As the COVID-19 pandemic spreads to every corner of the US, the plight of urban American Indian/Alaska Native (AI/AN) people is often overlooked or ignored. SARS-CoV-2 and the disease it causes, COVID-19, disproportionately affect AI/ANs, who are at highest risk of any US racial or ethnic group for developing severe disease and dying from COVID-19. Sadly, we have no data on infection rates, morbidity, or mortality on urban AI/ANs, who comprise 71% of the total AI/AN population. Urban AI/ANs may obtain clinical care through Urban Indian Health Programs (UIHPs), the Indian Health Service, tribal, public, and private facilities. Our discussions with UIHP leaders reveal complex barriers to testing, such as inability to procure test kits, reach homebound patients, and inadequate staffing for outreach. To increase SARS-CoV-2 testing among urban AI/ANs, we will draw on a nationwide network of Satellite Centers (all led by AI/AN scholars) established in 6 large NIH- sponsored initiatives that reach, engage, and ensure participation of community stakeholders in research at the local level. Our Satellite Centers will partner with 6 geographically contiguous UIHPs across the US to launch the ?Community Organizations for Natives: COVID-19 Epidemiology, Research, Testing, and Services? study (CONCERTS). The goal of CONCERTS is to remove barriers and increase SARS-CoV testing among urban AI/ANs. First, we will use data from these 6 UIHPs to estimate current uptake of SAR-CoV-2 testing and the burden of COVID-19 disease. Second, we will survey clinic administrators, providers, and 600 patients across all 6 UIHPs to understand testing barriers and promoters, and preferred testing options. Third, informed by these data, the 6 UIHPs will implement locally tailored clinic-associated (e.g., drive-through, mobile unit-based testing) and outreach-based strategies (e.g., COVID-19 navigators) to increase SAR-CoV-2 testing. After 1 year, we will re-examine testing rates for a pre-post comparison to establish if these strategies were successful. Fourth, we will collaborate with the UIHPs to produce a list of sustainable, pragmatic practices for future pandemics and vaccination programs. Our primary outcome is the monthly testing rate for SARS- CoV among urban AI/ANs.
The Specific Aims are to: 1) Estimate baseline SARS-CoV-2 testing and infection rates to identify disparities in testing and disease burden in urban AI/ANs; 2) Survey administrators, providers, and 100 patients from each of 6 UIHPs to identify barriers, facilitators, attitudes, risk factors, and necessary services pertinent to SARS-CoV-2 testing; 3) Implement clinic-associated and outreach-based strategies at each UIHP to increase testing rates and reduce spread of SARS-CoV-2, then compare testing rates before and after implementation; and 4) Evaluate CONCERTS and catalog pragmatic practices for application to future pandemics and successful vaccination campaigns among urban AI/ANs. The nation's efforts in AI/AN health care have been described as a ?historic failure.? This history continues during the current pandemic, underscoring the urgent needs of facilities serving America's ?largest tribe? ? urban AI/ANs.
American Indians and Alaska Natives have the highest risk of any US racial/ethnic group for becoming infected with the COVID-19 virus, as well as developing severe disease and dying from the infection. This is due, in part, to their excess burden of chronic health conditions such as type 2 diabetes, pulmonary disease, and heart disease, as well as other factors such as poverty. Our project will estimate the rate of infection and the influence of factors such as education, poverty, and poor health on being tested for COVID-19 among urban American Indian and Alaska Native people. The overall goal is to increase testing for the virus and address the many health disparities related to COVID-19 in this population, a group often overlooked in research.
