMPTOM SCREEN
IS POSITIVE, THEN THE ENTIRE
HOUSEHOLD IS PROMPTED TO UTILIZE
THE HOME ANTIGEN TESTING KISS.
AND ABOUT 3% OF OUR SCREENS HAVE
PROMPTED TESTING IN ALMOST HALF
OF THE PARTICIPATING HOUSEHOLDS.
OF THOSE FOR WHICH SCREENING --
FOR WHICH TESTING WAS PROMPTED,
BY THE SCREENING TOOL, MORE THAN
90% OF OUR HOUSEHOLDS HAVE BEEN
AGREED TO TEST WHEN PROMPTED.
AND INTERESTINGLY, EVEN THOUGH
JUST UNDER HALF OF HOUSEHOLDS
HAVE BEEN PROMPTED TO TEST BY
THE SCREENING TOOL, TWO-THIRDS
OF HOUSEHOLDS HAVE UTILIZED THE
TEST KITS WHEN MADE AVAILABLE TO
THEM.
SO I THINK THIS SHOWS THAT THE
WILLINGNESS TO UTILIZE HOME
TESTING TOOLS IS HIGH.
THE SECOND COMPONENT OF OUR
MHEALTH SCREENING PHASE II
HOUSEHOLD CHALLENGES.
AGAIN WE HAVE SEEN ROBUST UPTAKE
IN UTILIZATION OF THIS TOOL WITH
ALMOST 1600 SCREENS OR AROUND
ONE PER WEEK PER HOUSEHOLD.
AND THIS HAS RESULTED IN OVER A
THIRD OF HOUSEHOLDS REQUESTING
FAMILY NAVIGATOR ASSISTANCE.
THIS IS AN ASPECT OF OUR PROGRAM
THAT CONTINUES TO BE TRACKED AND
ANALYZED.
NEXT SLIDE, PLEASE.
FINALLY, WITH RESPECT TO
TESTING, THE SCREENING AGAIN HAS
PROMPTED MANY TESTING EVENTS NOW
AND WE'VE RECORDED 25 HOUSEHOLD
TESTING EVENTS.
OF THESE, THE POSITIVITY RATE IS
AT 16% SO ACTUALLY QUITE HIGH
MEMBERSHIPPING THAT I THINK WE
ARE IDENTIFYING AN APPROPRIATELY
TARGETING AT-RISK HOUSEHOLDS FOR
SCREENING.
AND I DO WANT TO ALSO NOTE THAT
NEARLY A QUARTER OF THESE
SCREENING EVENTS OR TEST EVENTS
THAT HAVE BEEN RECORDED HAVE
RESULTED IN AN INDETERMINATE
RESULT AND COMPLEXITIES OF THE
GUIDANCE AND NEED FOR SERIAL
TESTING TO HAVE A VALID NEGATIVE
RESULT WITH ANTIGEN TESTING.
SO WE HAVE PROVIDED TESTING
GUIDANCE AND EDUCATION IN AN
APPROPRIATE AT-HOME TESTING TO
FOLLOW FDA GUIDANCE.
OF COURSE THIS IS CHALLENGING.
SO, WE ARE CONTINUING TO LEARN
HOW BEST TO SUPPORT APPROPRIATE
USE OF ANTIGEN TESTING TOOLS IN
OUR PARTICIPANT POPULATION AND
THIS WILL ULTIMATELY HIGHLIGHT
SOME OF THE CHALLENGES HERE.
NEXT SLIDE, PLEASE.
>> SORRY, WE DON'T HAVE MUCH
TIME LEFT SO I'LL BE QUICK HERE.
I WANT TO TALK ABOUT SOME OF THE
COMMUNITY IMPACT WE HAVE BEEN
ABLE TO HAVE HERE.
SO ONE OF THE THINGS WE FIRST
WERE TOLD IS THAT THE
DEMOGRAPHICS WE WERE TRYING TO
REACH IS JUST SOMETHING --
CULTURALLY DIFFICULT AND ALSO IN
NEBRASKA GEOGRAPHICALLY, I DON'T
KNOW IF YOU CAN TELL BUT LIKE
BETWEEN THE WEST TO THE EAST,
IT'S A HUGE -- IT'S LIKE AN 8
HOUR DRIVE TO COVER THOSE TWO
POINTS.
SO IT'S QUITE THE DRIVE.
BUT, FROM THE PROGRAM, SOME OF
THE FEEDBACK WE HAVE BEEN ABLE
TO RECEIVE IS THAT IT'S BEEN A
LOT HELP HAVING SOMETHING TO
WALK THEM THROUGH THE RESOURCE
NAVIGATION.
THE USE OF THE GIFT CARDS THEY
RECEIVE FOR COMPENSATION FOR
THEIR TIME HAS MADE A HUGE
IMPACT IN THEIR LIVES THAT THEY
NOW RELY ON IT AND COUNT ON
HAVING THAT MONEY AFTER THE
MONTH IS OVER FOR EXPENSES THAT
AT OTHER TIMES THEY WOULDN'T BE
ABLE TO AFFORD.
AND ALSO THE IMPACT IT HAS HAD
BEING ABLE TO HAVE THOSE COVID
TESTS AT HOME HAS SAVED THEM A
LOT OF TIME AND A LOT OF STRESS.
AND I KNOW MOVING FORWARD, I
KNOW WE'LL BE ABLE TO CONTINUE
TO WORK WITH THE MIGRANT
EDUCATION PROGRAM AND OTHER
AGENCIES HERE IN CENTRAL
NEBRASKA TO CONTINUE TO PROVIDE
PROGRAMS AND RESOURCES FOR THESE
UNDERSERVED POPULATIONS IN THE
STATE.
ARE WE DOING QUESTIONS NOW?
DO WE HAVE TIME FOR QUESTIONS?
>> THANK YOU.
IF ANYONE HAS ANY QUESTIONS, I
THINK WE HAVE TIME FOR ONE
QUESTION.
ANYONE HAVE QUESTIONS?
I DO WANT TO SAY I APPRECIATE
YOU ALL'S INCORPORATION OF THE
COMMUNITY NAVIGATORS.
I THINK THAT IS SO IMPORTANT AND
SO CRUCIAL SO I APPRECIATE THAT.
ANY QUESTIONS BEFORE WE MOVE
FORWARD?
I'M SO GRATEFUL FOR THE WORK
YOU'RE DOING.
SO THANK YOU.
>> SO I'LL INTRODUCE OUR TEAM.
SO MY NAME IS CICI BAUER AND I'M
A ASSOCIATE PROFESSOR IN THE
DEPARTMENT OF BIOSTATISTICS DATA
SCIENCE TO UNIVERSITY OF TEXAS
HEALTH SCIENCE CENTER IN HOUS
HOUSTON.
GATHERED HERE WITH ME IS OUR
PIs FOR THIS PROJECT.
COULD YOU QUICKLY INTRODUCE
YOURSELF?
>> MY NAME IS RACHEL ROY FROM
HARRIS COUNTY PUBLIC HEALTH SO
I'LL BE GIVING THE COMMUNITY
PERSPECTIVE.
>> AND THIS IS REALLY A
COLLABORATION WITH HARRIS COUNTY
PUBLIC HEALTH DEPARTMENT,
CAMERON COUNTY PUBLIC HEALTH
DEPARTMENT AND NORTHEAST TEXAS
PUBLIC HEALTH DEPARTMENT.
OUR GOALS TO UNDERSTAND AND
ADDRESS COVID TESTING
DISPARITIES IDENTIFYING
VULNERABLE COMMUNITIES IN THOSE
NEIGHBORHOODS BASED ON SOCIAL
DETERMINANTS OF HEALTH AS WELL
AS COVID DISEASE BURDEN.
AND YOU CAN TELL THAT WE HAVE
CAMERON COUNT THEY IS SHOWN IN
THESE PARTS IN SOUTH TEXAS AND
IT HAS A LARGE POPULATION WITH
HISPANIC AND IN PARTICULAR
MEXICAN AND HISPANICS.
MEXICAN-AMERICANS.
WE HAVE HARRIS COUNTY AND THE
CITY OF HOUSTON.
THIS IS A VERY DIVERSE AND VERY
POPULATED CITY AND WE HAVE
NORTHEAST TEXAS INDICATED BY
THAT ORANGE COLOR AND THIS IS IN
NORTH TEXAS WHERE WE HAVE
RELATIVELY LARGE PERCENT OF
BLACK POPULATION AND ALSO MUCH
MORE RURAL COMMUNITIES COMPARED
TO THE OTHER REGIONS.
HOW DO WE USE SOME OF OUR
CURRENT PARTNERSHIP AND DATA
SETS TO IDENTIFY THE VULNERABLE
POPULATION?
AND INCREASING COVID TESTING
FROM 21 TO 22.
THE FIGURE ON THE RIGHT SHOWS WE
PLAN TO DO THE RANDOMIZED TRIAL
AND THEIR DIFFERENT ROUNDS ON
STARTING FROM GOING TO THE
COMMUNITIES AND IMPLEMENT THESE
INTERVENTIONS AND THEN HAVE TO
MOVE TO THE NEXT SET OF ROUNDS
AFTER THE SELECTION.
SO FROM THE FIGURES THAT YOU
ALREADY SEE, THERE IS DYNAMIC
PART OF THE SELECTIONS AND WE
REALLY WANTED TO BE ABLE TO
IDENTIFY THIS REALTIME
IDENTIFICATION OF THE VULNERABLE
POPULATION.
SO THE LAST PART IS PARTNER WITH
OUR COMMUNITIES AND STAKEHOLDERS
TODAY THE FIRST ITEM, HOW DO WE
IDENTIFY THE VULNERABLE
COMMUNITIES.
A COUPLE OF THINGS WE WANT TO
MAKE SURE WE CAPTURE.
THE FIRST THING I MENTIONED IS
WE KNOW THAT IN TEXAS,
GEOGRAPHICALLY IT'S VERY LARGE
AND VERY DIVERSE POPULATIONS.
WE ALSO KNOW FROM A LOT OF THE
STUDIES THAT THE SOCIAL
DETERMINANTS OF HEALTH PLAY A
SIGNIFICANT ROLE IN COMMUNITY
BURDEN AND HOW COVID MIGHT
IMPACT THEM.
AND THE OTHER PIECE WITH COVID
INFECTION AS YOU SEE ON THIS
TIME SERIES TREND OF THE COVID
CASES IN HARRIS COUNTY IS VERY
DYNAMIC.
AND IT COMES WITH -- WHAT IS
REQUIRED IS HOW TO CAPTURE THIS
DYNAMIC ASPECT OF A COVID CASE?
AND THE SOCIAL DETERMINANTS OF
HASHES ACTUALLY INCLUDED MORE
THAN 12 VARIABLES IN ACCESSING
THE SOCIAL DETERMINANTS OF
HEALTH ASPECT AND WE USED A
COMPONENT ANALYSIS COMBINING ALL
THESE MEASURES TOGETHER.
AND THAT GAVE US THIS MAP
SHOWING AT THE VERY GEOGRAPHIC
GRANULAR LEVEL WHERE THE MOST
IMPACTED COMMUNITIES ARE.
AND THAT IS INFORMATION SOURCED
INTO THE DESIGN OF THE
INTERVENTION TRIAL.
NEXT SLIDE, PLEASE.
JUST ILLUSTRATION OF THE DYNAMIC
ASPECT OF -- THESE ARE IN HARRIS
COUNTY, CAMERON COUNTY AND
NORTHEAST TEXAS COUNTIES.
AND WE ILLUSTRATED WHERE WE HAVE
IDENTIFIED.
WE CALLED THE UNIT MARKERS AND
THAT MEANS THESE ARE THE CENSUS
BLOCK GROUPS AND THESE ARE VERY
GEOGRAPHICALLY GRANULAR LEVEL OF
UNITS WHERE AT DIFFERENT REALMS
WE IDENTIFY THESE ARE THE
COMMUNITIES THAT ARE BEING
IMPACTED BY COVID THE MOST.
AND FROM THIS UNIVERSE, WE
IDENTIFIED AND SELECT THE CENSUS
BLOCK GROUPS FOR INTERVENTION
AND BECAUSE OF THE DYNAMIC
SELECTION NATURE OF THE
COMMUNITIES, WE ALSO HAVE TO
TAKE CONSIDERATION THAT THESE
UNITS FROM DIFFERENT REALMS HAVE
SUFFICIENT GEOGRAPHICAL
SEPARATIONS ALLOW US TO EVALUATE
THE INTERVENTIONS LATER ON.
THIS IS SHOWING SOCIAL
DETERMINANTS OF HEALTH AND COVID
BURDEN.
THERE IS JUST WITHIN HARRIS
COUNTY A SUBSTANTIAL GEOGRAPHIC
VARIATION.
AND ON THE RIGHT SIDE IS ANOTHER
DASHBOARD WE BUILT BUT NOW WE
ARE ACTUALLY PUTTING A LOT OF
ADDITIONAL RESOURCES SO OUR
WORKERS AND PARTNERS WILL HAVE
MORE INFORMATION TO HELP THEM DO
THE WORK.
AND I'LL PASS IT TO RACHEL TO
TALK MORE FROM THE COMMUNITY
PERSPECTIVE HOW THEY USE THESE
DASHBOARDS AND THEIR
PERSPECTIVE.
RACHEL.
>> THANK YOU DR. BAUER.
PLEASE, NEXT SLIDE.
SO I WANTED TO FIRST SAY THAT
HARRIS COUNTY PUBLIC HEALTH WAS
RESPONSIBLE FOR DISTRIBUTING,
TESTING FOR COVID AND
VACCINATIONS.
I WAS ACTIVATED IN THE COVID-19
RESPONSE AND THE INFORMATION THE
DASHBOARD JUST PRESENTED WAS
VERY HELPFUL.
AND SO, WE HAVE WHAT WE CALL
MOBILE UNITS, WHICH YOU WILL SEE
IN THESE PICTURES, WHICH DID GO
OUT FOR TESTING AND VACCINATION.
WE ALSO HAD STABLE SITES FOR
TESTING AND VACCINATION AS WELL.
AND SO, WE APPROACHED THIS WITH
A MULTI-LEVEL INTERVENTION
STRATEGY.
SO FIRST, DR. BAUER SHOWED A
DASHBOARD.
THIS HELPED THE COMMUNITY
UNDERSTAND WHERE THEY CAN GO FOR
TESTING AND VACCINATION.
AND WE INCLUDED MAPS LIKE THIS
ON OUR PUBLIC WEBSITE SO THAT
COMMUNITY MEMBERS COULD SEE
THEIR NEAREST LOCATION.
WHEN VACCINES BECAME AVAILABLE.
WE ALSO DELIVERED NAVIGATION AND
HAPPENS SO PEOPLE COULD FIND
WHERE THEIR TESTING AND
VACCINATION SITES WERE.
WE DID TRADITIONAL MEDIA,
FLYERS, POSTED THEM AT VARIOUS
COMMUNITY SHOPS AND.
>> THIS MULTILEVEL APPROACH
TOWARDS VACCINATION TESTING WAS
IMPROVED BY THIS OCCURRED WITH
UT SCHOOL OF PUBLIC HEALTH.
THIS HELPED US TO USE INNOVATIVE
WAYS TO IMPLEMENT THIS STRATEGY
AT THE COMMUNITY LEVEL.
-- PROVIDING DISTRIBUTION IN THE
COUNTY AND TARGETING THE MOST
VULNERABLE POPULATIONS AND THIS
INFORMATION THAT WE HAVE BEEN
TALKING ABOUT REALLY HELPED US
TO IDENTIFY THOSE NEIGHBORHOODS
AND EVEN LARGER GEOGRAPHIC UNITS
LIKE ZIP CODES AND BRING OUR
TESTING SITES AND VACCINATION
SITES.
SO SPECIFICALLY WE USED THESE
TYPES OF MAPS TO TARGET OUR
PUBLIC HEALTH INTERVENTIONS AND
THIS EXCHANGE REALLY ENABLED
COMMUNITY ENGAGED COLLABORATIVE
INTERVENTION.
>> SELECT AND RANDOMIZE
COMMUNITIES FOR INTERVENTION AND
TAKE CONSIDERATIONS OF THE
SOCIAL DETERMINANTS OF HEALTH.
>> THANK YOU.
ARE THERE ANY QUESTIONS?
FEEL FREE TO TYPE THEM IN THE
CHAT.
WE HAVE A SYMPOSIUM COMING UP
THIS MONTH.
SO EVERYONE, ESPECIALLY BECAUSE
OF COVID, BUT BEFORE COVID IS
REALLY STARTING TO RECOGNIZE THE
IMPORTANCE OF COMMUNITY HEALTH
WORKERS AND NAVIGATORS AND THEIR
ROLLS IN HELPING WITH HEALTH
OUTCOMES WITH DIFFERENT
POPULATIONS.
I DON'T KNOW IF YOU RECEIVED
FEEDBACK AND WANT TO SPEAK TO
THAT?
>> THIS IS SOMETIMES A BAD HABIT
WE GET INTO USING THAT LANGUAGE
BUT PRIORITY POPULATIONS AND
THAT'S THE WHOEL POINT OF
DR. BAUER'S PRESENTATION WHEN
YOU HAVE LIMITED RESOURCES AND
TIME, IT'S REALLY IMPORTANT TO
PRIORITIZE ONE OF THE
INFORMATIONAL -- ONE OF THE
REALLY IMPORTANT AND USEFUL
COMPONENTS OF THE COLLABORATION
WAS THE ABILITY FOR THE LOCAL
HEALTH DEPARTMENTS TO MAKE
DECISIONS AND THEY WERE ALREADY
THE MOST VULNERABLE.
THANK YOU FOR POINTING THAT OUT.
>> WE HAVE ONE ADDITIONAL
QUESTION.
PLEASE DESCRIBE HOW YOU SET UP
YOUR DASHBOARD VIA ESRI?
DEVELOPED IN HOUSE?
>> YES, WE DO EVERYTHING IN
HOUSE AND THAT'S WHY WE HAVE A
REALLY EXCELLENT TEAM THAT HAVE
THE DATA EXPERTISE AS WELL AS
THE DASHBOARD DEVELOPMENT.
SO THE DASHBOARD WE DEVELOPED
HAS THAT GS I SHOWED AND WE HAVE
OUR DASHBOARD WHICH USE A LOT OF
DATA SCIENCE TOOLS THAT BRING
ALL THE DATA PROCESSING ANALYSIS
AND DASHBOARD IN THE PIPELINE TO
ALLOW US TO DO DASHBOARD
DEVELOPMENT.
>> THAT WAS EXCITING TO LEARN
MORE ABOUT THE WORK GOING ON IN
TEXAS.
SO, WE WILL MIGHT HAVE TO OUR
THIRD PRESENTATION FOR THIS
SESSION.
COMMUNITY ENGAGED TESTING
POSITIVITY AND VACCINATION IN
MIAMI, FLORIDA.
RADX-UP PROJECTS 18 AND 87.
I'M IN COLLEGE OF PUBLIC HEALTH
AND MY CO-PRESENTER AND
DR. BROWN WHO SAY PROFESSOR AND
CHIEF OF FAMILY AND COMMUNITY
MEDICINE AT THE COLLEGE OF
MEDICINE.
WE ARE AT THE FLORIDA
INTERNATIONAL UNIVERSITY.
DR. BROWN IS A LEADER OF
NEIGHBORHOOD HEALTH WHICH IS A
COMMUNITY SERVICE PROGRAM WITH A
NETWORK OF 150 COMMUNITY PARTNER
ORGANIZATIONS AND ALSO THE CHAIR
OF THE COMMUNITY ADVISORY BOARD
AND COINVESTIGATOR IN RADX-UP.
NEXT SLIDE, PLEASE.
MOSTLY BLACK AND HISPANIC ADULTS
LIVING WITH CHRONIC DISEASES AND
WITH AND WITHOUT HIV IN THE MOST
VULNERABLE ZIP CODES OF
MIAMI-DADE COUNTY.
IN FLORIDA, OUR OVERALL AIM IS
TO INVESTIGATE ACCESS TO AND USE
OF COVID-19 PREVENTION.
TESTING AND TREATMENT AND
VACCINATION IN COLLABORATION
WITH COMMUNITY PARTNERS.
SO, YOU SEE THE MAP WHICH SHOWS
PRETTY MUCH THE DOWNTOWN AREA OF
DADE COUNTY.
WE WERE TO RECRUIT ONE HOURS 6
PARTICIPANTS AND ANOTHER 1600
PARTICIPANTS FOR PHASE II
PROJECT 87 WITH COMMUNITY
PARTNERS AND NEW PARTICIPANTS
AND TO GIVE SURVEY TO THE
PARTICIPANTS THAT WERE ALREADY
TESTED AND SURVEYED BEFORE.
