The NIH-funded work involves sending nurses and community health workers to households in public housing developments in The Bronx, N.Y., to offer health guidance and assistance.
New York University researchers will implement and evaluate an innovative, household-centered service-delivery model that, starting later this fall, sends nurses and community health workers door-to-door in public housing to prevent COVID-19.
The randomized clinical trial – newly funded under a $4.8 million grant from the National Institutes of Health – will assess the novel healthcare intervention’s capacity to improve uptake of COVID-19 testing and control measures. Participants will be offered COVID-19 testing and influenza vaccination. The latter has been correlated with acceptance of a future vaccine for the coronavirus.
The two-year project will be carried out within the Mott Haven section of the Bronx, one of the communities hardest-hit in New York City by the pandemic. It is also one of the most diverse and high-poverty communities in NYC.
The project will: gather insights into COVID-19 prevalence in socially and economically vulnerable households of the Bronx; improve the understanding of how Latino and Black families struggle to cope with the pandemic in NYC’s hardest-hit communities; and build capacity for prevention planning at the household level. It is centered on the intervention model known as the “Nurse/Community Health Worker/Family Partnership.”
The National Institutes of Health approved the grant for this research as part of phase one of the NIH’s national Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) program, which support projects designed to rapidly implement COVID-19 testing strategies in populations disproportionately affected by the pandemic. Professor Vincent Guilamo-Ramos (NYU Silver School of Social Work) and Professor Holly Hagan (NYU School of Global Public Health, GPH) are the principal investigators for this study. The project is a collaboration between two New York University research centers – the Center for Drug Use and HIV/HCV Research (CDUHR), which is an NIH-funded “Center for Excellence” led by Hagan, and the Center for Latino Adolescent and Family Health (CLAFH), headed by Guilamo-Ramos. They are joined by Melody Goodman, a biostatistician with the NYU School of Global Public Health, who will oversee data analysis for the randomized control trial.
“I’m excited to jointly lead this project with Dr. Guilamo-Ramos,” Hagan said. “It brings together the considerable strengths of our centers – CLAFH and CDUHR – to generate knowledge that is needed to reduce excess COVID-19 cases, illness, and deaths in underserved and vulnerable populations.”
Guilamo-Ramos notes the study’s implications for mitigating COVID-19 nationally.
“Families in communities like Mott Haven face an uphill battle against COVID-19: access to and quality of healthcare services is limited, recommended COVID-19 mitigation measures are not designed for the realities of low-income households, and contextual factors, such as reliance on essential service jobs, increase exposure,” said Guilamo-Ramos. “To address these multi-level disparity drivers in a comprehensive way, our interdisciplinary initiative draws on the nursing, public health, and social welfare disciplines to create a new type of partnership to prevent COVID-19: nurses, community health workers, and families.”
During the fall, nurses and community health workers (i.e., community members) hired and trained under the initiative will begin visiting public-housing households in Mott Haven. Both COVID-19 case rates and death rates are higher in the Bronx than in any other borough in New York City, and the rate of infection in the Mott Haven section is nearly twice the national average. Households in Mott Haven are primarily Latino or Black, typically intergenerational, and disproportionately burdened by chronic illnesses and limited access to quality health care.
Conditions at home and at “essential worker” positions in which many household members are employed are often characterized by high density and other barriers to implementing recommended COVID-19 prevention strategies, setting the stage for disproportionately high COVID-19 case and death rates in this community.
These and other risk factors – which are present in many socially and economically disadvantaged neighborhoods across the U.S. – led the researchers to conceptualize the family and household as a key context for research. The objective is to develop what the researchers envision as a holistic assessment and COVID-19 mitigation plan based on family circumstances, ongoing risk of exposure, and infection events in the household and the community.
As part of the randomized control trial, nurses and community health workers will offer many households free COVID-19 testing and flu vaccination, helping the researchers identify what works best to increase take-up of both the influenza vaccine and establish a sustainable infrastructure for future COVID-19 vaccines.
Implementation of the overall household-level intervention program will be coordinated by nurses, who represent the largest segment of the U.S. healthcare workforce and are consistently rated as the most trusted profession. Community health workers will provide culturally-appropriate support to families, addressing stigma and other barriers to engagement in health care