AND WE ARE CONDUCTING A
LONGITUDINAL ANALYSIS ON THE
PARTICIPANTS WHO WERE TESTED
MORE THAN ONCE.
NEXT SLIDE, PLEASE.
A GREAT MAJORITY OF INFECTIONS
ARE FOUND IN MIAMI-DADE, AS YOU
CAN SEE BY THE DARK COLORS ON
THE MAP.
THIS WILL COUNTY EXPERIENCED --
ALSO EXPERIENCES A
DISPROPORTIONATE BURDEN OF
SOCIAL VULNERABILITY WITH HIGH
RATES OF POVERTY HOUSING
INSTABILITY, FOOD INSECURITY AND
DISABILITY AS WELL AS SUBSTANCE
ABUSE.
THE UNDER SERVED MINORITY
POPULATIONS EXPERIENCE MORE
DISPARITIES IN SOCIAL
DETERMINANTS OF HEALTH AND MAY
BE MORE EXPOSED IN TRANSMISSION.
WE WILL BE ABLE TO CONDUCT THE
STUDY BY LEVERAGING THE LARGE
EXISTING NETWORK OF STRONG
COMMUNITY PARTNER RELATIONSHIPS
AS WELL AS LEVERAGING AN
EXISTING NIH-FUNDED PROSPECTIVE
COHORT STUDY NAMED MIAMI ADULT
STUDIES ON HIV COHORT.
DR. BROWN PLEASE TAKE OVER.
>> SO IS THE NEIGHBORHOOD HEALTH
PROGRAM IS A COMMUNITY ENGAGED
PROGRAM INTEGRATED INTO THE
COLLEGE OF MEDICINE.
WE PARTNER WITH THESE DIFFERENT
COMMUNITY ORGANIZATIONS,
CHURCHES AND DAY CARE CENTERS
ET CETERA AND OUR OUTREACH TEAM
SPECIALISTS AND PROGRAM MANAGERS
WORK WITH THOSE ORGANIZATIONS
AND GET TO KNOW THEM, VOLUNTEER
AT THEM AND HAVE THEM REFER
PEOPLE WHO AREN'T HAVING THEIR
NEEDS MET INTO OUR PROGRAM.
OUR PROGRAM IS BASED ON TEAMS
MAKING LONGITUDINAL SERIES OF
HOME VISITS TO HOUSEHOLDS IN
MEDICALLY UNDERSERVED
NEIGHBORHOODS FOCUSING ON THE
SOCIAL DETERMINANTS OF HEALTH
AND BOTH MULTIDISCIPLINARY
OUTREACH TEAM AND COMMUNITY
UNIVERSITY COALITION WORK TO
ASSESS AND UNDERSTAND THE SOCIAL
NEEDS AND THEN TO PROVIDE
SERVICES EITHER DIRECTLY OR BY
REFERRAL BACK TO THIS COMMUNITY
NETWORK.
WE REACHED OUT TO OUR EXISTING
PARTNERS TO PARTICIPATE IN THE
COMMUNITY ADVISORY BOARD AND
ENGAGE THEM TO HELP US SET UP
TESTING EVENTS AND DEVELOPED
QUESTIONNAIRES VIA INFO GRAPHICS
AND LANGUAGES AND ENGAGING
COMMUNITY PARTNERS ON OUR TEAM.
ONE OF OUR PARTNERS PROVIDES
FOLLOW-UP CARE AND PUBLIC HEALTH
MITIGATION.
NEXT SLIDE.
SO, FOR RECRUITMENT, WE WENT TO
THESE SOCIOECONOMICALLY
DISADVANTAGED PREDOMINANTLY
BLACK AND HISPANIC
NEIGHBORHOODS.
WE PARTNERED WITH OUR COMMUNITY
ORGANIZATIONS TO IDENTIFY THE
BEST SITES FOR US TO HAVE
TESTING EVENTS GOING TO SCHOOLS
AND CHURCHES, FOR EXAMPLE.
BUT WE ALSO USED DR. BROWN'S
COHORT TO REACH OUT FOR TESTING
OF PEOPLE THAT HAVE BEEN
FOLLOWED UP AND SNOWBALL
SAMPLING TO OBTAIN ADDITIONAL
PARTICIPANTS FOR TESTING.
OUR PARTICIPANTS COMPLETED THE
COMMON DATA ELEMENTS AND HAD
TESTING DONE WITH RCPCR.
PARTICIPANTS WERE COMPENSATED
FOR COMPLETION OF THE DIFFERENT
STAGES OF THE PROJECT.
WE CONFIRMED VACCINATION OVER
80% OF THOSE WHO REPORTED THEY
HAVE BEEN VACCINATED BY REVIEW
OF MEDICAL RECORDS.
NEXT SLIDE.
SO WE ARE ABLE TO COLLECT CDS
AND TESTING FROM ALMOST 1800
PARTICIPANTS.
PROJECT 87 IS STILL ONGOING.
BEGAN COLLECTING CDEs IN MAY
OF 2022.
AND HAVE COMPLETED ABOUT 1200
PARTICIPANTS DOING THE TESTING
IN THE COMMUNITY AND COLLECTING
THE CDEs WAS VERY COMPLEX
ENDEAVOR SO WE WORKED WITH
PARTNERS TO RECRUIT PEOPLE IN
ADVANCE AND TO COMPLETE THE
QUESTIONNAIRES BY PHONE AND THEN
TO GO BACK AT A LATER TIME TO DO
A TESTING EVENT OR HAVE PEOPLE
COME TO OUR CLINIC FOR TESTING.
44% ARE HISPANIC.
63% HAD HIGH SCHOOL EDUCATION OR
LESS AND MORE THAN 1/3 ARE
LIVING WITH DISABILITY.
ANNUAL INCOME IS LESS THAN
15,000 DOLLARS PER YEAR.
THESE ARE VARIABLES ASSOCIATED
WITH TESTING.
WERE ADJUSTED FOR AGE, SEX, RACE
AND ETHNICITY AS WELL AS INCOME.
THIS SHOWS YOU THAT THOSE WHO
PERCEIVE POSITIVE RESULT IN
TESTING ARE 1 1/2 TIMES MORE
LIKELY TO BE TESTED FOR COVID-19
THAN THOSE WHO DID NOT THINK
POSITIVE RESULTS WERE ACCURATE.
THOSE WHO ARE CURRENTLY EMPLOYED
HAD INSURANCE COVERAGE, WERE
ALSO MORE LIKELY TO BE TESTED
AND FINALLY, THOSE WHO HAD
HIGHER EDUCATIONAL LEVEL WERE
ALMOST TWICE AS LIKELY TO BE
TESTED FOR COVID-19.
SO, NEXT SLIDE, PLEASE.
SO, I'M SORRY.
I GOT LOST HERE IN BETWEEN THESE
SO ON THE LEFT SIDE AGAIN,
REGRESSION ANALYSIS ADJUSTED FOR
THE SAME VARIABLES SHOW THAT
COVID-19 VACCINATIONS WHICH WE
OBTAIN EITHER WITH.
THOSE WHO LOST EMPLOYMENT INCOME
HAD CHALLENGES WITH
TRANSPORTATION.
CHALLENGES WITH FOOD INSECURITY
AND CHALLENGES WITH HOUSING AND
HEALTH CARE ACCESS WERE
SIGNIFICANTLY LESS LIKELY TO BE
VACCINATED AGAINST COVID-19.
ON THE OTHER HAND, THOSE WHO HAD
HIGH COVID RELATED WORRY AND HAD
HEALTH INSURANCE COVERAGE WERE
FAR MORE LIKELY TO BE VACCINATED
AGAINST COVID-19.
AND THEN, THOSE WHO BELIEVE THAT
COVID-19 VACCINATION WAS
EFFECTIVE, ALMOST 13 TIMES MORE
LIKELY TO HAVE BEEN VACCINATED
AS THOSE WHO DID NOT HAVE THAT
BELIEF.
AS FAR AS COVID-19 POSITIVITY,
WE HAD A TOTAL OF 22% WHO WERE
COVID-19 POSITIVE EITHER FROM
OUR OWN TESTING OR FROM THEIR
REPORTS.
AND THERE WAS SOME VARIABLES
ASSOCIATED WITH TESTING POSITIVE
ON COVID-19 TEST.
BELIEF THAT COVID-19 VACCINATION
IS EFFECTIVE ACTUALLY PREVENTED
APPROXIMATELY HALF OF THE
POSITIVE TESTS.
ON THE OTHER HAND, LOSS OF
HEALTH INSURANCE AND LOSS OF
EMPLOYMENT WAS ALMOST TWICE AS
MUCH ASSOCIATED WITH BEING COVID
POSITIVE.
WHAT ARE THE CHALLENGES?
RECRUITMENT HAD SOME CHALLENGES
BUT WE ALSO HAVE CHALLENGES WITH
TIMELY NOTIFICATION OF THIS HARD
TO REACH POPULATION.
THIS TOOK A LOT OF EFFORT
SOMETIMES MORE THAN 20 PHONE
CALLS AND OTHER WAYS OF CONTA
CONTACTING THIS INDIVIDUALS.
SEEMS PEOPLE ARE POOR, MAY NOT
HAVE PHONES OR MAY NOT ANSWER.
SO REACHING THEM TO REPORT THE
RESULTS WAS VERY TIME CONSUMING.
OUR KEY TAKEAWAYS WERE THAT
HAVING PARTNERSHIPS WERE CENTRAL
TO OUR COMMUNITY ENGAGEMENT
EFFORTS.
OUR FINDINGS ALSO REINFORCE THE
HEALTH BELIEF MODEL, BELIEFS
ABOUT VACCINATION, EFFICACY AND
TEST ACCURACY PREDICTED
BEHAVIORS AND OUTCOMES.
AND FINALLY, OUR FINDINGS ALSO
DEMONSTRATED THE IMPACT OF
SOCIAL DETERMINANTS OF HEALTH
WITH EMPLOYMENT AND HEALTH
INSURANCE IMPACTING BOTH TESTING
AND VACCINATIONS.
THAT CONCLUDES OUR PRESENTATION
AND I WOULD LIKE TO THANK THE
MIAMI-DADE COMMUNITY AND STUDY
PARTICIPANTS AND THE COMMUNITY
PARTNERS THAT HAVE PARTICIPATED
IN US BEING ABLE TO RECRUIT
THOUSANDS OF PARTICIPANTS.
THANK YOU VERY MUCH.
>> GREAT PRESENTATION.
ANY QUESTIONS?
AGAIN, FEEL FREE TO TYPE IN THE
CHAT OR RAISE YOUR HAND.
SOMEONE IS ASKING WHAT IS YOUR
SAMPLE SIZE?
>> SO WE SAW ALMOST 1,800
PARTICIPANTS.
WE EXCEEDED OUR GOAL AND PHASE
II WE ARE NOW 1,2000
PARTICIPANTS.
>> THERE IS ANOTHER QUESTION,
WHY IS HEALTH INSURANCE
IMPORTANT WHEN VACCINES ARE
FREE?
WERE YOU ABLE TOL DETERMINE THAT
FROM YOUR STUDY?
>> MOST LIKELY PEOPLE WERE NOT
AWARE THAT TESTING AND
VACCINATIONS WERE FREE.
>> ILS ALSO THINK THAT HEALTH
INSURANCE STAT SUSA MEASURE OF
SOCIOECONOMIC STATUS TO A DEG
DEGREE.
>> CAN YOU ELABORATE ON THAT
JUST A LITTLE BIT?
>> SO, PEOPLE -- IN FLORIDA, WE
HAVE NOT GOT MEDICAID EXPANSION.
SO THE UNINSURED OFTEN
REPRESENTS WORKING POOR
POPULATION.
THAT ISN'T POOR ENOUGH TO
QUALIFY FOR MEDICAID.
DOESN'T HAVE EMPLOYER-BASED
HEALTH CARE, ISN'T MAKING
SOMEHOW NOT ENOUGH MONEY FOR
SUBSIDIES AND SO WE SEE A LOT OF
PEOPLE AND THOSE WHO ARE
UNINSURED ARE OFTEN STRUGGLING
ON MANY DIFFERENT -- IN MANY
DIFFERENT WAYS.
MAYBE TRANSPORTATION, SECURITY,
HOUSING INSECURITY ET CETERA.
>> SO ALL OF THESE OTHER FACTORS
ALSO COME INTO PLAY.
NOT REALLY JUST ONE.
AND THEN ONE FINAL QUESTION.
IT SAYS ALL THE VARIABLES WERE
SIGNIFICANT IN YOUR PLOT.
WERE THERE ANY NON SIGNIFICANT
PREDICTORS AS WELL?
>> YES.
WE TESTED ALL THE CDEs THAT
WERE RELEVANT TO THESE
PARTICULAR RESULTS.
AND PRESENTED ONLY THE THE
SIGNIFICANT ONES.
>> THANK YOU.
THAT WAS A WONDERFUL
PRESENTATION.
AND THANK YOU FOR TAKING TIME TO
SHARE ABOUT YOUR WORK WE ARE
GOING TO MOVE ON TO OUR FINAL
PRESENTATION.
THEY WILL TALK ABOUT THEIR
STUDY, INCREASING COVID-19
TESTING WITH AFRICAN-AMERICAN
CHURCH, HEALTH AND ACADEMIC
PARTNERS, A FAITHFUL RESPONSE TO
COVID-19.
SO I'M GOING TO PASS IT TO YOU
ALL.
THANK YOU.
>> THANK YOU.
HELLO, EVERYONE.
I'M JANNETTE BERKLEY-PATTON.
I'M A PROFESSOR AT THE
UNIVERSITY OF MISSOURI, KANSAS
CITY IN THE SCHOOL OF MEDICINE.
MY DIRECT HEALTH EQUITY
INSTITUTE ALONG WITH OUR
COMMUNITY RESEARCH GROUP.
AND WE ARE GOING TO SHARE WHAT
WE ARE LEARNING WITH OUR
FAITHFUL RESPONSE TO COVID-19
PROJECT, PROJECT 44.
AND THE REST OF OUR TEAM WILL
INTRODUCE THEMSELVES AS THEY
BEGIN TO PRESENT.
I'D LIKE TO START BY SHARING
SOME OF OUR PROJECT GOALS.
SIMILAR TO THE OTHER STUDIES, WE
WANTED TO EXPAND COVID-19
TESTING WITH OUR
AFRICAN-AMERICAN CHURCHES AND
THE URBAN KANSAS CITY, MISSOURI
AREA.
WE WANTED TO EXAMINE OUR
RELIGIOUSLY AND CULTURALLY
TAILORED INTERVENTION AND IMPACT
ON TESTING RATES ALONG TO
UNDERSTAND THE DIFFERENT FACTORS
IN STRATEGIES THAT COULD
CONTRIBUTE TO WHETHER OR NOT A
PERSON WOULD RECEIVE TESTING IN
THE CHURCH SETTING.
AND THEN ULTIMATELY, WE WANTED
TO INCREASE THE COVID-19 TESTING
RATES WITH OUR AFRICAN-AMERICAN
CHURCHMEMBERS AND THE COMMUNITY
MEMBERS THAT THEY SERVE THROUGH
THEIR OUTREACH MINISTRIES LIKE
FOOD PANTRIES AND SOCI SOCIAL
SERVICES AND RECOVERY PROGRAMS.
NEXT UP WE'LL HAVE REVEREND
WILLIAMS WHO WILL TALK ABOUT HOW
OUR FAITH LEADERS SERVE AS FIRST
RESPONDERS TO COVID-19.
NEXT SLIDE.
>> THANK YOU DOCTOR JANNETTE
BERKLEY-PATTON.
MAYBE THE TERM, FIRST RESPONDERS
DOESN'T QUITE CLICK WHEN YOU
TALK ABOUT PREACHERS AND FAITH
LEADERS BUT THE REALITY IS THAT
IN MOST CASES, OUR COMMUNITIES
EXPECT US TO BE ON THE FRONT
LINE.
THEY EXPECT US TO BE THERE WHEN
SOMEONE IS ILL.
THEY EXPECT US TO CHIME IN WHEN
PEOPLE ARE HUNGRY AND SO, THIS
WAS ABSOLUTELY NO DIFFERENT.
AND WE HAD THE OPPORTUNITY TO
ACT AS FIRST RESPONDERS TO
EXPAND FOOD PROGRAMS.
WE FED SO MANY PEOPLE DURING
THIS INTERIM.
OF COURSE GRIEVE COUNSELING.
WHO ARE YOU GOING TO CALL?
IT'S YOUR PASTOR.
AND THE ROLE THAT WE PLAY, FAITH
LEADERS PLAY IN URBAN
COMMUNITIES IS ESPECIALLY
IMPORTANT AS WE ARE ABLE TO SIGN
PEOPLE IN AND ACT AS A LIAISON
BETWEEN ACADEMIC AND HEALTH AND
JUST ON THE GROUND PEOPLE THAT
NEEDED HELP, WE DEVELOPED THE
CLERGY RESPOND NETWORK SO WE CAN
ENGAGE MORE OF MY COLLEAGUES IN
FIGHTING THE BATTLE.
WE WANTED THEM TO HAVE THE RIGHT
TOOLS, THE INFORMATION AND THE
RESOURCES TO SHARE WITH THEIR
PARISHIONERS AND THEIR COMMUNITY
THAT SURROUNDED THEM.
I'D LIKE TO INTRODUCE CAROLE
THOMPSON WHO WILL TAKE IT FROM
HERE.
>> THANK YOU REVEREND OF
REVEREND WILLIAMS.
MY NAME IS CAROLE THOMPSON AND
I'M THE PROJECT DIRECTOR FOR OUR
COMMUNITY HEALTH RESEARCH GROUP.
AS OF MANY OF YOU, WE DEVELOP
OUR RESEARCH INTERVENTIONS USING
A COMMUNITY-BASED PARTICIPATORY
RESEARCH APPROACH WITH OUR
AFRICAN-AMERICAN FAITH LEADERS.
WE SAY WE DRINK THE CDPR
KOOL-AID BECAUSE WE BELIEVE IN
THE PROCESS AND HAVE WITNESSED
INFLUENCE AND IMPACTS ON OUR
PARTNERSHIPS.
FOR THIS STUDY, LIKE REVEREND
WILLIAMS SAID, HE PULLED
TOGETHER THIS.
HE IS SELFED NAMED CLERGY
RESPONSE NETWORK AND INVITED US
TO THE TABLE WHERE WE WORKED
WITH THEM TO SET THE RESEARCH
AGENDA AND DESIGN THE
INTERVENTION, EVALUATE THE
INTERVENTION'S IMPLEMENTATION
PROCESS, DISSEMINATE OUTCOMES
AND ULTIMATELY PROVIDE A PROJECT
TO HAVE DEEP IMPACT WITH A LONG
TERM SUSTAINABILITY IN OUR FAITH
COMMUNITY TOOLS WOULD BE
NEEDED TO SUPPORT THEIR EFFORTS
TO ENCOURAGE COVID-19 PREVENTION
AND TESTING ACTIVITIES AT THEIR
CHURCHES.
TOGETHER WE DEVELOPED A
RELIGIOUSLY AND TAILORED AND
CULTURALLY TAILORED TOOLKIT WITH
THE INNOVATION BEING HOW THESE
TOOLS AND MATERIALS COULD BE
DELIVERED NATURALISTICALLY WITH
THEIR NEW WAY OF CONVENING THEIR
CONGREGATES.
TOOLS LIKE BROCHURES AND FACT
SHEETS WERE CREATED IN
ELECTRONIC VERSIONS ABLE TO BE
UPLOADED ON OUTLETS AND TO
PROJECTION SCREENS WHILE THEY
ARE SOCIALLY DISTANCED IN THEIR
PEWS.
THEY ALSO HELPED US DESIGN A
CATALOG OF CULTURALLY AND
RELIGIOUSLY TAILORED TEXT
MESSAGES DELIVERED DAILY AND
INCLUDED MESSAGES LIKE, GOD
KNOWS YOUR HEART BUT DO YOU KNOW
YOUR STATUS?
GET TESTED FOR COVID-19 AND STAY
SAFE.
FIND OUT WHEN TESTING IS OFFERED
AT YOUR CHURCH.
WE STRONGLY BELIEVE THAT PASTORS
NEEDED TO ROLE MODEL IN FRONT OF
CONGREGATES TO REDUCE THE FEAR.
WE ALSO WANTED TO BE SURE THE
TESTING PROCESS WAS COMFORTABLE,
RESULTS WERE RECEIVED QUICKLY
AND THAT PROVIDING DRIVE UP
TESTING WOULD BE AN OPTION.
SO NEXT OUR PARTNER, LESHA DENNY
WILL TALK ABOUT THE TESTING
PROCESS -- YOU'RE MUTED.
>> THANK YOU, CAROLE.
AGAIN, I'M LESHA DENNIS,
EPIDEMIOLOGIST WITH THE KANSAS
CITY HEALTH DEPARTMENT.
WE WANTED TO LEVERAGE TECHNOLOGY
TO EFFICIENTLY MEET PROJECT
DEMANDS.
WE COLLABORATED TO CUSTOMIZE
SOFTWARE THAT ALLOW FOR ONLINE
REGISTRATION BOTH PRE EVENT AND
ON SITE.
WE WORK WITH CHURCH LIAISONS TO
NOT ONLY COORDINATE TESTING
EVENT DATES BUT ALSO MAP OUT
LOGISTICS OF SERVICE DELIVERY
FOR EACH EVENT.
AGAIN, WE WANTED TO INCREASE
COVID ACCESS TO COVID-19 TESTING
SO TESTING WAS OFFERED AFTER
SUNDAY CHURCH SERVICES, DURING
MID-WEEK SERVICES AND DURING
COMMUNITY OUTREACH EVENTS N
CHURCH PARKING LOTS AND
FELLOWSHIP HALLS.
TO ENSURE WE HAD ENOUGH STAFF TO
EFFICIENTLY PROVIDE TESTING, WE
WORK WITH THEM TO TRAIN THEIR
MEDICAL STUDENTS ON SITE BEFORE
EACH EVENT.
ADDITIONALLY, UNIQUE TO THIS
STUDY, OUR HEALTH DEPARTMENT
CONTACT TRACERS INTRODUCE
THEMSELVES AT EACH TESTING EVENT
AND ALSO SERVED AS COMMUNITY
HEALTH WORKERS IN PROVIDING
SERVICES.
LASTLY, TO ADDRESS FAITH-HELD
LEADERS CONCERNS ABOUT
UNCOMFORTABLE NASAL TESTING,
SELF-ADMINISTERED PCR TEST THAT
ONLY NEEDED TO GO INTO THE
NOSTRIL ABOUT A QUARTER OF AN
INCH WAS USED.
TEST RESULTS WERE AVAILABLE
WITHIN 24-48 HOURS.
DR. JANNETTE?
>> NEXT SLIDE.
THANK YOU.
SO I WANT TO TAKE A LITTLE BIT
OF TIME AND REVIEW OUR RESEARCH
DESIGN DRIVEN BY OUR RESEARCH
QUESTION WHICH WAS, CAN A
RELIGIOUSLY AND CULTURALLY
TAILORED FAITH-BASED
INTERVENTION INCREASE TESTING
RATES COMPARED TO A STANDARD
COVID-19 INTERVENTION?
WE ANSWERED USING A RANDOMIZED
CONTROL TRIAL WITH 16 AFTERCAN
AMERICAN CHURCHES.
OUR ANALYSIS -- AFRICAN-AMERICAN
CHURCHES.
WE NEEDED 960 PARTICIPANTS AND
THE 16 CHURCHES WERE RANDOMIZED
TO TWO STUDY ARMS.
EITHER TAILORED FAITHFUL
RESPONSE OR NON TAILORED
EDUCATION INTERVENTION.
EACH CHURCH PARTICIPATED FROM
ABOUT 4-6 MONTHS.
EACH CHURCH ALSO CONDUCTED TWO
COVID-19 TESTINGS AT THEIR
CHURCH.
AND THEN WE ASSESSED THE
OUTCOMES OF THE STUDY USING A
BASELINE AND 6 MINUTE FOLLOW-UP
SURVEY WITH OUR PRIMARY OUTCOME
BEING RECEIPT OF COVID-19 TEST.
AND WE COLLECTED DATA FROM OUR
HEALTH DEPARTMENT ON THE NUMBERS
OF PEOPLE TESTED WHICH WILL BE
SHARED WITH YOU TODAY.
ALONG WITH SELF REPORT FROM OUR
PARTICIPANTS.
NEXT SLIDE.
AS FAR AS OUR STUDY PARTICIPANTS
ARE CONCERNED, OUR CHURCHES WERE
IN THE URBAN KANSAS CITY,
MISSOURI AREA.
150 CHURCHMEMBERS OR THAT'S WHAT
THE PASTORS TOLD US.
THEY DID NEED TO HAVE ONGOING
COMMUNITY OUTREACH MINISTRY
ALONG WITH COMMITTED PASTOR AND
CHURCH HEALTHILY A SONS WHO WERE
PAID ALONG WITH OUR PARTICIPANTS
WHO WERE ADULT
AFRICAN-AMERICANS.
THEY NEEDED TO BE A REGULAR
CHURCH MEMBER WHICH WE
IDENTIFIED AS ATTENDING CHURCH
AT LEAST ONCE A MONTH OR A
COMMUNITY MEMBER RECEIVING
OUTREACH SERVICES ABOUT 4 TIMES
A YEAR.
THEY NEEDED TO BE ABLE TO SPEAK
ENGLISH AND COMPLETE THE SURVEY
INDEPENDENTLY BUT OF COURSE WE
PROVIDED SUPPORT WHEN NEEDED.
NEXT SLIDE.
SO HERE IS SOME OF OUR RESULTS
AS FAR AS OUR PARTIS PAINTS ARE
CONCERNED.
OUR GOAL WAS 960.
WE RECRUITED 981 PARTICIPANTS.
WE WERE EXCITED ABOUT THAT IN
DOING SO DURING THE HEIGHT OF
THE PANDEMIC.
THOSE PARTICIPANTS WERE
PRIMARILY CHURCHMEMBERS AND
FEMALES.
WE TYPICALLY SEE ABOUT 60-70% OF
FEMALES IN OUR STUDIES.
AND THE AVERAGE AGE WAS 51.
NEXT SLIDE.
I LIKE TO HIGHLIGHT A FEW OF OUR
COVID-19 RISK AND SOCIAL
DETERMINANTS THAT WERE REPORTED
BY OUR PARTICIPANTS.
ONE BEING THAT 70% OF OUR
PARTICIPANTS REPORTED THEY WERE
LIVING WITH EXISTING HEALTH
ISSUES.
WHICH REALLY TELLS US WE WERE IN
THE RIGHT PLACES IN CHURCHES
REACHING PEOPLE WHO WOULD BE AT
RISK FOR COVID-19 AND POSSIBLY
OTHER HEALTH CONCERNS.
AND ALSO ABOUT A THIRD OF OUR
PARTICIPANTS REPORTED HAVING
FOOD INSECURITY AND ALMOST 20%
WITH TRANSPORTATION CHALLENGES.
AGAIN HIGHLIGHTING THE FACT THAT
SOCIAL DETERMINANTS WERE IN PLAY
THAT COULD GET IN THE WAY OF
PEOPLE GETTING TESTED AND HAVING
BASIC NEEDS MET.
NEXT SLIDE.
THEN ALSO AS FAR AS OUR REASONS
WHY PEOPLE REPORTED GETTING
TESTED, I'LL HIGHLIGHT A COUPLE.
ONE BEING THAT PEOPLE WERE
CONCERNED IF THEY TESTED
POSITIVE, THAT PEOPLE WILL
CONTACT PEOPLE THEY KNEW.
WE WERE TOLD THIS EARLY ON IN
CONCEPTUALIZING THE STUDY WITH
THE CRN AND SO PLANNED FOR OUR
CONTACT TRACERS TO BE AT THOSE
TESTING EVENTS AND THEN ALSO
ABOUT 50% SAID THEY DIDN'T HAVE
SYMPTOMS.
WE WANTED TO ENCOURAGE TESTING
FOR ANYONE WHO DIDN'T HAVE
SYMPTOMS EVEN IF THEY DIDN'T
HAVE SYMPTOMS TO NORMALIZE THE
TESTING.
NEXT SLIDE.
SO AS FAR AS OUR NUMBERS WHO --
NUMBERS OF TESTS GIVEN, OVER ALL
THE TEST IS 635 PEOPLE.
YOU CAN SEE OUR INTERVENTION ARM
AND TESTING 414 AND DELIVERING
414 TESTS OUTPERFORMED THE
COMPARISON ARMS BY NEARLY TWICE
AS MANY TESTS.
NEXT SLIDE.
AND THEN LASTLY, SOME OF OUR
LESSONS LEARNED.
OUR FAITH COMMUNITY AS FIRST
RESPONDERS IS CRITICALLY
IMPORTANT.
CERTAINLY HISTORICALLY AND EVEN
NEEDED NOW.
WE FOUND THAT PROVIDING COVID-19
TESTING AT A NON TRADITIONAL
TIME AND NON TRADITIONAL PLACES
WAS HIGHLY FEASIBLE.
WE KNOW THAT WHAT THE PASTOR
SAYS MATTERS.
IF THE PASTOR SAYS GET IN LINE
AND GET TESTED, USUALLY PEOPLE
WILL LINE UP.
AND THAT USING THIS TYPE OF
PARTNERSHIP BETWEEN CHURCHES,
HEALTH AGENCIES AND ACADEMIC
INSTITUTIONS MAY BE PART OF THE
SECRET SAUCE FOR INCREASING
ACCESS TO HEALTH SERVICES.
AND THAT CONCLUDES OUR
PRESENTATION.
THANK YOU.
>> THANK YOU.
THAT WAS AN AMAZING
PRESENTATION.
WE HAVE A QUESTION IN THE CHAT.
SO THEY WANTED TO KNOW HOW WERE
YOU ABLE TO NAVIGATE AROUND THE
COVID RESTRICTIONS FOR CHURCHES
LIKE GOING VIRTUAL SO YOU COULD
MEET YOUR GOAL?
>> YOU WANT TO ANSWER THAT?
>> ABSOLUTELY.
SO YOU KNOW, WHEN DESIGNING THE
TOOLS, WE TRIED TO FIGURE OUT
HOW TO DEVELOP TOOLS THAT WOULD
NATURALISTALLY INTEGRATE IN HOW
THE CHURCH WAS DOING BUSINESS
DURING COVID.
THAT WAS ELECTRONIC.
MANY OF THE TOOLS WERE DEVELOPED
TO BE PRESENTED ON A PROJECTOR
SCREEN.
ALSO THOSE TOOLS WERE DEVELOPED
TO BE UPLOADED INTO THE SOCIAL
MEDIA PLATFORMS WITH LIVE LINKS
SO THEY COULD LINK TO MORE
RESOURCES AND EDUCATION OUTLETS
THROUGH THE CDC.
AND SO, ALL OF THOSE TOOLS WERE
DEVELOPED ELECTRONICALLY AND
INTEGRATED INTO THE CHURCHES.
SO IT WAS ON THE CHURCHES TO
KIND OF CONNECT WITH THEIR AUDIO
VISUAL TEAM AND MAKE SURE THESE
TOOLS WERE UPLOADED AND
UTILIZED.
AND THEY DID A REALLY GOOD JOB.
I MEAN A GREAT JOB OF
INTEGRATING THE TOOLS
ELECTRONICALLY.
>> AWESOME.
SO ANOTHER QUESTION THAT CAME
IN.
THIS WAS DONE AT THE HEIGHT OF
THE PANDEMIC.
BUT HAVE THE CHURCHES YOU ALL
WORKED WITH CONTINUED TO PROMOTE
TESTING AND THE BOOSTERS?
>> REVEREND WILLIAMS?
>> LET ME TRY TO ANSWER THAT.
I THINK THE ANSWER WOULD BE
DEFINITELY YES.
I THINK ESPECIALLY SINCE MANY OF
US HAD TO LOCKDOWN.
IT WAS THE WAY THAT WE COULD
KEEP TRACK AND WE COULD KEEP IN
COMMUNICATION WITH FOLKS.
AND OF COURSE YOU HAVE THE
TRACKERS AND PEOPLE THAT DON'T
BELIEVE THAT THIS PANDEMIC EVER
EXISTED.
BUT WE CONTINUE TO BE TRUSTED
PARTNERS IN HELPING PEOPLE MOVE
TO THE NEXT LEVEL AND THINKING.
SO IT'S STILL TREMENDOUS.
>> GREAT.
I HAVE ANOTHER QUESTION.
DID YOU ALL INVOLVE HEALTH CARE
PROFESSIONALS WITHIN THE
CHURCHES IN THE PLANNING OR
OTHER PARTS OF THE STUDY?
>> I'LL TAKE THAT ONE.
OUR CHURCH HEALTHILY A SONS,
MANY OF THEM WERE JUST PEOPLE
WHO WERE REALLY CONCERNED ABOUT
COVID-19.
WE TRAINED THEM.
THEY PARTICIPATED IN AT LEAST
TWO GROUP TRAININGS AND THEN ONE
VIRTUAL TRAINING AND THEN
ONE-ON-ONE TRAININGS AS WELL.
IN SOME CASES THEY MAY HAVE BEEN
HEALTH PROFESSIONALS BUT WE WERE
TRYING TO DEMONSTRATE THAT THIS
INTERVENTION COULD BE EASY TO
IMPLEMENT.
LIKE CAROLE SAID, USING A LOT OF
THE ELECTRONIC TOOLS AND ALSO
EVEN WHEN THEY DECIDED TO COME
BACK IN PERSON, THE TOOLS COULD
STILL BE DELIVERED AS THEY
FOLLOWED THEIR RESTRICTION
GUIDELINES WHETHER THAT WAS
HAVING PEOPLE SIT IN EVERY OTHER
PEW, HAVING PEOPLE COME ON EVERY
OTHER HEALTH EVENT AS FAR AS
LAST NAME WAS CONCERNED.
OUR CHURCHES DID PARKING LOT
SERVICES.
AND REALLY GOT CREATIVE IN HOW
TO CONVENE THEIR PEOPLE.
SO WE WANTED TO MAKE SURE THAT
NO MATTER HOW THEY REACHED OUT
TO THEIR PARISHERSERS AND
COMMUNITY MEMBERS THAT THEY HAD
THE TOOLS AND TRAINING TO DO
THAT, WHETHER OR NOT THEY WERE A
HEALTH PROFESSIONAL.
>> ALL RIGHT.
SO WE'LL TAKE A COUPLE MORE
QUESTIONS.
SOMEONE WANTED TO KNOW DID YOU
FIND CERTAIN DENOMINATIONS WERE
MORE RECEPTIVE TO THE COVID-19
MESSAGING?
OR WAS THIS PRIMARILY FOCUSED
WITHIN ONE DENOMINATION?
>> REV, DO YOU WANT TO ANSWER
THAT?
>> MULTIPLE DENOMINATIONS.
AND AGAIN, IT'S ABOUT TRUST.
AND SINCE WE HAVE BEEN DOING
THESE COMMUNITY COLLABORATIONS
FOR YEARS WITH HIV AND DIABETES
AND HEART DISEASE, IT'S JUST A
NATURAL FIT.
THEY TRUST US AND THEY FOLLOW
ALONG.
>> AND I DO REMEMBER JUST BEFORE
WE GET TO THE LAST QUESTION, YOU
ALL TALKING ABOUT IN A PREVIOUS
PRESENTATION HOW THIS HAS BEEN A
LONG TERM PARTNERSHIP.
YOU HAD THIS RELATIONSHIP EVEN
BEFORE COVID.
SO I THINK THAT SPEAKS TO THE
IMPORTANCE OF BUILDING
PARTNERSHIPS AND THEN CONTINUING
THOSE PARTNERSHIPS EVEN OUTSIDE
OF FUNDING TIMES AND THINGS LIKE
THAT.
SO --
>> ABSOLUTELY.
I WANT TO COMMENT REAL QUICKLY
THAT WE HAVE PARTNERED WITH THE
HEALTH DEPARTMENT AND LESHA AT
THE HEALTH DEPARTMENT FOR MORE
THAN 12 YEARS ON A NUMBER OF
DIFFERENT STUDIES THAT REVEREND
WILLIAMS NAMED OFF.
SO MAINTAINING THOSE
RELATIONSHIPS WERE KEY,
ESPECIALLY IN ADDRESSING
COVID-19.
>> AND WE HAVE LIKE ONE MORE
QUESTION I'D LIKE TO TAKE TOO.
I THINK IT'S -- HOW DID YOU
REACH OUT TO PEOPLE WITHOUT
HOUSING?
AND SO, OUR CHURCHES HAVE THEIR
TENTACLES IN THE COMMUNITY.
THEY HAVE THEIR FOOD PANTRIES.
CLOTHING DRIVES AND AS REVEREND
WILLIAMS SAID, A LOT OF FOOD WAS
DELIVERED.
OUR CHURCHES REACHED OUT TO ALL
OF THOSE FOLKS THAT RECEIVE
SERVICES THROUGH THEIR OUTREACH
MINISTRIES AND THAT IS HOW WE
CONNECTED WITH THE HOMELESS
POPULATION AS WELL.
THEY CAME IN THROUGH THOSE
OUTREACH MINISTRIES AND WE HAD
SPECIFIC TESTING EVENTS, TWO
TESTING EVENTS WITHIN A 6 MONTH
PROJECT.
AND FOR BOTH THE INTERVENTION
AND COMPARISON CHARGES AS TO
THOSE POINTS EARLIER.
AND WE TARGETED THE CONGREGANTS
WITH ONE TESTING EVENT AND THE
OUTREACH MEMBERS WITH ANOTHER
TESTING EVENT.
SO THAT IS HOW THEY WERE EXPOSED
TO THE INTERVENTION.
>> OKAY.
AWESOME.
I THINK THAT SPEAKS TO THE LAST
QUESTION ABOUT IF THE
PARTICIPANTS IN THE STUDY
REPRESENTED A SIGNIFICANT
PORTION OF MEMBERS OF THE
PARTICIPATING CHURCHES OR WERE
THEY COMING FROM OTHER AREAS OR
CONGREGATIONS?
>> YES, MOST OF THE PARTICIPANTS
IN THE STUDY WERE MEMBERS OF THE
CHURCHES.
OR THOSE COMMUNITY MEMBERS USING
OUTREACH MINISTRIES.
I DO HAVE TO SAY FOR THE TESTING
NUMBERS THAT WE SHARED, THOSE
ARE OBJECTIVE DATA AT THIS
POINT.
AND THOSE ARE REPRESENTING
ANYBODY WHO RECEIVED A TEST.
YOU DID NOT NEED TO BE A STUDY
PARTICIPANT TO TAKE ADVANTAGE OF
FREE TESTING IN ONE OF THE
PARTICIPATING CHURCHES, WHETHER
IT WAS INTERVENTION OR
COMPARISON CHURCH.
WE WANTED TO MAKE SURE THAT
ANYONE WHO WANTED TO GET TESTED
COULD GET TESTED AS WE TRACKED
THOSE WHO WERE ENROLLED AS
PARTICIPANTS IN OUR STUDY.
WE WILL BE ABLE TO ANALYZE AND
SHARE THAT DATA AT A FUTURE
TIME.
>> ALL RIGHT.
WELL, THANK YOU.
WE REALLY APPRECIATE IT.
WONDERFUL WORK.
SO, NOW WE ARE GOING TO TAKE A
BREAK.
THIS CONCLUDES THE FIRST SESSION
OF PRESENTERS.
I WANT TO THANK ALL THE
PRESENTERS FOR COMING SHARING
THEIR WORK.
SO WE'LL TAKE A 20-MINUTE BREAK
AND THEN WHEN WE RETURN, WE ARE
GOING TO START WITH OUR POSTER
SESSION, WHICH IS THE FIRST FOR
US THIS YEAR.
WE ARE REALLY EXCITED ABOUT
THAT.
AND THEN AFTER THE POSTER
SESSION WE WILL HAVE OUR FINAL
BLOCK OF PRESENTERS.
SO, TAKE 20 MINUTES, STRETCH
YOUR LEGS AND WE WILLY SEE YOU
BACK.
WE ARE GOING TO START THE NEXT
SESSION OF PRESENTATIONS.
SO WE'RE GOING TO CONTINUE WITH
FOUR MORE PRESENTATIONS AS
BEFORE.
EACH WILL BE APPROXIMATELY 10
MINUTES AND THEN WE'LL HAVE
APPROXIMATELY 5 MINUTES FOR Q&A
IF YOU HAVE QUESTIONS, PUT THEM
IN THE CHAT OR IF YOU WANT TO
RAISE YOUR HAND AND ASK YOUR
QUESTION, FEEL FREE TO DO THAT.
SO OUR NEXT PRESENTATION IS FROM
THE PROJECT TEAM WORKING WITH
THE NORTHERN PLAINS TRIBE AND
THE TITLE IS THE PROOF IS IN THE
PUDDING: VALIDATION OF COVID-19
MONITORING METHODS, BUILDING
CAPACITY AND INDIGENOUS DATA
SOVEREIGNTY WITH THE NORTHERN
PLAINS TRIBE AND THE FUTURE OF
PANDEMICS.
I HAND IT OFF TO YOU ALL.
>> THANK YOU RADX-UP FOR HAVING
US HIGHLIGHT SOME OF OUR KEY
WORK AND ADVOCACY BUILDING WITH
THE NORTHERN PLAINS TRIBE.
I'M JENNIFER AND I'M THEY WOULD
TO HAVE COPRESENTING KALI DALE
WHO IS THE POSTDOC AT THE
CONSORTIUM AS WELL AS JOSEPH
YRACHETA, IN THE DATA
SOVEREIGNTY PIECE AND THE
EXECUTIVE DIRECTOR.
AND WE REALLY HAVE A SPECIAL
COLLABORATION.
NEXT SLIDE, PLEASE.
AS A RESEARCHER WORKING WITH THE
NORTHERN PLAINS TRIBE FOR WELL
OVER A DECADE, WE OFTEN SEE
TRIBES AS SPECIAL POPULATIONS
THAT RETAIN A CULTURE CUSTOMS
LANGUAGES AND BECAUSE OF THEIR
RELATIVE ISOLATION THEY ARE
USUALLY OF GREAT INTEREST TO
RESEARCHERS BECAUSE OF GENETIC
UNIQUENESS AND INDIGENOUS
COMMUNITIES ARE VERY INTERESTED
IN BIG DATA SCIENCE.
WE ALSO NEED TO BE COGNIZANT
THAT DNA IS SACRED, WITH A DEEP
RELIGIOUS SIGNIFICANCE AS WELL
AS PART OF ESSENCE OF THE
PERSON.
SO THIS LED TO -- NEXT SLIDE.
THANK YOU.
COLLABORATION WITH SPHERE, WHICH
HAD THREE PROJECTS AND THE FIRST
BEING THE BIOREPOSITORY
BUILDING.
AND THAT BOTH SPEAKS TO BUILDING
CAPACITY AS WELL AS THE DATA
SOVEREIGNTY PIECE BECAUSE IT'S
THE FIRST-OF-ITS-KIND BIOBANK
HELD WITHIN THE TRIBE.
NOW THAT BIOBANK IS THE NATIVE
BIODATA CONSORTIUM.
HERE ON THE RIGHT YOU CAN SEE
THAT THIS IS FIRST-OF-ITS-KIND
BIOBANK.
RUN BY INDIGENOUS COMMUNITY AND
HELD WITHIN INDIGENOUS LAND.
NEXT SLIDE, PLEASE.
SO THIS IS SOUTH DAKOTA NINE
TRIBES HERE AND WE HAVE
PERMISSIONS TO WORK WITH THE
SIOUX TRIBE AT THE CENTER OF THE
MAP IN BROWN.
AND AS MOST TRIBES WERE HEAVILY,
HEAVILY DISPROPORTIONATELY
AFFECTED BY COVID-19 IN 2020,
EVEN THE ABILITY TO DO TESTING
HAD TO BE SENT TWO HOURS AWAY
FROM THE TRIBE TO GET RESULTS
BACK.
AND WITH POSITIVE RATES OF 37%,
DEATHS IN THE SPRING OF 2020,
HEAVILY HIT AND THIS IT HAPPENED
THROUGHOUT 2021 TO 2022 WITH A
DIFFERENT VARIANCE ALSO
AFFECTING THE TRIBE HEAVILY.
WITH THE NATIVE BIODATA
CONSORTIUM, WE WERE ABLE TO
IMAGINE THIS PIECE, WHICH IS
HAVING A LOCAL ABILITY TO DO
DIFFERENT TYPES OF MONITORING,
TESTING IN THE TRIBE WITH THE
LAB COMPONENT OF THE NATIVE
BIODATA CONSORTIUM.
NEXT SLIDE, PLEASE.
AND SO WITH THIS TRIBAL BUILD
OUT OF COVID-19 BRANCH OR VIRAL
TESTING BRANCH, THIS IS OUR MAIN
FOCUS OF THIS WORK.
NOT ONLY BUILD THE LAB BUT ALSO
GAIN INSIGHTS FROM OUR LOCAL
COMMUNITY ADVISORY BOARD AS WELL
AS SCIENCE ADVISORY GROUP AND I
MENTIONED SPHERE, DR. BONNIE
MALDONADO IS THE HEAD SCIENTIST
AND THE HEAD PI AND ALSO
INFECTIOUS DISEASE SCIENTIST AND
EXPERT HERE AT STANFORD ON THE
SCIENCE ADVISORY GROUP.
WE HAD KEY ENGAGEMENT EXPERTS,
TRIBAL VENTURES BEING ONE OF
THEM AND WE WERE ABLE TO BOTH
LEARN WITH THE TRIBAL COMMUNITY
OF WHAT THE PANDEMIC WAS -- HOW
IT WAS AFFECTING THEM AS WELL AS
THE DIFFERENT TYPES OF LATEST
AND THE GREATEST OF THE
STANDARDS OF TESTING.
THIS INCLUDED THE GOLD STANDARD
YPCR.
SO I'LL FORWARD THIS TO CALI.
>> NEXT SLIDE, PLEASE.
SO LIKE JENNIFER SAID, THE MAIN
PART OF THE PROECT JUDGE WAS
ABOUT BUILDING CAPACITY AND WE
BUILT CAPACITY IN FOUR DIFFERENT
WAYS.
AND I'LL BE SPECIFICALLY TALKING
ABOUT HOW WE BUILT LAB TESTING
FACILITY CAPACITY ON THE
RESERVATION.
AND THEN HEALTHPOLOGIY CAPACITY.
WE ARE USING OUR CAPACITY, THE
CAPACITY THAT WE BUILT WAS USING
CERTIFICATION WITH
STATE-OF-THE-ART GENOMIC AND
COVID SEQUENCING.
WE ARE ALSO BUILDING SUSTAINABLE
HEALTH RESOURCES BY STORING AND
PROTECTING TRIBAL DATA SO THAT
THE COMMUNITY CAN AT A MOMENT'S
NOTICE, USE THIS DATA TO -- IT
HELPED THE COMMUNITY IN THE WAYS
IT NEEDS TO AND WE ARE --
WORKING WITH EXPERTS ON
PROTECTING THAT DATA AND SO THAT
IT STAYS ON OWNED BY THE TRIBE.
NEXT SLIDE, PLEASE.
SO SPECIFICALLY, NATIVE BIODATA
CONSORTIUM IS PROVIDING HIGH
RESOLUTION MONITORING THE COVID
BEFORE AND AFTER THE PANDEMIC
STATUS.
AND FOR THE COMMUNITY'S HEALTH.
WE ARE SEQUENCING THE SARS-COV-2
VIRUS FOR VARIANT DETECTION AND
CALLING.
AND WE ARE IMPLEMENTING THIS
BECAUSE IT'S IMPORTANT TO
UNDERSTAND WHERE THIS VIRUS IS
COMING FROM AND WHERE IT'S GOING
AND HOW IT'S CHANGING.
AND THE U.S. HASN'T BEEN ABLE TO
IMPLEMENT THIS WIDELY.
WE ARE ALSO ABLE TO PROCESS
SAMPLES AT A HIGH LEVEL AND WE
ARE JUST AN ALLY IN THIS
MONITORING PROCESS BECAUSE WE
ARE COMMUNICATING WITH OUR
TRIBAL HEALTH FACILITIES TO
DESCRIBE AND RECOMMEND WHAT IS
HAPPENING WITH LONG COVID.
NEXT SLIDE, PLEASE.
THE TESTING INTERVENTIONS THAT
WE ARE USING IS THE GOLD
STANDARD QPCR USING A RAPID QPCR
METHOD USING THIS INSTRUMENT AND
WE ARE USING THE ALUMINA NEXT
GENERATION SEQUENCER TO SEQUENCE
SARS-COV-2 FOR DETECTION AND
CALLING.
NEXT SLIDE, PLEASE.
OTHER DIAGNOSTIC INTERVENTIONS
THAT WE ARE WORKING ON BUT WILL
NOT TALK ABOUT TODAY IS LOOKING
AT PLASMA SERUM TO LOOK AT THE
IMMUNE RESPONSE OF COVID
PATIENTS.
AND WEARABLES FOR DETECTION OF
INFECTION AND ULTRARURAL AREAS.
NEXT SLIDE, PLEASE.
WE ARE BUILDING TRUST IN OUR
COMMUNITY BY HAVING THIS LOCAL
TESTING CAPACITY.
HERE IS THE STANDARD OPERATING
PROCEDURE THAT IS THE GOLD
STANDARD DEVELOPED BY THE W.H.O.
AND THE CDC.
WE ARE USING QPCR NOT JUST FOR
COVID BUT TO ADAPT IT FOR FUTURE
VIRUSES FOR THE FUTURE OF
PANDEMICS AND EPIDEMICS IN OUR
COMMUNITY.
AND WE ARE ABLE TO DO THIS WITH
OUR CERTIFICATION HAVING
BIOBANKING TO CREATE
INSTITUTIONAL MEMORY AND
SUSTAINABLE HEALTH RESOURCES.
THIS DATA IS CORROBORATED BY THE
STANFORD CLINIC.
100% OF THE QPCR RESULTS HAVE
BEEN CORROBORATED.
A SMALL SUB SET OF THE COVID-19
SAMPLES ARE NOT BEING DETECTED
AT THE GOLD STANDARD QPCR DUE TO
LOW VIRAL LOAD.
BECAUSE IT HAS HIGHER
SENSITIVITY TO DETECTING THIS.
SO WE'RE WORKING ON SPECIFICITY
AND SENSITIVITY ISSUES TO FIX
THIS.
IN THIS GRAPH IT'S SHOWING OUR
TESTING RATES FOR THE PAST FEW
MONTHS AND YOU CAN SEE IT WAS
HIGHEST BACK DURING HOLIDAYS AND
THE TESTING DECREASING
SIGNIFICANTLY.
NEXT SLIDE, PLEASE.
>> SO ONE OF THE GOD OUTCOMES OF
THIS WORK IS THAT THE NVDC ALONG
WITH OTHER INDIGENOUS GROUPS
THROUGHOUT THE UNITED STATES
HAVE HELPED RADX-UP DEVELOP A
TRULY TRIBALLY SOVEREIGN DATA
POLICY AND WE HAVE WORKED WITH
THE CDCC AND THE NIH BEFORE.
WE STARTED COLLECTING DATA AND
TOWARDS THE FINAL POLICY DRAFT.
WE ALSO WORKED ON A SUBCONTRACT
BETWEEN THE NVDC WITH STANFORD
THAT ALIGNED WITH THE NIH
RADX-UP POLICY AND THEN LOCALLY
WE ALIGNED THE TRIBAL PUBLIC
HEALTH ORDINANCE WITH THESE
FEDERAL POLICIES AND HAVE GONE
FURTHER TO PROTECT TRIBAL DATA
IN THIS PUBLIC HEALTH SPHERE.
AS MANY OF YOU KNOW, BECAUSE OF
THE COVID URGENCY, LOTS OF
REGULATIONS WERE PUT ON HOLD
MIXING DATASETS TO GET A HOLD ON
COVID AND THOSE SORT OF MIXINGS
WERE NEVER DONE PROPERLY WITH
TRIBAL CONSULTATION IN MIND
PRIOR TO THIS PANDEMIC.
SO WE ARE TRYING TO MAKE SURE
THAT THOSE THINGS ARE GOING TO
BE ALIGNED IN THE FUTURE SO THAT
THE TRIBES CAN FEEL SAFE IN
SHARING DATA GOING FORWARD.
NEXT SLIDE.
SO THIS IS ALL SUPPORTED BOY THE
CLINTON ADMINISTRATION, OBAMA
ADMINISTRATION AND BIDEN
ADMINISTRATION BY EXECUTIVE
ORDER.
THIS DATA SHOULD BE PART OF
TREATY NEGOTIATIONS BUT THAT NOT
BEING DONE RIGHT NOW AT THIS
TIME, THAT IS DEFINITELY
RECOGNIZES THE RESERVE RIGHT OF
TRIBES THAT ANY DATA THAT WASN'T
SEATED IN ANY TREATED OR LEGAL
DOCUMENT BEFORE NOW REMAINS THE
OWNERSHIP OF THE TRIBE.
NEXT SLIDE.
SO SOME OF THE CHALLENGES OF
COURSE WERE TIME DELAYS IN
GETTING APPROVAL FROM THE TRIBE
BUT ALSO DELAYS IN WORKING OUT
THE POLICY WITH STANFORD AND THE
CDCC AS WELL AS SOME OF THE
DELAYS IN GETTING FUNDING TO
START THE WORK.
ACROSS TONSALATION BARRIERS TO
OUTSIDE AFFILIATES IN
UNDERSTANDING THE ALL OF THESE
PROCESSES, NOT ONLY TECHNICAL
BARRIERS BUT POLICY BARRIERS AND
THEN LOGISTICAL BEAR WHYERS AND
ACCESSING ESPECIALLY ORDERING
SUPPLIES IN A RURAL INDIGENOUS
COMMUNITY MAKING SURE THEY GET
HERE ON TIME AND HAVE NOT BEEN
SUBJECT TO ANY SORT OF
ENVIRONMENTAL DEGRADATION.
NEXT SLIDE.
SO CONCLUSIONS AND KEY
TAKEAWAYS.
THE BIGGEST TAKE AWAY FROM THIS
IS THAT WE ARE BUILDING LOCAL
CAPACITY BECAUSE THAT WAS ONE OF
THE BIGGEST PROBLEMS IN THE
PANDEMIC FOR TRIBES IS TRYING TO
FIND OUT WHAT THE LEGAL AND
SCIENTIFIC PERMISSIONS WOULD
ALLOW THIS STUFF TO BE RAPIDLY
DEPLOYED ON A RESERVATION
BECAUSE AS YOU KNOW, STATES DO
NOT GET INTO THE BUSINESS OF
TRIBES.
AND AT LEAST IN SOUTH DAKOTA,
THE TENSION BETWEEN THE GOVERNOR
AND THE TRIBES IS VERY
HIGH-TENSION POOR COOPERATIVE.
SO WE ARE BUILDING THAT LOCAL
CAPACITY SOY THEY CAN RESPOND AS
QUICKLY IF NOT QUICKER THAN
NEW YORK STATE.
WE ALSO HAVE INCREASED CAPACITY
BY LEADING WITH INDIGENOUS
SCIENTIST AND HEALTH LEADERS AND
THEN WE ARE GOING TO CREATE
HOPEFULLY, A MODEL THAT OTHER
TRIBES CAN FOLLOW AND RADx CAN
REFERENCE IN THE FUTURE.
NEXT SLIDE.
SO WE LIKE TO SAY THANK YOU TO
THE TRIBE, TO STANFORD AND THE
MIKE SNYDER LAB AND BONNIE
MALDONADO AS WELL AS TRIBAL VEN
TORS, OUR LOCAL COMMUNITY
ENGAGEMENT GROUP.
AND THE STANFORD CLIA LAB.
THANK YOU VERY MUCH.
>> THANK YOU.
THIS IS EXCITING WORK.
ARE THERE ANY QUESTIONS?
YOU CAN FEEL FREE TO PUT THEM IN
THE CHAT OR YOU CAN RAISE YOUR
HAND AND ASK YOUR QUESTION OUT
LOUD.
ANY QUESTIONS?
WILL THE COLLECTION OF TESTING
DATA AND MAINTENANCE OF DATA BE
ONGOING?
>> YES, WE WILL WORK TO FIND
OTHER FUNDING TO CONTINUE THE
WORK THAT IS A PART OF THAT THE
NBDC IS LOCAL.
IT'S RIGHT IN THE CENTER OF THE
RESERVATION.
SO WE WILL HAVE TO -- IDENTIFY
FUNDING FUR SUSTAINABILITY BUT
YES, WE ARE HERE FOR THE LONG
HAUL.
>> AWESOME.
>> LORI YOU HAVE YOUR HAND UP.
YOU NOTED TO ASK A QUESTION?
>> YES, THANK YOU.
GREAT PRESENTATION.
I'M CURIOUS IF THERE IS IN THE
WORK SOME SORT OF A TOOLKIT OR A
GUIDE WHERE OTHER TRIBAL
COMMUNITIES COULD SORT OF
DUPLICATE WHAT YOU HAVE BUILT
HERE?
IT FEELS LIKE THIS WOULD BE
SOMETHING THAT WOULD BE VERY
VALUABLE TO BE DISSEMINATED MORE
AS A PRACTICAL GUIDE.
AND I'M CURIOUS IF THAT IS IN
THE WORKS?
>> NO, WE DON'T HAVE ANY PLANS
YET BECAUSE A LOT OF THE
INFRASTRUCTURE TO DO THIS
PROJECT WAS ALREADY IN EXISTENCE
THROUGH OTHER FUNDING AND OTHER
MECHANISMS.
SO WE HAVE BEEN BUILDING THE
NATIVE BIODATA CONSORTIUM SINCE
2015.
THIS IS JUST ONE OF THE THINGS
WE DO.
WE DO LOTS OF OTHER THINGS.
SO I THINK IT WOULD BE HARD FOR
OTHER TRIBES TO MIMIC, AT LEAST
IN THE SHORT TERM, BECAUSE IT
DID TAKE US 12 -- 10-12 YEARS TO
GET MOST OF THIS STUFF OFF OF
THE GROUND.
SOME OF THIS STUFF WAS DONE WITH
FUNDING THAT WE'VE GARNERED FROM
OTHER PLACES.
AND SO RADx HELPED US WITH THE
SPECIFICS OF COVID BUT THERE IS
A LOT MORE THAT GOES INTO THIS
THAN JUST THE PARTICULAR TESTING
FOR COVID.
SO, WE PROBABLY COULD MAKE SOME
RECOMMENDATIONS IN TERMS OF
POLICY AND SOURCES FOR OBTAINING
FUNDING AND EXPERTISE BUT IT'S A
LARGE PROJECT THAT TOOK A LONG
TIME TO DO.
>> OKAY.
AND THEN WE HAVE A COUPLE MORE
QUESTIONS.
FIRST, THEY WANTED TO KNOW IF
THERE ARE ANY PRELIMINARY
FINDINGS RELATED TO LONG COVID
THAT YOU CAN SHARE?
>> NO, NOT RIGHT NOW.
>> OKAY.
AND THEN FINAL QUESTION.
SOMEONE WANTS TO KNOW, CAN YOU
SHARE THE DUA?
>> YES, WE CAN DO THAT.
>> ALL RIGHT.
AND THE DATA SHARING POLICY,
THAT CAME IN LAST.
DUA AND DATA SHARING POLICY.
>> WE'LL HAVE THEM REACH OUT TO
YOU AS WELL SEPARATELY.
>> THANK YOU, THANK YOU FOR YOUR
WONDERFUL WORK AND WE APPRECIATE
IT.
AND NOW WE ARE GOING TO
TRANSITION TO OUR NEXT PROJECT.
SO OUR NEXT PROJECT TITLED
FACILITATORS AND BARRIERS IN
IMPLEMENTING A COVID-19
EDUCATION INTERVENTION: FINDINGS
FROM A MULTI-SITE RANDOMIZED
CONTROL TRIAL.
THEY WILL NOW DISCUSS THEIR
WORKS.
SO I HAND IT OFF TO YOU.
>> I'M WITH THE UNIVERSITY OF
OKLAHOMA HEALTH SCIENCES CENTER,
ASSISTANT PROFESSOR OF
EPIDEMIOLOGY AND I'M HERE WITH
ASHLEY COMIFORD, EPIDEMIOLOGIST
WITH THE CHEROKEE NATION.
WE CALL IT CHEROKEE PROTECT.
NEXT SLIDE, PLEASE.
SO WE'RE GOING TO TALK ABOUT TWO
OF OUR OBJECTIVES FOR THIS
PROJECT.
SO FIRST EP ABLING
COMMUNITY-BASED COVID-19 TESTING
CONTACT TRACING AND EDUCATION
WITH THE PUBLIC HEALTH AND
ASHLEY WILL GO OVER THAT WORK
AND I'LL TALK ABOUT HOW TO
IDENTIFY BARRIERS AND
FACILITATORS TO COVID-19 TESTING
WITHIN CHEROKEE NATION TO HELP
DEVELOP A TAILORED EDUCATIONAL
CAMPAIGN.
INCREASED TESTING, CONTACT
TRACING AND DECREASED SPREAD OF
COVID.
THROUGH OUR SURVEYS AND
INTERVIEWS AND WE'LL TALK ABOUT
HOW WE EXPECT TO IDENTIFY
DIFFERENCES IN AVAILABILITY AND
UPTAKE OF TESTING ACROSS
DEMOGRAPHIC FACTORS WITHIN THE
CHEROKEE NATION RESERVATION.
NEXT SLIDE.
>> SO I'LL GO OVER A LITTLE BIT
OF BACKGROUND ABOUT CHEROKEE
NATION.
IT'S THE LARGEST FEDERALLY
RECOGNIZED TRIBE IN THE UNITED
STATES WITH NEARLY HALF A
MILLION REGISTERED TRIBAL
MEMBERS.
ABOUT 140,000 RESIDE WITHIN THE
RESERVATION OF CHEROKEE NATION
LOCATED IN THE NORTH EAST CORNER
OF OKLAHOMA WITHIN ABOUT 14
COUNTIES WITHIN OKLAHOMA.
NEXT SLIDE, PLEASE.
CHEROKEE NATION DOES RUN ITS OWN
HEALTH SYSTEM AND IT CONSISTS OF
ONE HOSPITAL, ONE IN-PATIENT
ADOLESCENT TREATMENT CENTER AND
NINE CLINICS LOCATED
STRATEGICALLY AROUND CHEROKEE
NATION TO KIND OF REDUCE THE
BARRIER OF TRAVEL THAT TRIBAL
CITIZENS MAY COME ACROSS TRYING
TO TRAVEL TO GET HEALTH CARE.
WE DON'T -- CHEROKEE NATION
DOESN'T JUST SERVE CHEROKEE
NATION CITIZENS.
WE SERVE ALL CITIZENS AND
MEMBERS OF FEDERALLY RECOGNIZED
TRIBES.
NEXT SLIDE.
SO CHEROKEE NATION PROTECT
UNITES TRIBAL, ACADEMIC AND
COMMUNITY PARTNERS UNDER THE
RELATIONSHIP OF CHEROKEE NATION
AND IT WAS DESIGNED TO ADDRESS
THE NEED FOR COVID-19 TESTING
CONTACT TRACING, VACCINATION AND
INFORMED EDUCATION AND THEN
UNDERSERVED AND VULNERABLE WORLD
POPULATION.
NEXT SLIDE.
THE REASON WHY THIS POPULATION
WAS TARGETED IS AMERICAN
INDIANTS DO HAVE A HIGHER RISK
OF SEVERE COVID COMPLICATIONS
DUE TO CO-MORBIDITIES.
FIVE COUNTIES ARE IN THE TOP 20%
OF U.S. COUNTIES AT RISK TO
SEVERE COVID DUE TO UNDERLYING
MEDICAL CONDITIONS.
THIS POPULATION HAS A HIGH
POVERTY RATE AND GEOGRAPHIC
BARRIERS AND THEN PEOPLE LIVING
IN RURAL AREAS OF CHEROKEE
NATION MAY HAVE TO TRAVEL FAR TO
GET TESTING.
NEXT SLIDE.
SO JUST A LITTLE BIT ABOUT THE
CHEROKEE NATION VIRAL TESTING.
AS OF MARCH 20, 2023, WE HAD
NEARLY 400,000 VIRAL TEST THAT
WERE CONDUCTED WITH MORE THAN
55,000 TESTED POSITIVE.
WE OFFERED BOTH ANTIGEN POINT OF
CARE TESTING AND PCR TESTS.
THIS HAS BEEN DONE THROUGH
DRIVE-THROUGH TESTING, DRIVE-UP
TESTING AND INPATIENT AND
CLINIC-BASED TESTING AND
PROVIDING AT-HOME TESTING KITS
AS WELL AS A FEW COMMUNITY
TESTINGS, ESPECIALLY WITH
CHEROKEE NATION BUSINESSES AND
EVEN CHEROKEE NATION
GOVERNMENTAL EMPLOYEES.
NEXT SLIDE.
SO WITH COMMUNITY ENGAGEMENT, WE
HAVE MAILED OUT AT-HOME TESTING
KITS.
WE MAILED OUT EDUCATIONAL
BROCHURES ABOUT TESTING AND
VACCINATION AVAILABILITY AND
ALSO PROVIDED EDUCATION ON POINT
OF CARE TESTING, COVID
MITIGATION EFFORTS, QUARANTINE
AND ISOLATION GUIDANCE.
AND A FEW OF THE COMMUNITY
PARTNERS THAT WE HAVE DONE THIS
WITH INCLUDE CHEROKEE NATION
ASSOCIATED SCHOOLS, YOUTH
SHELTERS, EMS,ELEDDER CARE PACE
PROGRAM, HEAD START CENTERS AND
THE JACK BROWN YOUTH TREATMENT
CENTER AS WELL AS BUSINESSES,
CHEROKEE NATION BUSINESSES.
NEXT SLIDE.
>> SO AS PART OF OUR PROJECT WE
CONDUCTED A POPULATION-BASED
SURVEY WITHIN CHEROKEE NATION.
WE PURCHASED ADDRESSES THROUGH
THE MARKETING USING GEOGRAPHIC
BOUNDARIES OF THE RESERVATION SO
WITHIN THE ZIP CODES AND CENSUS
BLOCKS THAT DESIGNATE THE
RESERVATION.
WE OVERSAMPLED IN GEOGRAPHIC
AREAS WITH HIGH NUMBER OF
AMERICAN INDIAN RESIDENTS USING
CENSUS DATA.
WE WANTED TO HAVE FEEDBACK FROM
ALL AMERICAN INDIANS RESIDING
WITHIN CHEROKEE NATION NOT ONLY
THOSE WHO ACCESS THE HEALTH
SERVICES.
SINCE ALL THESE PEOPLE ARE
ELIGIBLE TO RECEIVE SERVICES BUT
NOT ALL OR WILL COME TO THE
CHEROKEE NATION HEALTH SYSTEM.
WE WANTED TO CAPTURE ALL THOSE
OPINIONS AND FEEDBACK ABOUT
TESTING AND COVID ISSUES.
SO WE FOR ELIGIBILITY CRITERIA
WE INCLUDED THOSE WITH A
HOUSEHOLD MEMBER WHO SELF
REPORTED AS AMERICAN INDIAN OR
ALASKA NATIVE, 18 YEARS OF AGE
AND LIVED WITHIN THE 14
COUNTIES.
THIS WAS A MAIL SURVEY.
PARTICIPANTS COULD RESPOND USING
PRE-STAMPED ENVELOPE OR ON LINE
THROUGH RED CAP.
MOST MAILED THEIR SURVEYS BACK
AND THEN WE HAD JUST DESCRIPTIVE
STATISTICS.
NEXT SLIDE, PLEASE.
WE ARE WORKING ON DOING
STATISTICAL WAITING OF OUR
SURVEY DATA SO WE WILL BE
UPDATING RESULTS SOON.
INITIAL DESCRIPTIVE RESULTS, WE
HAD 761 ELIGIBLE PARTICIPANTS IN
OUR STUDY.
MOST OF THEM WERE FEMALE AND
THEN HALF WERE 60 YEARS OF ANAL
AND OLDER.
ABOUT 45-46% WERE IN THE LOWER
INCOME CATEGORY SO LESS THAN
35,000.
MAJORITY HAD A TEST, COVID-19
TEST AND ONE DOSE OF A COVID
VACCINE.
AMONG THOSE WHO HAD NEVER BEEN
VACCINATED, 60% SAID THEY WERE
UNLIKELY TO RECEIVE A VACCINE.
SO THINGS WE WERE HAPPY TO SEE
IS MOST KNEW WHERE TO GET TESTED
AND IT WAS EASY TO GET A TEST.
AMONG THOSE WHO HAD A TEST, MOST
WERE TESTED AT CHEROKEE NATION.
WE FOUND THAT NEARLY ALL
RESPONDENTS TRUST THEIR DOCTOR
OR HEALTH CARE PROVIDER,
SOMEWHAT OR A GREAT DEAL, WHICH
WAS MORE THAN OTHER SOURCES OF
INFORMATION WE ASKED ABOUT
INCLUDING MEDIA, FRIENDS AND
FAMILY, SOCIAL MEDIA AND THAT
SORT OF THING.
AND GOVERNMENT LEADERS AS WELL.
THE MOST COMMON REASONS TO GET A
VACCINE TO KEEP THEIR FAMILIES
SAFE AND THEMSELVES SAFE AND
VACCINE CONCERNS INCLUDED SIDE
EFFECTS, LACK OF TRUSTED SAFETY
AND LACK OF KNOWLEDGE OF HOW THE
VACCINE WORKS.
WHICH WE SEEN CONSISTENTLY IN
OUR OTHER STUDIES AS WELL.
WE CONDUCTED INTRODUCE AND
INTERESTED IN RESOURCES.
WE WANTED TO HEAR WHAT THE
COMMUNITY MEMBERS WERE HEARING
ABOUT TESTING AND VACCINE UPTAKE
AND ALSO HOW COMMUNITY MEMBERS
PERCEIVED PUBLIC HEALTH
MITIGATION MEASURES.
WE STARTED THESE INTERVIEWS
BEFORE VACCINES CAME OUT.
SO I THINK AROUND DECEMBER OF
2020 IS WHEN WE STARTED AND
CONTINUED DOING THESE THROUGHOUT
THE PANDEMIC FOR AT LEAST --
PROBABLY ABOUT A YEAR.
SO, WE INCLUDED THOSE WHO WERE
COMMUNITY MEMBERS OR WITHIN
CHEROKEE NATION LEADERSHIP, HAD
TO BE 18 YEARS OF AGE AND ALSO
LIVING WITHIN THE CHEROKEE
NATION RESERVATION.
SO I'LL GIVE YOU OUR PRELIMINARY
ANALYSIS RESULTS THERE AS WELL.
NEXT SLIDE.
SO WE CONDUCTED 32 INTERVIEWS.
MOST WERE CHEROKEE NATION
EMPLOYEES AND SO WE REALIZING WE
TRIED TO WORK HARD TO IDENTIFY
NON-CHEROKEE NATION EMPLOYEES TO
GET VARYING PERSPECTIVES USING
PEOPLE WORKING IN SCHOOLS,
WITHIN THE JUSTICE SYSTEM AND
ALSO BUSINESS LEADERS, BUSINESS
OWNERS IN THE COMMUNITY.
SO THOSE WHO -- ONE FINDING IS
THOSE WHO ACCESSED THE INDIAN
HEALTH SERVICES CLINIC INSTEAD
OF CHEROKEE NATION-RUN CLINIC
EXPRESSED MORE BARRIERS TO
TESTING WITH SUPPLY SHORTAGES
AND NEEDED AN APPOINTMENT.
AND WE DIDN'T FIND A LOT OF
REASONS OR METHODS TO HELP
ENCOURAGE VACCINATION, WHETHER
CAMPAIGNS COMING FROM
EDUCATIONAL CAMPAIGNS, SOCIAL
MEDIA, THAT SORT OF THING,
WORKING WITH CHEROKEE NATION
NATIVE SPEAKERS AND ELDERS WAS
THE MOST COMMON SUGGESTION WE
HEARD FROM PARTICIPANTS WITHIN
OUR INTERVIEWS.
AND ESPECIALLY THE CHEROKEE
SPEAKERS ARE A GROUP OF PEOPLE
WHO ARE VALUED AND THAT WE NEED
TO WORK TO HELP KEEP THEM SAFE
IN TERMS OF INCREASING
VACCINATION.
NEXT SLIDE, PLEASE.
SO OUR KEY TAKEAWAYS.
WE WERE ABLE TO SEND OUT 100,000
COVID TESTING AND VACCINATION
INFORMATION BROCHURES.
WE OBSERVED FROM OUR SURVEYS AND
INTERVIEWS THERE WAS
SATISFACTION WITH EASE OF
ACCESSING THE CHEROKEE NATION
HEALTH SERVICES FOR COVID
TESTING.
SURVEYS WERE TRUSTED --
IDENTIFIED THAT HEALTH CARE
PROVIDERS ARE TRUSTED SOURCE OF
COVID-RELATED INFORMATION.
SO FUTURE INTERVENTIONS SHOULD
FOCUS ON PROVIDER EDUCATION,
WORKING WITH PROVIDERS TO HELP
ENCOURAGE UPTAKE OF TESTING AND
ALSO VACCINES, COVID AND
NON-COVID RELATED.
CHEROKEE NATION SUCCEEDED IN
MAKING TESTING READILY AVAILABLE
FOR THE COMMUNITY AND CAN SERVE
AS A MODEL FOR OTHER TRIBAL
HEALTHS IS SYSTEM.
ASHLEY?
>> CHEROKEE NATION DID A REALLY
GOOD JOB IN TESTING AND
VACCINATION EFFORTS ACROSS A
VARIETY OF DIFFERENT WAYS.
AND I THINK THAT WAS REFLECTED
IN THE SURVEYS -- FEEDBACK WE
GOT IN THE SURVEYS.
SO I THINK THE TRIBE CAN SERVE
AS A MODEL FOR OTHER HEALTH
SYSTEMS AND TRIBAL ORGANIZATIONS
ON HOW TO IMPLEMENT THIS KIND OF
PANDEMIC, EMERGING INFECTIOUS
DISEASES AND HOW TO GET PEOPLE
TESTED AND TREATED FOR THOSE
DISEASES.
SO THE GOAL WILL BE TO DEVELOP
SOME GUIDANCE FOR OTHER
TRIBES -- SO THEY MAY FACILITATE
OR DEVELOP THEIR OWN PROGRAMS IN
RELATION TO EMERGING INFECTIOUS
DISEASES.
>> NEXT SLIDE, PLEASE.
THANK YOU.
WE LOOK FORWARD TO YOUR
QUESTIONS.
OUR CONTACT INFORMATION IS HERE
IF YOU WISH TO REACH OUT TO US
LATER.
>> ALL RIGHT, THANK YOU.
GREAT WORK.
WE HAVE A QUESTION IN THE CHAT.
THEY WANT TO KNOW, HAVE YOU
CORRESPONDED WITH IHS TO DISCUSS
BARRIERS TO TESTING THAT YOU ALL
FOUND IN YOUR WORK?
>> NO, WE HAVEN'T DISCUSSED THAT
WITH IHS.
I DON'T KNOW IF -- WHAT
DISCUSSIONS LIKE LEADERSHIP
LEVELS WOULD BE DISCUSSING
BARRIERS THAT IHS MAY FOUND BUT
WE HAVEN'T COORDINATED ANYTHING
WITH IHS SO FAR.
>> OKAY.
>> AND I CAN ADD, WE ARE STILL
WORKING ON THOSE ANALYSIS SO WE
HAVEN'T DEVELOPED A REPORT YET
TO SHARE WITH CHEROKEE NATION
LEADERSHIP.
WE HAVE OUR STAFF THAT ARE
CURRENTLY GOING INTO THOSE
INTERVIEWS AND DOING THE MORE
DETAILED QUALITATIVE ANALYSIS TO
GENERATE THE ADDITIONAL THEMES.
SO THAT IS SOME INFORMATION THAT
WE'LL BE ABLE TO PREPARE IN OUR
REPORT THAT CHEROKEE NATION CAN
HAVE THOSE CONVERSATIONS WITH AS
WELL.
>> ALL RIGHT.
ANY ADDITIONAL QUESTIONS?
I'M GOING TO HAND OFF TO OUR
NEXT PRESENTATION, FACILITATORS
AND BARRIERS IN IMPLEMENTING
COVID-19 EDUCATION INTERVENTION,
FINDINGS FROM A MULTI-SITE
RANDOMIZED CONTROL TRIAL.
I'LL HAND IT OFF TO THIS TEAM.
>> THANK YOU VERY MUCH FOR BEING
HERE TODAY.
OUR PRESENTATION IS ON
FACILITATORS AND BARRIERS IN
IMPLEMENTING COVID-19 EDUCATION
INTERVENTION.
WE HAVE SOME FINDINGS AND WE
WANT TO SHARE THAT WITH OTHER
PEOPLE WHO MIGHT BE IMPLEMENTING
A RANDOMIZED CONTROL TRIAL OR
IMPLEMENTING THE STUDY AT THEIR
RADx SITE.
WE WANTED TO SHARE THAT
INFORMATION.
I'M SONIA AND I WORKY WITH
UNIVERSITY OF CHICAGO AND I WORK
WITH THE OPERATIONS TEAM AT THE
UNIVERSITY OF CHICAGO TO PUT
TOGETHER THIS RESEARCH STUDY AND
I'LL LET MY CO-PRESENTER
INTRODUCE HERSELF.
>> HELLO, EVERYONE.
WE WORK TO HELP WITH SERVICES
HELPING TO STOP -- I'M SORRY.
I'M NERVOUS.
WE ARE A COMMUNITY-BASED
ORGANIZATION AND WE PROVIDE
SERVICES AND WE AIM AT HELPING
WITH -- SORRY.
I NEED TO LOOK AT MY NOTES.
SORRY.
TO PRODUCE HEALTH DISPARITIES
AMONG PEOPLE WHO INJECT DRUGS IN
THE LGBT+ INDIVIDUALS.
SO THAT IS WHAT WE DO.
WE PROVIDE THE SERVICES AND
PROGRAMS AND WE PROVIDE SERVICES
AS FAR AS TESTING FOR HIV.
THANK YOU.
>> THANK YOU VERY MUCH, CYNTHIA.
WITH THAT, I'LL BE ABLE TO TALK
A LITTLE BIT ABOUT OUR STUDY.
NEXT SLIDE, PLEASE.
SO FOR OUR OVERVIEW AND
METHODS -- NEXT SLIDE.
FOR THE RADx SITES WE WANTED
TO TEST WITHIN THE CGI, CRIMINAL
JUSTICE IN RURAL POPULATIONS AND
HISPANIC AND LATINX COMMUNITIES.
WE USE THE COMMUNITY NETWORK
DRIVEN COVID-19 TESTING OF
VULNERABLE POPULATIONS IN THE
U.S., CAN WHICH IS C3.
WITH THAT WE ARE HOPING TO --
EDUCATE THEM ABOUT COVID-19 TO
SEE HOW EFFECTIVE THAT IS.
NEXT SLIDE, PLEASE.
AND SO, SOME OF OUR STUDY SITES
YOU CAN SEE HERE.
AT THE UNIVERSITY OF CHICAGO
IDENTIFIED CERTAIN AREAS THAT
ALREADY WERE USING C3 IN THEIR
STUDY SITES SO YOU CAN SEE THERE
IS ARKANSAS, ILLINOIS, INDIANA,
LOUISIANA, TEXAS.
SO THESE WERE THE SITES THAT HAD
COMMUNITY CONNECTIONS WHERE WE
KNEW WE WOULD BE ABLE TO GET
THIS DATA AND WORK IN THESE
COMMUNITIES AND HOPEFULLY MAKE
AN IMPACT.
NEXT SLIDE, PLEASE.
SO DURING OUR IMPLEMENTATION, WE
DID SOME FOCUS GROUPS TO
UNDERSTAND FROM PROJECT SITES
WHAT THEY NEEDED IN ORDER TO
IMPLEMENT THIS STUDY
SUCCESSFULLY.
SO WE FOUND THAT PEOPLE WANTED
TO UNDERSTAND RECRUITMENT
STRATEGIES, HOW TO BUILD STRONG
PARTNERSHIPS, HOW TO ENGAGE
THEIR COMMUNITIES AND HOW TO
COMMUNICATE EFFECTIVELY.
SO OUR QUALITATIVE STUDY THAT
WAS EVALUATING OUR RADx STUDY
WAS TO IDENTIFY BARRIERS AND
FACILITATORS TO THE
IMPLEMENTATION OF THIS STUDY.
NEXT SLIDE, PLEASE.
SO WE DID THREE
POST-IMPLEMENTATION FOCUS GROUPS
AND AN INTERVIEW WITH 18 STAFF
AND SUPERVISORS REPRESENTING
SEVEN SITES.
SO THERE WERE ABOUT THREE-FOUR
PEOPLE IN EACH FOCUS GROUP.
AND WE AIM FOR PLANNING AND
EVALUATION BUT WE MAINLY USE THE
CONSOLIDATED FRAMEWORK FOR
IMPLEMENTATION RESEARCH IN ORDER
TO CREATE OUR EVALUATION
QUESTIONS.
SO WE ASKED PEOPLE QUESTIONS
RELATED TO IMPLEMENTATION, SUCH
AS HOW DO YOU THINK
IMPLEMENTATION WENT?
WHAT DO YOU THINK OPERATIONS
TEAM CAN DO TO SUPPORT YOU FOR
RECRUITMENT?
WHAT WERE SOME CHALLENGES?
WHAT WERE SOME FACILITATORS TO
RECRUITMENT FOR THE RADx STUDY
AND PROJECT STOP.
HOW WELL DO YOU FEEL SUPPORTED?
WHAT ARE SOME OTHER THINGS THAT
YOU WOULD NEED IN ORDER TO
IMPLEMENT THIS STUDY?
SO WE DID THE STANFORD LIGHTNING
METHOD FOR ANALYSIS AND THAT
ALLOWED US TO DO A RAPID
ANALYSIS IN ORDER FOR US TO
INFORM OUR IMPLEMENTATION FOR
PHASE II FOR RADx AS SOON AS
POSSIBLE.
AND THEN FOR THE SITE SELECTION
AGAIN WE CHOSE SITES THAT WE
KNEW WERE ALREADY DOING THIS
WORK.
NEXT SLIDE, PLEASE.
SO, FOR OUR FINDINGS, NEXT
SLIDE, PLEASE.
WE IDENTIFIED A FEW FACILITATORS
AND CYNTHIA WAS WORKING ON THE
GROUND SO SHE CAN TALK A LITTLE
BIT MORE ABOUT THESE BULLET
POINTS ABOUT WHAT WORKED WELL
AND WHAT WERE SOME BARRIERS.
>> OKAY.
THANK YOU.
SO YES, WE ARE -- AND I'M THE
RESEARCH COORDINATOR ON THE
RADx PROJECT.
I DON'T KNOW IF I SHARED THAT
THE FIRST TIME.
BUT WE PARTICIPATED IN PHASE I
OF THE RADx PROJECT AND NOW WE
HAVE STARTED INTERVENTION FOR
PHASE II.
AND WE HAVE FOUND THAT THE EARLY
TRAININGS, THEY WERE HELPFUL IN
HELPING US TO UNDERSTAND HOW TO
IMPLEMENT THE PROJECT, BEING ON
THE ZOOM CALLS, THOSE ZOOM
MEETINGS, GETTING THAT
CONSISTENT FEEDBACK ON OUR RED
CAP ENTRIES.
ALL WE FOUND THAT VERY HELPFUL.
AND OUR AGENCY REPUTATION.
IT WAS HELPFUL WITH RECRUITING.
WE HAVE SEVERAL METHOD THAT IS
WE USE TO RECRUIT.
WE SHARED ON SOCIAL MEDIA.
WE DISTRIBUTED FLYERS IN THE
COMMUNITY AT PUBLIC
ESTABLISHMENTS SUCH AS THE LOCAL
LIBRARY.
BUT FOR THE MOST PART, WE GET
MOST OF OUR RECRUITS FROM
WORD-OF-MOUTH.
THOSE THAT ENROLLED IN THE STUDY
THAT HAVE WENT THROUGH THE
RESEARCH STUDY.
THEY GO OUT AND SHARE WITH THEIR
FAMILY, FRIENDS AND NEIGHBORS
ABOUT THE RESEARCH STUDY.
SO THAT'S HOW WE GET MOST OF OUR
RECRUITS.
AND THE CONSISTENCY OF
COMMUNICATION WITH THE
COORDINATOR CALLS, THE RA CHECK
INS, SITE CALLS, HAS BEEN
HELPFUL FOR US IN IMPLEMENTING
THE PROJECT.
NEXT SLIDE.
AND WE HAVE A FEW PHOTOS HERE.
THIS IS FROM OUR FIRST
INTERVENTION SESSION.
HERE IN THE FIRST PHOTO THAT IS
ONE OF THE PARTICIPANTS.
SHE IS RECEIVING HER CASH AT THE
END OF THE SESSION AND WE HAVE
THE MOTIVATIONAL AND EDUCATIONAL
SESSION GOING ON HERE.
THEY ARE EATING THEIR LUNCH.
BUT WE FIND THE PARTICIPANTS, A
LOT OF OUR PARTICIPANTS THEY
HAVE NEVER PARTICIPATED IN A
RESEARCH STUDY BEFORE BUT WE DO
FIND THAT THEY WERE EXCITED TO
PARTICIPATE.
A LITTLE CURIOUS BECAUSE THEY
DIDN'T KNOW WHAT TO EXPECT.
FOR THE MOST PART, THEY ENJOYED
PARTICIPATING IN THE STUDY.
AT THE END, THEY GO BACK AND
TELL THEIR FAMILY, FRIENDS, TELL
EVERYBODY ABOUT PARTICIPATING.
SO WE HAVE HAD GREAT TURNOUT SO
FAR.
EVERYBODY EVERYBODY IS EXCITED
ABOUT PARTICIPATING.
AND NEXT SLIDE.
SO THE NEXT SLIDE HERE SHOWS ONE
OF OUR RESEARCH FLYERS WE USE TO
RECRUIT AND WE SHARED THIS FLYER
ON SOCIAL MEDIA, WE KEEP SOME IN
THE LOBBY, AT OUR OFFICE.
WE DISTRIBUTE IN THE COMMUNITY
TO ENROLL.
THEY CALL US AND WE GET THEM
SIGNED UP FOR THE RESEARCH
STUDY.
SO THAT IS JUST A FLYER THAT WE
HAVE INCLUDED THERE.
NEXT SLIDE.
AND HERE I'M GOING TO SHARE SOME
OF THE BARRIERS THAT WE FOUND
SINCE IMPLEMENTING THIS STUDY.
ONE BARRIER WE FOUND IS
TECHNOLOGY WITH OUR
PARTICIPANTS.
A LOT OF THEM, NOT ALL, BUT --
BECAUSE WE DO OUR INITIAL
SCREENING OVER THE PHONE ONCE
THEY CONTACT US.
THEY DO THE SCREENING TO FIND
OUT IF THEY ARE ELIGIBLE OR NOT.
WE ARE FINDING A LOT OF OUR
ENROLLMENTS ARE COMPUTER
ILLITERATE OR DON'T HAVE E-MAIL
ADDRESS.
SO WE ARE FINDING THAT WE HAVE
TO WORK CLOSELY WITH THEM TO
HELP THEM TO COMPLETE THEIR
INFORMED CONSENT AND HELP THEM
COMPLETE THEIR SURVEY.
WE HAVE TO WORK CLOSELY WITH
THEM IN PERSON TO GET THEIR
INFORMATION COMPLETED PRIOR TO
THE INTERVENTION SESSIONS.
ANOTHER BARRIER WE ARE FINDING
IS WITH TRANSPORTATION.
A LOT OF THEM JUST DON'T HAVE
TRANSPORTATION TO COME TO THE
INTERVENTION SESSIONS.
NEIGHBORS WILL RIDE TOGETHER.
THOSE ARE THE TWO MAIN BARRIERS
WE FOUND.
TECHNOLOGY AND TRANSPORTATION.
AND SENSITIVE QUESTIONS AS WELL.
WE DON'T GET THIS A WHOLE LOT
BUT WE HAVE FOUND THAT POTENTIAL
TRAINING ON ENGENDERING TRUST
WITH PARTICIPANTS CAN BE HELPFUL
BECAUSE WE FOUND SOME OF THE
PARTICIPANTS WHEN WE ASK THOSE
QUESTIONS -- BECAUSE THE
POPULATION THAT WE FOCUS ON ARE
CRIMINAL JUSTICE INVOLVED SO
WHEN WE ASK THOSE QUESTIONS
ABOUT THEIR CRIMINAL JUSTICE
HISTORY, WHEN WE ASK THOSE
QUESTIONS ABOUT THEIR GENDER
IDENTITY, SOMETIMES THEY ARE
HESITANT ANSWER THOSE QUESTIONS.
SO WE PROBABLY CAN BENEFIT FROM
TRAINING ON ENGENDERING TRUST
WITH PARTICIPANTS.
NEXT SLIDE.
>> QUI WANT TO KEEP OUR
RECOMMENDATIONS PRETTY SHORT AND
SWEET AND WITHIN THE THREE
BUCKETS WE IDENTIFIED FOR
IMPLEMENTATION, RECRUITMENT AND
PROJECT STAFF.
SO SOME OF THE RECOMMENDATIONS
WE HAVE FOR ANYBODY WHO WOULD
LIKE TO IMPLEMENT THIS KIND OF
STUDY IS FOR IMPLEMENTATION
TRAININGS FOR ENGENDERING TRUST
WITHIN PARTICIPANTS COULD BE
HELPFUL.
ESPECIALLY WORKING WITH CGI
POPULATIONS OR CERTAIN
POPULATIONS YOU MAY WANT TO
CONSIDER HOW TO ENGENDER THAT
TRUST.
FOR RECRUITMENT, WE SAW CERTAIN
BARRIERS, FOR EXAMPLE THERE CAN
BE TRANSPORTATION BARRIERS.
THERE CAN BE TECHNOLOGICAL
BARRIERS SO CONSENT IN
INTERVENTIONS AND LOCATIONS
HAVING DIFFERENT LOCATIONS CAN
BE HELPFUL.
ALONG WITH PARTNERSHIPS WITH
LOCAL PARTNERS.
SO SHE HAD THAT ESTABLISHED
TRUST IN THE COMMUNITY AND THAT
REALLY HELPED THIS PROJECT.
ALSO PROJECT STAFF LOVE TO LEARN
FROM EACH OTHER.
SO HAVING A WAY TO FACILITATE
THAT COMMUNICATION WHETHER
THROUGH MEETINGS, OR THROUGH
WRITTEN COMMUNICATION TO MAKE
SURE THAT PEOPLE CAN COMMUNICATE
WITH EACH OTHER IS VERY
IMPORTANT.
NEXT SLIDE, PLEASE.
AND STOW LASTLY, SUMMARIZING THE
KEY TAKEAWAYS FOR PEOPLE TO
BRING HOME.
HAVING A TRAINING CAN BE REALLY
HELPFUL FOR ENGENDERING TRUST.
PEOPLE CAN USE TECHNOLOGY TO
ADAPT TO LOCAL CONTENTS AND
CHALLENGES.
AND THAT PEOPLE SHOULDN'T
UNDERESTIMATE HOW EXCITED
PROJECT STAFF ARE TO COMMUNICATE
WITH EACH OTHER.
SOME OF THE FEEDBACK THAT WE GOT
WAS THAT PEOPLE LOVED TO ENGAGE
WITH STAFF, THE OPERATIONS TEAM
AND THEY WANTED THAT TO CONTI
CONTINUE.
THANK YOU VERY MUCH.
THIS IS OUR CONTACT INFORMATION.
>> THANK YOU.
THAT YOU BOTH.
YOU MADE IT THROUGH AND YOU DID
A GREAT JOB.
SO, SOMEONE MADE A COMMENT.
ONE AROUND LIKE THEM SEEING THE
SAME LEGSITATION REGARDING THE
GENDER SEXUALITY QUESTIONS FROM
THE CDE AMONG IMMIGRANT
PARTICIPANTS.
SO I GUESS THAT IS SOMETHING
THAT YOU ALL WERE SEEING A CROSS
PROJECTS SO EACH THOUGH IT'S
DIFFERENT POPULATIONS.
ANOTHER THING THAT CAME UP WAS
AROUND THE CASH ON THE FLYER.
BUT DID YOU FIND ADDS PEOPLE
PARTICIPATED THAT IT WAS STILL
PRIMARILY ABOUT THE MONEY THAT
WAS PRIMARILY DRAWING PEOPLE IN?
AND KEPT THEM INVOLVED?
OR ONCE THEY WERE INVOLVED WAS
IT NOT AS MUCH ABOUT THE MONEY?
>> I WOULD THINK IT WAS ABOUT
THE MONEY.
ONCE THEY COME TO PARTICIPATE,
WE FIND THEY ARE HAVING
CONVERSATIONS AROUND COVID THEY
HAVEN'T HAD BEFORE.
I THINK IT WAS THE MONEY THAT
DREW THEM IN AND -- BECAUSE JUST
CONSIDERING THE POPULATION THAT
WE WORK WITH, THEY ARE CRIMINAL
JUSTICE INVOLVED, UNDERSERVED
POPULATIONS.
SO I THINK IT WAS INITIALLY
ABOUT THE MONEY.
THE ONES THAT CAME IN.
THEY WERE CURIOUS AND A LOT OF
THEM HAVE NEVER PARTICIPATED IN
A RESEARCH STUDY BEFORE.
SO JUST DIDN'T KNOW WHAT TO
EXPECT.
ONCE THEY COME INTO THE
INTERVENTION, I THINK THEY
REALLY APPRECIATE THE EDUCATION
THAT THEY ARE RECEIVING AROUND
HELPING TO PREVENT THE SPREAD.
AND OF COURSE THE MONEY IS A
GREAT MOTIVATOR BUT I THINK THEY
APPRECIATE THE EDUCATION THAT
THEY ARE RECEIVING AS WELL.
>> I WAS GOING TO SAY, A BIG
PART OF OUR STRATEGY WAS THE
SOCIAL NETWORKING STRATEGY.
WE WANTED TO SEE HOW PEOPLE
WOULD BE ABLE TO SPREAD
INFORMATION TO OTHERS.
SO WE FOUND THAT PEOPLE, WHEN
THEY SAID THERE IS CASH
INCENTIVE, THEY WERE LIKELY TO
TELL THEIR FRIENDS AND THOSE
FRIENDS WERE LIKELY TO TELL
THEIR FRIENDS AND SO THAT WAS
PART OF OUR STRATEGY TO
EMPHASIZE THAT TO GET THE
WORD-OF-MOUTH GOING.
>> ALL RIGHT.
THANK YOU.
ANY OTHER QUESTIONS?
OR THOUGHTS?
GREAT WORK.
THANK YOU FOR COMING TO SHARE
YOUR WORK TODAY.
WE APPRECIATE IT.
SO WE ARE NOW GOING TO MOVE ON
TO OUR FINAL PRESENTATION I'D
LIKE TO WELCOME THE TEAM TO TALK
ABOUT SARS-COV-2 TESTING IN
DIALYSIS FACILITIES.
I AM HANDING OFF TO YOU ALL.
>> HI, I'M NIV, ONE OF THE
NEPHROLOGY FELLOWS AT STANFORD.
AND I'M HERE WITH DR. SHUCHI
ANAND WHO I'M JUST GOING TO SEE
IF SHE IS ON.
WE ARE VERY EXCITED TO PRESENT
THIS RESEARCH PROJECT AND VERY
HONORED TO BE HERE.
THANK YOU FOR HAVING US.
I THINK WE WERE UNDER THE
IMPRESSION WE MIGHT HAVE BEEN AT
1:30.
BOTH OF US ARE ATTENDING ON
SERVICE.
SO LET ME JUST TEXT HER VERY
QUICKLY.
>> NO PROBLEM.
WE ARE A LITTLE AHEAD OF
SCHEDULE.
GO AHEAD.
JENNIFER, I SEE YOUR QUESTION
ABOUT ACCESS TO THE RECORDINGS
AND HONESTLY, I'M NOT SURE.
I DON'T WANT TO TELL YOU THE
WRONG THING.
BUT, I'M SURE THE TEAM, WHEN
THEY FOLLOW-UP, BECAUSE THEY
WILL FOLLOW-UP AFTER THE
SCIENTIFIC MEETING, WILL THEN BE
ABLE TO PROVIDE MORE INFORMA
INFORMATION.
>> DR. SHUCHI ANAND IS COMING.
>> SORRY ABOUT THAT.
>> WE ARE DELIGHTED TO BE
PRESENTING ON SARS-COV-2 TESTING
IN DIALYSIS FACILITIES.
COULD YOU GO TO THE NEXT SLIDE,
PLEASE.
SO THIS IS A RESEARCH PROJECT
THAT INVOLVED MULTIPLE DIFFERENT
COMMUNITIES COMING TOGETHER.
MEMBERS OF THE ACADEMIC
COMMUNITY WHO WERE INVOLVED
PRIMARILY FROM STANFORD AND
THESE INCLUDED NEPHROLOGISTS,
RESEARCHERS AND INFECTIOUS
DISEASE, FOLKS WHO WERE INVOLVED
IN EPIDEMIOLOGY AND ALSO
BIOSTATISTICIANS WHO CAME
TOGETHER TO DESIGN THIS REACH
PROJECT.
WE ACTUALLY WORKED WITH DIALYSIS
FACILITIES MOSTLY FROM U.S.
RENAL CARE, A LARGE CONSORTIUM
OF DIALYSIS FACILITIES ACROSS
THE UNITED STATES.
SERVING IN 35 STATES OVER 22,000
FACILITIES AND WE'LL TALK A
LITTLE BIT LATER ABOUT WHICH
SPECIFIC FACILITIES WE PARTNERED
WITH.
AND A HUGE PART OF THESE
DIALYSIS FACILITIES ARE VERY
THANKFUL TO THE INDIVIDUAL
PATIENTS AND TO THE MEDICAL
STAFF WHO ARE INTEGRAL TO THIS
RESEARCH PROJECT.
WE ALSO PARTNERED WITH ABBOTT
LABORATORY TO OBTAIN THE COVID
PCR TESTS THAT WERE USED FOR
THIS STUDY AND THEN A SET OF
CLINICAL LABORATORY EASE WAS
GRACIOUS ENOUGH TO RUN THESE
TESTS FOR US.
SO THE SHARED GOAL IS OVERALL TO
IMPROVE TESTING IN EARLY
DETECTION OF SARS COVID 2 IN A
MEDICALLY VULNERABLE AND HARD TO
REACH POPULATION.
NEXT SLIDE, PLEASE.
SO WE WANTED TO TAKE ONE STEP
BACK TO -- GET DEEPER INTO WHY
DIALYSIS PATIENTS ARE SO
MEDICALLY VULNERABLE.
AND WE PUT THIS SLIDE HERE FOR
INDIVIDUALS WHO MAY NOT BE AS
FAMILIAR WITH DIALYSIS.
AS EVERYONE KNOWS, DIALYSIS IS A
RENAL REPLACEMENT THERAPY.
WHEN THE KIDNEYS AREN'T WORKING,
DIALYSIS SERVES AS A
REPLACEMENT.
THE GOAL IS TO HELP CLEAN THE
BLOOD AND HELP REMOVE EXTRA
FLUID.
DIALYSIS FACILITIES OFTENTIMES
ARE DESIGNED IN THIS WAY.
PEOPLE ARE SEATED IN CLOSE
PROXIMITY TO ONE ANOTHER WHILE
GETTING DIALYSIS.
AND THERE IS ALSO A LOT OF
MEDICAL STAFF WHO THEY ARE IN
CONSTANT CONTACT WITH.
THESE ARE NURSES, TECHNICIANS
CHECKING UP ON THE PATIENTS,
MAKING SURE THEY ARE DOING OKAY
WHILE ON DIALYSIS.
THE CHAIRS ARE IN RELATIVE
PROXIMITY TO ONE ANOTHER AND
PATIENTS ARE OFTENTIMES ON
DIALYSIS FOR THREE-FOUR HOURS,
THREE-FOUR TIMES A WEEK ON
AVERAGE.
SO THIS IS OVERALL HIGH-RISK
SETTING FOR THE SPREAD OF
INFECTIOUS ILLNESSES LIKE SARS
COVID 2.
NEXT SLIDE, PLEASE.
THEN THE QUESTION ARISES LIKE
WHO EXACTLY IS ON DIALYSIS?
AND THIS IS A GRAPH LOOKING AT
THE INCIDENTS OF DIALYSIS FROM
2000 TO 2020 STRATIFIED BY AGE.
THE HIGHEST INCIDENCE IS REALLY
IN OUR OLDER POPULATION IN
INDIVIDUALS WHO ARE 65 AND
ABOVE.
NEXT SLIDE, PLEASE.
THERE ARE ALSO RACIAL
DISPARITIES IN DIALYSIS.
THE HIGHEST INCIDENCE OF
DIALYSIS IS AMONG PATIENTS WHO
ARE BLACK, FOLLOWED BY
NATIVE-AMERICAN, THEN HISPANIC,
FOLLOWED BY ASIAN AND FINALLY
WHITE INDIVIDUALS.
NEXT, PLEASE.
IN ADDITION, THERE IS A HIGH
ACCESS MORTALITY IN OUR DIALYSIS
PATIENTS DURING THE COVID
PANDEMIC.
THIS IS A GRAPH THAT WAS LOOKING
AT PREDICTED DEATHS WHAT
OCCURRED FROM FROM 2016-2020.
IN 2020, THERE WAS A SIGNIFICANT
EXCESS DEATH RATE IN OUR
DIALYSIS POPULATION AND IT WAS
ESTIMATED TO BE ABOUT 10,000
EXCESS DEATHS.
AND PART OF THE REASONS FOR THIS
JUST TO SUMMARIZE WHAT PRIOR
SLIDES HAVE SHOWN, IS THAT THIS
IS OVERALL A VERY MEDICALLY
VULNERABLE POPULATION WHO ARE
GENERALLY OLDER, HAVE MULTIPLE
CO-MORBIDITIES, PATIENTS ARE
EXPOSED MORE READILY TO COVID
AND ALSO RESEARCH OUT IN PRIOR
LITERATURE THAT SHOWS THAT
PATIENTS ON DIALYSIS DON'T
MOUNTAIN ADEQUATE IMMUNE
RESPONSE TO INFLUENZA AND
HEPATITIS.
NEXT SLIDE, PLEASE.
THIS IS JUST TO POINT OUT THE
2020 EXCESS.
NEXT SLIDE.
SO THESE ARE TWO EXAMPLES OF HOW
PATIENTS ON DIALYSIS GOT EXPOSED
TO SARS COVID 2 AND THESE ARE
REAL-LIFE EXAMPLES THAT HAPPENED
IN OUR UNITS.
IN THE INTEREST OF TIME I WON'T
GO INTO WHAT EACH CASE EXAMPLE
IS BUT BASICALLY THE GIST IS
PATIENTS PRESENTED TO DIALYSIS,
GOT THE FULL SESSION AND THEN
UNFORTUNATELY BECAME SYMPTOMATIC
WITH SARS COVID 2, PRESENTED TO
THE ED AND TESTED AND THEY CAME
BACK POSITIVE.
IT WASN'T B. UNTIL ABOUT 36
HOURS LATER OR LONGER THE
FACILITIES DIALYSIS FACILITIES
WERE NOTIFIED ABOUT THE POSITIVE
TESTS AND ULTIMATELY THERE WAS
SORT OF SCRAMBLE AS THE DIALYSIS
FACILITY TRIED TO TRACK DOWN ALL
OF THE INDIVIDUAL PATIENTS,
OTHER PATIENTS WHO WERE EXPOSED
TO THE FIRST PERSON WHO WAS
INFECTED AS WELL AS IDENTIFYING
OTHER STAFF MEMBERS WHO MIGHT
HAVE BEEN EXPOSED.
AND UNFORTUNATELY IN THE SECOND
SITUATION, I THINK THE PATIENT
WHO WAS INFECTED WAS IN CLOSE
CONTACT WITH A STAFF MEMBER WHO
WAS ALSO HEAVILY PREGNANT.
THIS WAS THE BASIS FOR WHY WE
FELT THIS WAS AN IMPORTANT STUDY
IN COMING UP WITH A WAY TO TEST
OUR PATIENTS IN THESE DIALYSIS
FACILITIES.
NEXT SLIDE, PLEASE.
I'LL HAND THIS OVER TO
DR. SHUCHI ANAND.
>> THANK YOU.
EXCELLENT.
I WANT TO SAY THANK YOU FOR
INVITING US AND IT'S SUCH A
PLEASURE TO BE IN THE GREAT
COMPANY OF AMAZING COMMUNITY
PARTICIPATORY WORK THAT OCCURRED
THROUGH THE RADX-UP CONSORTIUM.
IT'S EYE-OPENING TO WATCH ALL
THE WORK IN CHURCHES, SCHOOLS,
THAT'S BEING PERFORMED.
AND WE HAVE A UNIQUE ACCESS TO
OUR PATIENTS ON DIALYSIS AND AS
LAID OUT, THEY ARE OF MEDICALLY
VULNERABLE.
THEY CAN OR ARE
DISPROPORTIONATELY DISADVANTAGED
FROM RACIAL, ETHNIC MINORITY
GROUPS.
SO WE THOUGHT THAT OUR PATIENT
POPULATION VERY RIGHTLY, BELONGS
IN THE PATIENT POPULATION OF
UNDERSERVED PERSONS.
AND SO, WHAT WE WERE TRYING TO
DO AT THE START OF THIS STUDY
WAS TO SEE WHETHER A TEST
STRATEGY -- TO INCREASE TESTING
AND DIALYSIS UNITS AND ALSO TRY
TWO DIFFERENT TESTING
STRATEGIES.
ONE TO OFFER TESTING EVERY TWO
WEEKS IN THE FACILITY VERSUS
ANOTHER WOULD BE MORE DYNAMIC
BASED ON THE LEVEL OF COMMUNITY
TRANSMISSION.
AND OUR PRIMARY OUTCOME WAS TEST
ACCEPTABILITY AND WE ALSO WOULD
LIKE TO LOOK AT DEATH AND
HOSPITALIZATIONS.
NEXT SLIDE.
SO THE MAIN OBJECTIVE IS TO
EVALUATE ACCEPTABILITY AND
FEASIBILITY.
THESE ARE VULNERABLE PATIENTS
BUT ALSO COMING INTO A
FREESTANDING FACILITY THAT IS
ALREADY PRETTY BUSY.
THEY HAVE A HIGH VOLUME OF
PATIENTS THEY ARE SEEING.
SO, TRYING TO ACCEPT THE
FEASIBILITY -- EVALUATE THE
FEASIBILITY AS WELL.
AND ALSO LOOK AT THE POPULATION
THAT WE TALKED ABOUT, PATIENTS
RECEIVING DIALYSIS AND WE ARE
AIMING TO LAUNCH OUR STUDY
ADDICTED TO DIALYSIS, NATIONWIDE
AND OFFER THE TESTS TO THE 2200
PEOPLE.
AND LIKE I SHOWED YOU, WE ARE
LOOKING AT WHETHER A DYNAMIC
TESTING STRATEGY IN COMMUNITY
TRANSMISSION RATES WILL HAVE A
TIER TEST ACCEPTABILITY.
NEXT SLIDE, PLEASE.
SO THIS IS OUR FANTASTIC
COMMUNITY PARTNER, U.S. RENAL
CARE.
AND THIS IS THE SPREAD OF THEIR
DIALYSIS FACILITIES.
YOU CAN SEE THEY ARE LOCATED
NATIONWIDE AND WE SAMPLED FROM
THIS RANDOMLY BUT TRIED TO
SAMPLE TWO FACILITIES WITHIN THE
SAME COUNTY TO TRY TO CONTROL
FOR WHAT IS HAPPENING IN THE
COMMUNITY IN TERMS OF BOTH TEST
ACCEPT BUILTY AND THAT MIGHT BE
INFLUENCED BY COMMUNITY FACTORS
BUT ALSO IN TERMS OF DISEASE
TRANSMISSION.
NEXT SLIDE.
AND WHEN WE WERE TRYING TO
INVESTIGATE HOW TO PUT TOGETHER
OUR DYNAMIC TESTING FREQUENCY,
WE STUMBLED INTO THE ISSUE AS
AND OTHERS MAY HAVE AS WELL THAT
LATER IN THE PANDEMIC, CASE
COUNTS ARE NOT AS RELIABLE AS
THEY PREVIOUSLY WERE BECAUSE
PEOPLE ARE TESTING MORE OFTEN AT
HOME OR TESTS ARE NOT BEING
REPORTED TO PUBLIC HEALTH
AUTHORITIES.
AND SO, WASTEWATER HAS CLEARLY
EMERGED AS THE POTENTIAL BETTER
MARKER FOR DISEASE TRANSMISSION.
SO WE WORKED WITH THE HELP OF
POSTDOC IN OUR LAB, TO
INCORPORATE WASTEWATER TESTING
AS A THRESHOLD DEFINER FOR OUR
COMMUNITY TRANSMISSION RATES.
AND THE CDC HAS DONE A FANTASTIC
JOB PUTTING TOGETHER THESE DATA
PUBLICLY THROUGH THE WASTEWATER
SYSTEM AND SHE WAS ABLE TO LOOK
AT THAT DATA CAREFULLY AND
EVALUATE IT AND HELP US
DETERMINE THRESHOLDS FOR
COMMUNITY TESTING WHICH ARE
SHOWN ON THE NEXT SLIDE.
SO, WE USED A VIRAL PERCENTILE
WILLFUL, THE PERCENT OF VIRUS
CIRCULATING IN THE COMMUNITY
RELATIVE TO THE HIGHEST PEAK IN
THAT COMMUNITY.
AS THRESHOLD TO DETERMINE
WHETHER SOMEONE WOULD BE OFFERED
A TEST IN THE DYNAMIC -- ON A
WEEKLY BASIS, THE HIGH CATEGORY
EVERY TWO WEEKS AND THE MODERATE
CATEGORY OR LOW TRANSMISSION
BASED ON WASTEWATER THEY WOULD
BE OFFERED THE TEST LESS THAN --
ONCE A WEEK -- ONCE A MONTH.
THEN WE ALSO STILL ENGAGED WITH
THE COMMUNITY CLINICAL
INDICATORS BECAUSE SOME
COMMUNITIES STILL DID NOT HAVE
WASTEWATER SURVEILLANCE BUT A
MAJORITY OF OUR SELECTED
COUNTIES DO HAVE WASTEWATER
SURVEILLANCE.
AND THESE ARE PILOT DATA THAT WE
CONDUCTED -- A PILOT WE
CONDUCTED IN FOUR STATES AND
FOUR FACILITIES.
FACILITIES RANGE FREQUENTLY SIZE
FROM 13-111 ELIGIBLE PEOPLE.
IN WHOM WE OFFERED TESTING.
THIS IS ONLY TESTING THE STATIC
ARM AND WILL WE'LL SEE THIS WORK
WAS DONE TO DETERMINE
FEASIBILITY OF OUR LARGER STUDY,
WHICH IS IT STILL ONGOING.
AND WHAT WE SAW?
THIS PILOT WAS THAT WE WERE --
ALTHOUGH THERE IS DISTRIBUTION
OF ANAL, ABOUT 40% IN THIS
OVERALL WERE OLDER AS WE WOULD
PREDICT BASED ON WHO IS ON
DIALYSIS.
A MAJORITY WERE HISPANIC AND
ABOUT 17% WERE BLACK.
A MAJORITY HAD DIABETES.
AND THEN NEXT SLIDE.
WE THEN LOOKED AT TEST
ACCEPTABILITY -- THESE ARE
PICTURES OF THE DIALYSIS BECAUSE
ONE OF THE DIALYSIS FACILITIES
WHERE WE PILOTED OUR WORK AND
YOU CAN SEE WE NEED YOU POSTER,
WHICH GETS THE PATIENT A LINK TO
THE RADX-UP CDE SURVEY, WHICH
THE PATIENT COULD EITHER USE THE
FACILITY iPAD THAT WAS
AVAILABLE FOR TELEMEDICINE IN
THE FACILITY OR USE THEIR OWN
SMARTPHONE TO DO THAT SURVEY.
NEXT SLIDE.
AND THEN THESE ARE TWO NURSES.
IT'S A NURSE AND A TECH WHO
ACTUALLY OFFERED THE TEST,
PERFORMED THE TEST.
THIS IS THEM PACKAGING UP THE
TEST AND SENDING IT OUT TO
PARTICIPANTS.
NOW OUR PARTNER LABORAT LABORATD
WE USED PCR TESTING FROM ABBOTT
WHO DONATED THE TESTING SUPPLIES
TO US.
NEXT SLIDE.
AND SO WE OFFERED THE TESTING
EACH FACILITY TWICE.
SO THIS IS JUST TESTING THE
STATIC ARM MOSTLY FOR TESTING
FEASIBILITY.
AND YOU CAN SEE WE WERE ABLE TO
OFFER THE TEST TO PRETTY MUCH
EVERYONE THAT WAS ELIGIBLE IN
THE FACILITY.
SO ABOUT 213 PEOPLE WERE
ELIGIBLE AND WE WERE ABLE TO
OFFER THE TEST 198 IN THE FIRST
ROUND AND 209 IN THE SECOND
ROUND.
AND WE SAW -- THIS WAS IN THE
FALL OF 2022.
THERE WAS STILL A LOT OF COVID
AROUND AND WE SAW ABOUT 70% TEST
ACCEPT BUILTY WHICH DID NOT SEEM
TO DECLINE BY THE SECOND TEST
OFFER.
BUT ALSO NOTABLY WE SAW ABOUT 7%
POS POS ACTIVITY I RATE IN THE
FIRST ROUND AND -- POSITIVITY
RATE -- HIGH DETECTION RATES.
SO WHAT THE PILOT DATA INFORMED
US IS THAT WE CAN SCREEN THIS
UNDERSERVED MEDICALLY VULNERABLE
POPULATION.
IT IS FEASIBLE.
IT DOES REQUIRE SIGNIFICANT
RESOURCES.
THERE WAS A LOT OF WORK THAT OUR
PARTNER ORGANIZATION DID TO
INTEGRATE THE TESTING INTO THEIR
ROUTINE WORK FLOW AND THE TEST
OFFERING INTO THEIR WORK FLOW
DOWN TO THE LABELING OF THE
LABS.
ALL OF THAT HAS TO BE COMPLIANT
WITH THEIR HIGH STANDARDS OF
ROUTINE LAB TESTING.
SO LABELING THE LABS, SENDING
THEM OFF TO THE CENTRAL
LABORATORY IN THE RIGHT WAY.
AND ALSO GETTING THE RESULTS
RETURNED IN A WAY THAT WAS
CLINICALLY FORMATTED AND TIMELY.
SO THAT REQUIRED A LOT OF LEG
WORK WHICH WE ARE SO GRATEFUL TO
OUR COMMUNITY PARTNERS FOR
WORKING TOGETHER TO ACCOMPLISH
THAT.
AND I THINK IN THE PILOT
FACILITIES WE SAW REASONABLY
HIGH ACCEPT BUILTY AND WE ARE
NOW RULED OUT OF THE 62 DIALYSIS
STUDIES,.
WE THINK THIS WORK HIGHLIGHT
THAT THE DIALYSIS FACILITIES ARE
UNTAPPED PUBLIC HEALTH
SURVEILLANCE TOOL BECAUSE THEY
HOST A VULNERABLE POPULATION.
POPULATIONS ARE HARD TO REACH.
THEY TEND TO BE SOCIALLY
DISADVANTAGED AND YOU KNOW, BUT
YET THEY ARE COMING TO THIS AREA
REGARDLESS OF INSURANCE STATUS,
REGARDLESS OF OVERALL POVERTY.
THEY ARE STILL COMING TO OUR
FACILITY TO GET TREATMENT.
AND THEREFORE IF WE CAN TAP THIS
RESOURCE AND INTEGRATE MORE INTO
A PUBLIC HEALTH SURVEILLANCE
SYSTEM, THAT WOULD BE AN OVERALL
NET GAIN FOR FUTURE PANDEMICS.
AND I JUST WANT TO END BY
THANKING THE GROUP OF PEOPLE
THAT HAVE BEEN INVOLVED IN THIS
WORK.
THE LEADERSHIP AT U.S. RENAL
CARE WHO PROVIDED SIGNIFICANT
SUPPORT EATING ALL THE PERFORM
COSTS ENGAGED WITH THIS SO WE
ARE GRATEFUL FOR THEM AND
RECOGNIZING THE IMPORTANCE OF
THIS WORK AND FOR SUPPORTING IT.
AND ALSO, LAST BUT NOT LEAST, IF
YOU COULD PUT THE NEXT BUTTON, I
WANT TO THANK THE PEOPLE, THE
STAFF, WHO HAVE BEEN
ENTHUSIASTICALLY OFFERING THE
TEST TO OUR PATIENTS AND THEN
PERFORMING THE EXTRA WORK OF
GETTING THE TEST DONE AND
SENDING IT OFF AND PULLING UP ON
THE RESULTS.
SO THANK YOU VERY MUCH FOR YOUR
TIME AND I LOOK FORWARD TO
QUESTIONS.
>> ALL RIGHT, THANK YOU!
I HONESTLY NEVER THOUGHT ABOUT
DIALYSIS FACILITIES AND PEOPLE
UNTIL DIALYSIS FACILITIES.
SO VERY GOOD POINT MADE.
ANY QUESTIONS?
FEEL FREE TO PUT THEM IN THE
CHAT OR RAISE YOUR HAND AND ASK
THEM OUT LOUD.
GOING ONCE, GOING TWICE -- ALL
RIGHT, WELL THANK YOU.
THAT WAS A GREAT PRESENTATION.
I LEARNED A LOT.
AND SO NOW WE HAVE REACHED THE
END OF OUR PRESENTATIONS.
I WANT TO THANK ALL OF OUR
PRESENTERS BOTH WITHIN OUR
SESSIONS AND ALSO IN THE POSTER
SESSION.
THANK YOU FOR TAKING TIME TO
COME AND TALK ABOUT YOUR WORK.
I THINK WE HAVE ALL LEARNED A
LOT MORE.
WHOMEVER THOUGHT THERE WOULD BE
MORE TO LEARN ABOUT COVID, BUT
WE ARE CONTINUING TO LEARN MORE.
COVID IS THE GIFT THAT KEEPS ON
GIVING AROUND EDUCATION.
SO NOW WE'RE GOING TO TAKE SOME
TIME TO HEAR CLOSING REMARKS
FROM ELISEO PEREZ-STABLE,
DIRECTOR OF THE NATIONAL
INSTITUTES ON MINORITY HEALTH
AND HEALTH DISPARITIES.
SO NOW I TURN IT OVER TO YOU.
>> THANK YOU VERY MUCH.
I WANT TO THANK BOTH THE
LEADERSHIP OF CDCC AND ALL THE
STAFF FOR ORGANIZING WHAT HAS
BEEN REALLY A STELLAR AFTERNOON
OF LISTENING TO THESE WONDERFUL
PRESENTATIONS.
I WANT TO START JUST BY
BASICALLY CONGRATULATING ALL OF
YOU FOR YOUR EFFORTS IN WORKING
FROM THIS.
IT'S HARD TO REMEMBER THREE
YEARS AGO WHEN WE WERE JUST
STANDING THIS PROGRAM UP AT NIH.
AND ALL THE CHALLENGES THAT WE
WERE THINKING ABOUT, ALL THE
FEAR, REALLY, THAT EXISTED AMONG
ALL OF US WHETHER RECOGNIZING IT
OR NOT, ABOUT WHAT WAS HAPPENING
AND WHAT COULD HAPPEN.
AND SO, I THINK THAT THE
COMMUNITY, OUR COMMUNITY HAS
REALLY STEPPED UP.
THEY MOBILIZED.
THEY TOOK -- THIS WAS A
PARTICULAR PROGRAM THAT WE
FUNDED BUT SEPARATE FROM THAT,
TO REALLY IMPACT OUR POPULATION
HEALTH IN A WAY THAT REALLY HAS
MADE ME VERY PROUD OF ALL OF
YOU.
I WANT TO EMPHASIZE THAT RADx
FOR UNDERSERVED POPULATIONS IS
REALLY PART OF THIS SOLUTION.
WE DID SEE IMPROVEMENT.
WE HAD TREMENDOUS LOSS OF LIFE,
TREMENDOUS DISPARITIES AMONG
COMMUNITIES OF COLOR IN 2020,
2021.
SLOWER UPTAKE OF VACCINES
INITIALLY BUT BY THE FALL OF
2022, WE WERE PRETTY EVEN IN
TERMS OF VACCINE UPTAKE AND IN
TERMS OF AGE ADJUSTED DEATH
RATES.
AND AS WE LOOK AT THE EVOLUTION
OF COVID AND PEOPLE DON'T WANT
TO TALK ABOUT COVID ANYMORE.
THEY KIND OF SAY, THAT WAS --
THAT'S IN THE PAST.
IT WILL BECOME PART OF OUR
RESPATORY INFECTIONS WE DEAL
WITH, WE THINK.
MAYBE SEASONAL, WE THINK.
MAYBE WE'LL NEED A REGULAR DOSE
OF VACCINE.
SO THE ISSUES WILL NOT DISAPPEAR
OR GO AWAY WITH THE END OF THE
PUBLIC HEALTH EMERGENCY OR THE
END OF YOUR GRANTS.
BUT I DO WANT TO MAKE SURE THAT
EVERYONE ACKNOWLEDGES THE
SUCCESS THAT HAS BEEN ACHIEVED
THROUGH ALL OF THESE EFFORTS.
I DON'T KNOW THAT ANYTHING
SPECIFIC WE DID IN RADX-UP OR
ANY OF THE OTHER PROGRAMS LED TO
A BETTER OUTCOME.
BUT I'M CONVINCED THAT THE
ACCUMULATIVE AFFECT OF ALL THAT
HAPPENED REALLY MADE A
DIFFERENCE.
IF WE HADN'T DONE MUCH OF
ANYTHING, HOW MANY LIVES WOULD
HAVE BEEN LOST.
WE LOST WELL OVER A MILLION
PEOPLE.
WOULD IT HAVE BEEN TEP MILLION?
5 MILLION?
I DON'T KNOW.
BUT I THINK WE SHOULD ALL BE
REFLECTIVE ON THE LAST THREE
YEARS, LOOK FORWARD TO WHAT WE
HAVE LEARNED FROM THIS
EXPERIENCE, AND REALLY BE PROUD
OF OUR COMMUNITIES AND OF THE
WORK WE HAVE DONE.
A COUPLE OF OTHER THEMES
ACROSS-THE-BOARD.
IT'S CLEAR FROM THESE
PRESENTATIONS THAT WE HAVE VERY
STRONG COMMUNITY PARTNERSHIP AT
THE TABLE.
I BELIEVE EVERY PROJECT HAD A
COMMUNITY LEADER REPRESENTING
PARTNERSHIP IN A TRUE WAY AND
THAT WAS REFLECTED IN THE
CONTENT OF THE PRESENTATIONS.
SO, I THANK YOU FOR THAT.
I WAS PROUD TO SEE THE TRIBAL
COMMUNITIES REPRESENTED.
I WAS PARTICULARLY HAPPY TO SEE
PUERTO RICO REPRESENTED.
AS WELL AS OUR AFRICAN-AMERICAN
AND NATIVE HAWAIIAN PACIFIC
ISLANDER COMMUNITIES.
THE SCIENTISTS NEED TO BE
ENGAGED IN THE COMMUNITY.
WE CANNOT AFFORD TO DELEGATE
THIS.
WE NEED SCIENTISTS OF ALL COLORS
TO ROLE UP THEIR SLEEVES AND GO
TO THE HOOD.
OR GO TO THE COMMUNITIES.
WHEREVER THEY ARE.
AND BE THERE WITH OUR
POPULATIONS BECAUSE THAT IS THE
ONLY WAY TO BUILD THAT TRUST
THAT WAS DISCUSSED EARLIER IN
ONE OF THE PROJECT
PRESENTATIONS.
THAT'S THE ONLY WAY THAT WE CAN
CREATE A BOND TO ADDRESS ISSUES
OF MISS INFORMATION TO REALLY
GET CLARITY ON COMMUNICATION.
THIS IS NOT SOMETHING WE CAN
DELEGATE.
AND UNDERSTANDING THERE IS A
LACK OF UNREPRESENTED SCIENTISTS
TO WORK IN OUR COMMUNITIES, WE
REALLY DEPEND ON ALL SCIENTISTS
AND CLINICIANS TO BE ON THE
FRONT LINES HERE
SHOULDER-TO-SHOULDER WITH OUR
COMMUNITY ORGANIZATIONS AND
LEADERSHIP AND STAFF.
THE COMMON DATA ELEMENTS ISSUES
WERE RAISED A COUPLE OF TIMES,
ALTHOUGH NOT EMPHASIZED.
THIS WAS A REQUIREMENT THAT CAME
FROM NIH.
WE DIDN'T DO BADLY IN GETTING
PEOPLE TO ADMINISTER THEM AND
REPORT THEM.
BUT OF COURSE, IT WASN'T 100% AS
YOU MIGHT EXPECT.
AND THIS IS SEPARATE FROM THE
RESPECT FOR TRIBAL DATA
SOVEREIGNTY.
BUT I WANT TO EMPHASIZE WHAT AN
IMPORTANT PART RADx UPUSING
THE SAME SURVEY INSTRUMENTS WAS.
AND WHAT AN IMPORTANT COMPONENT
IT WAS TO ASK QUESTIONS THAT IN
THE PAST PEOPLE WOULD DISMISS AS
NOT APPROPRIATE FOR MY
POPULATION.
BECAUSE THEY NEVER HAD REALLY
BEEN TESTED AND ALTHOUGH THAT
MAY BE THE CASE SOMETIMES, WE
NEED TO MORE AND MORE ADDRESS
THESE FUNDAMENTAL IDENTITY
FACTORS, THESE FUNDAMENTAL
ELEMENTS, SOCIAL DETERMINANTS OF
HEALTH, THAT WE ALL REFER TO IN
OUR WORK, GROWTH OUR RESEARCH
AND OUR GENERAL WORK, AND REALLY
MEASURE THESE FACTORS THE SAME
WAY.
OTHERWISE HOW DO WE COMPARE?
WE CAN'T REALLY COMPARE IF WE
KEEP ALL USING DIFFERENT
MEASURES.
I DON'T LIKE THAT QUESTION, I'LL
ASK THREE OUT OF FOUR QUESTIONS.
THESE KINDS OF APPROACHES.
SO, THIS IS, I THINK, WAS A
MAJOR STEP IN THE RIGHT
DIRECTION.
LOTS TO REFLECT ON.
THE SPECIFIC PROJECTS IN THE
INITIAL PRESENTATION.
I CHOSE TO GO TO THE SCHOOL
POPULATIONS PANEL IN PART
BECAUSE I THINK I FELT I KNEW
LESS ABOUT IT AND THIS IS REALLY
A CRITICAL AREA.
WE HEARD FROM -- A DISCUSSION
FROM DIFFERENT REPRESENTATIVES,
PARTICULARLY FASCINATED BY THE
DIFFERENT REGIONS, GEOGRAPHIC
EVENS, ISSUES IN FLORIDA,
HAWAII, CALIFORNIA.
THERE WAS INTENSE PARTNERSHIP
WITH SCHOOL DISTRICTS WHERE A
SCHOOL DISTRICT WASN'T TOO
THRILLED WITH WHAT THE PROJECT
WAS DOING.
AND LOOKING BACK, I THINK BOTH
AS A SCIENTIFIC COMMUNITY AS
WELL AS A SOCIETY, WE HAVE TO
THINK ABOUT WHAT HAPPENED WITH
OUR SCHOOLS.
I THINK THAT MANY, AND I SHARE
MUCH OF THIS, THINK THAT WE KEPT
THEM CLOSED FOR WAY TOO LONG.
MANY -- THE IMPACT ON OUR
CHILDREN, PARTICULARLY THOSE
FROM ECONOMICALLY DISADVANTAGED
BACKGROUNDS, IS GOING -- IT'S A
COST THAT WE WILL BE DEALING
WITH FOR YEARS.
A YEAR LOST OF LEARNING AND
SOCIALIZING.
A YEAR PLUS IN SOME CASES.
AND YES, THE ISSUES OF MENTAL
HEALTH RECEIVE SOME ATTENTION
AND WILL CONTINUE TO RECEIVE
ATTENTION.
BUT OVERALL, SOME SELF
REFLECTION AS A SCIENTIFIC
COMMUNITY, AS LEADERS, AS TO
WHAT WAS -- WHAT DID WE DO?
WHAT DID WE DO RIGHT?
WHAT DID WE NOT DO RIGHT?
AND I DON'T BELIEVE THAT WE
HEARD ENOUGH ON THAT.
I ENJOYED HEARING ABOUT THE ROLE
OF MOBILE HEALTH IN MIGRANTS IN
THE AGRICULTURAL AREA OF
NEBRASKA.
THIS WAS PREDOMINANTLY
SPANISH-SPEAKING IMMIGRANTS OR
AGRICULTURAL WORKERS AND THEIR
FAMILIES.
I THINK TO BREAK THE MYTH ABOUT
SOME POPULATIONS DON'T KNOW OR
KEPT USE TECHNOLOGY, IS
IMPORTANT.
FREQUENTLY IT'S AN ISSUE OF COST
RATHER THAN OF WANTING TO OR
ABLE TO USE IT.
AND THE PARTNERSHIP WITH
COMMUNITY NAVIGATORS, COMMUNITY
HEALTH WORKERS, WAS CONSTANTLY
RAISED IN MANY OF THESE
PROJECTS, NOT JUST IN THAT ONE.
THE MAPPING OF GEOSPATIAL
METHODS THAT WERE SHOWN TO US IN
TEXAS IS A GREAT EXAMPLE OF HOW
WE SHOULD BE THINKING IN TERMS
OF THE PUBLIC'S HEALTH, NOT JUST
WITH PANDEMIC LIKE WOE VID, BUT
ALL THE TIME.
WE SHOULD LOOK AT DISTRIBUTION
OF CASES OF DIABETES OR NEW
CASES OF THE MOST COMMON CANCERS
OR INTIMATE PARTNER VIOLENCE.
ALL KINDS OF INFORMATION THAT WE
HAVE TO GUIDE WHERE RESOURCES
FOR PUBLIC HEALTH PARTLY WITH
CLINICAL SERVICES, NEED TO
EMPHASIZE.
AND LEVERAGING OUR UNDERSTANDING
OF SOCIAL DETERMINANTS OF HEALTH
TO REALLY ADDRESS THESE
FUNDAMENTAL ISSUES.
IN A REPORT FROM FLORIDA, FROM
SOUTH FLORIDA, WITH THE FLORIDA
INTERNATIONAL UNIVERSITY ON
COMMUNITY ENGAGEMENT APPROACH TO
PROMOTE TESTING AND VACCINATION,
THEY LEVERAGED AN EXISTING
COHORT OF PERSONS WITH HIV.
AND I THINK THIS IS A GREAT WAY
OF ADDRESSING -- HOW DO WE GO
ABOUT DOING A STUDY IN A NEW
AREA BUT WE HAVE THIS EXISTING
STUDY WE COULD USE BOTH.
WE COULD LEVERAGE THAT TO
ENHANCE OUR SAMPLE SIZE.
THEY HAD A CURIOUS FOUNDING
ABOUT PEOPLE WITH HEALTH
INSURANCE BEING MORE LIKELY TO
OBTAIN THE VACCINE.
AND I ASKED ABOUT THAT BECAUSE I
WAS PERPLEXED BY THAT GIVEN THAT
THE VACCINE WAS FREE TO
EVERYONE.
NO ONE WAS BEING ASKED FOR
DOCUMENTATION PAPERS.
THE PHARMACIES OFTEN ASKED ABOUT
IF YOU HAVE HEALTH INSURANCE SO
THEY CAN GET REIMBURSED FOR
FACILITY COSTS.
BUT IT WASN'T A NECESSARY STEP.
AND YET, MANY IN OUR
COMMUNITIES, MANY HAVE THOUGHT
THAT YOU NEEDED TO HAVE
INSURANCE OR WHAT IF I GOT A
PROBLEM AND THEN I HAVE TO SEE
SOMEONE AND THEREFORE I'M
AVOIDING THE VACCINE?
YET IF THEY GOT COVID, OBVIOUSLY
IT COULD BE MUCH WORSE.
IT MAY HAVE ALSO JUST BEEN A
SOCIOECONOMIC MARKER FOR OTHER
FACTORS.
I WAS ALSO DELIGHTED TO HEAR THE
FIRST RESPONDERS FAITH-BASED
LEADERS AS FIRST RESPONDERS.
I THOUGHT THAT WAS A PRETTY GOOD
CONCEPT AND OF COURSE THERE IS
HISTORY BEHIND IT.
AND OFTENTIMES AS A CLINICIAN,
IN MY PRIOR POSITION, I WOULD
CROSS PATHS WITH LEADERS,
FAITH-BASED LEADERS DEALING WITH
PATIENTS WHO WERE DYING
FREQUENTLY AND DEALING WITH
FAMILIES IN THEIR HOMES.
SO THERE IS CLEARLY A PLACE IN
THIS.
AND IT MADE ME REMEMBER AN EVENT
THAT I PARTICIPATED IN, IN
FEBRUARY OF 2021 WITH NIH
LEADERSHIP DR. COLLINS WAS
THERE, DR. FAUCI.
THERE WAS A FAITH-BASED LEADER'S
INITIATIVE TO VACCINATE THE
COMMUNITY.
IT WAS DONE AS A MULTI-FAITH
ALLIANCE TO ILLUSTRATE THE
IMPORTANCE OF GETTING THE
VACCINE.
THIS IS IN THE EARLY PHASE OF
THE FIRST VERSION OF THE COVID
VACCINE.
BUT IT WAS, I THINK, A VERY
IMPORTANT EVENT IN THE NATIONAL
CATHEDRAL HERE IN WASHINGTON,
D.C.
THERE WAS A PRESENTATION IN
SPANISH AND IN ENGLISH BY THE
GROUP FROM PUERTO RICO THAT I
LIFT END TO OF THE POSTERS THAT
I WENT TO.
I SELECTED THAT ONE.
AND ONE OF THE INTERESTING
POINTS MADE IS THE MOST OF THEIR
PARTICIPANTS IN THEIR STUDY
ACTUALLY IDENTIFIED AS BLACK IN
A COMMUNITY IN NORTHEASTERN
PUERTO RICO THAT IS A
CONCENTRATION OF PUERTO RICANS
WITH AFRICAN ANCESTRY.
WE HEARD FROM THE NATIVE BIOBANK
DATA CONSORTIUM AND THEIR
ALLIANCE AND HOW THEY SET UP
CAPACITY BUILDING IN SOUTH
DAKOTA RELATING TO BOTH TESTING,
GENE SEQUENCING AND POLICY
ADVOCACY, PARTICULARLY AROUND
DATA SOVEREIGNTY AND HOW THESE
BUILDING THIS CAPACITY WAS A
VERY IMPORTANT PART AND TO BE
CONTINUED.
AND ALSO FROM CHEROKEE NATION
AND OKLAHOMA WHERE TESTING AND
CONTACT TRACING WAS WIDELY
IMPLEMENTED AND THERE WAS MORE
OF A QUALITATIVE REPORT ON WHAT
THE CHALLENGES WERE.
IT ALSO MADE ME THINK ABOUT
URBAN INDIANS JUST LIKE I
FREQUENTLY THINK ABOUT IN
LATINOS, 70% ARE BORN IN THE
U.S. AND YET WE FREQUENTLY FOCUS
ON THE LATINO HISPANIC COMMUNITY
AS IMMIGRANTS OR AGRICULTURAL
WORKERS.
AND YET THE MAJORITY REALLY ARE
U.S.-BORN AND GROWING UP IN THIS
COUNTRY.
AND HOW ARE WE GETTING TO THEM?
SIMILARLY THE 70% OF AMERICAN
INDIANS LIVE IN CITIES AND NOT
IN PROXIMITY TO THE TRADITIONAL
TRIBAL LANDS OR THE RESERVATION
LANDS IN THE AREAS AROUND THEM.
AND I WILL SAY THAT FIGURING OUT
HOW TO GET BETTER EDUCATION TO
OUR COMMUNITIES IS GOING TO BE
AN ONGOING CHALLENGE.
I'M NOT SURE THAT THE COVID
EXPERIENCE IS GOING TO TELL US
WHAT TO DO.
THERE IS A TREMENDOUS AMOUNT OF
MISINFORMATION OR DISINFORMATION
THAT GETS DISSEMINATED.
THE PERSPECTIVE OF SCIENTISTS,
SOMETIMES IS NOT CLEAR, IN PART
BECAUSE IT'S IN OUR NATURE.
WE SAY THERE IS A POSSIBLY OF
THIS AND POSSIBLY OF THAT.
SO RE-THINKING OF HOW WE
COMMUNICATE THINGS IN A
FUNDAMENTAL WAY THAT IS
CONCRETE, CLEAR AND WILLING TO
BE MODIFIED AS INFORMATION COMES
OUT.
BUT SOMEHOW WE DIDN'T GET IN A
COORDINATED SPACE.
MANY WILL BLAME THE FACT THAT
U.S. DOESN'T HAVE A PUBLIC
HEALTH -- NATURAL PUBLIC HEALTH
SYSTEM.
THEY WERE REALLY 50 DIFFERENT
STATES THAT DO THINGS THEIR OWN
WAY.
OUR COORDINATION IS OFTEN
LACKING AND MANY FACTORS.
BUT THIS DOESN'T MEAN THAT WE
SHOULDN'T BE THINKING ABOUT HOW
TO ADDRESS THIS.
AND FINALLY, I REALLY WAS
PLEASED TO SEE A COMMUNITY IN
THE CLINICAL SETTING GIVEN THAT
CLINICAL SETTINGS ACTUALLY
EXCEPT FOR CHRONIC CARE
FACILITIES, AND SKILLED NURSING
FACILITIES, REALLY DID WELL
DURING THE PANDEMIC.
THEY WERE VERY FEW CASES OR
OUTBREAKS IN HOSPITALS OR
CLINICS.
NOW DIALYSIS SETTINGS WOULD BE
ONE THAT WOULD BE PARTICULARLY
VULNERABLE GIVEN THAT PATIENTS,
AS YOU SAW, IN PROXIMITY, SIT
THERE FOR FOUR HOURS AND TOL
SOME EXTENT NOT FULLY IMMUNE
COMPETENT.
MANY HAVE OTHER COMPLICATIONS.
AND RENAL REPLACEMENT THERAPY IS
LIFE-SAVING.
THEY DON'T HAVE A CHOICE.
THEY CAN'T POSTPONE IT LIKE MANY
PEOPLE POSTPONE THEIR ROUTINE
VISITS FOR MULTIPLE CONNICK
DISEASES.
PEOPLE ON RENAL REPLACEMENT
COULDN'T.
SO IT WAS A PARTICULARLY
RELEVANT IN THAT WAY.
ALSO MADE ME REMEMBER THE FACT
THAT MASKING EFFECTIVE MASK DO
WORK.
AND THAT'S A CONTEXT WHERE ONE
WOULD, ESPECIALLY WOULD PROMOTE
IT AS A MITIGATION INTERVENTION.
AND THEN VENTILATION.
VENTILATION WORKS AS WELL.
I KNOW THAT SOME HOSPITALS ENDED
UP MAKING UNEXPECTED
CONSTRUCTION CHANGES LIKE
BREAKING HOLES IN WALLS TO BE
ABLE TO INSTALL VENTILATION TO
GET AIR FLOW GOING IN THE
HOSPITAL ROOMS OUTSIDE OF THE
INTENSIVE CARE UNIT.
SO ALL OF THESE FACTORS, I
THINK, ARE THINGS THAT WE HAVE
LEARNED OUR EXPERIENCE.
SO I WANT TO AGAIN THANK ALL OF
THE PRESENTERS, ALL OF THE
ORGANIZERS, THE NATIONAL
INSTITUTES OF HEALTH IS VERY
PROUD OF ALL THE ACCOMPLISHMENTS
OF RADX-UP.
YOU'RE NOT DONE YET.
AND SO WE LOOK FORWARD TO SEEING
MORE RESULTS AND GREATER
BENEFITS FROM ALL OF THE
INFORMATION AND DATA THAT HAS
BEEN COLLECTED AND SHARED WITH
OUR COORDINATING CENTERS.
SO THANK YOU VERY MUCH FOR THIS
AFTERNOON.
>> THANK YOU AND AGAIN, THANK
YOU TO EVERYONE WHO CAME TODAY
WHETHER YOUR PRESENT OR CAME TO
SHARE ABOUT YOUR WORK.
I WANTED TO JUST REMIND YOU ALL
THAT OUR NEXT BIG EVENT IS THE
COMMUNITY HEALTH WORKER
SYMPOSIUM ON MAY 24 FROM
WOB:00-3 P.M.
AS WE LEARNED EARLIER TODAY IN
SEVERAL PRESENTATIONS, THE ROLE
OF THE COMMUNITY HEALTH WORKER
IS REALLY IMPORTANT AND SO
PLEASE REGISTER AND ENJOY AT THE
SYMPOSIUM.
FINALLY JUST A REMINDER TO
COMPLETE THE SCIENTIFIC MEETING
FEEDBACK SURVEY.
YOUR FEEDBACK IS REALLY
IMPORTANT AND HELPS SPEAK TO HOW
FUTURE EVENTS LOOK AND THE
DIFFERENT THINGS THAT ARE ADDED,
THE POSTER SESSION IS ONE
EXAMPLE OF THAT.
SO PLEASE PROVIDE YOUR FEEDBACK
THROUGH THE FEEDBACK SURVEY.
THE LINK HAS BEEN PLACED IN THE
CHAT SEVERAL TIMES.
I THINK IT WILL GO IN THE CHAT
ONE MORE TIME.
SO THANK YOU FOR TAKING TIME
TODAY TO SHARE PART OF YOUR DAY
WITH US.
WE APPRECIATE IT.
AND WE LOOK FORWARD TO
INTERACTING WITH YOU AGAIN
SOMETIME IN THE FUTURE.
HAVE A GREAT ONE, EVERYBODY.