Coronavirus (949) Community Health Research Round-Up 040

27 August, 2020

A 0% infection rate? Breaking evidence on PPE for CHWs!

Hello all,

Welcome to the latest edition of the Community Health Research Round-up. We're so proud to be part of of this growing community of evidence-based practitioners—nearly 1.2k strong!—who are committed to staying up-to-date with the latest community health research.

This issue covers papers indexed (largely!) since August 11.

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* As always, previous editions of the round-up are available in our archive here (https://chwimpact.org/research-round-up)

Dr. Madeleine Ballard

Executive Director | Community Health Impact Coalition

Community Health Research Round-Up, Issue 040

August 11 - August 24, 2020

1. SARS-CoV-2 Infection Among Community Health Workers in India Before and After Use of Face Shields (http://https//jamanetwork.com/journals/jama/fullarticle/2769693)

* Comments: New study outlining the importance of COMPLETE personal protective equipment (PPE), including eye protection, for CHWs. Limitations include the before-after design; however, the unique living circumstances of the workers (alone in catered rooms) minimized other sources of transmission.

* Methods: Before and after on the use of face shields

* Takeaway: This study found no SARS-CoV-2 infections among community health workers after the addition of face shields to their PPE. Before face shields, 19% of CHWs were infected after routine home visits, after face shields 0%.

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2. Using Implementation Science to Disseminate a Lung Cancer Screening Education Intervention Through Community Health Workers (https://link.springer.com/article/10.1007/s10900-020-00864-2)

* Comments: Good case study of aligning w/ the existing health system and its priorities. Would have been nice to measure uptake of screening

* Methods: Pre-post (RE-AIM)

* Takeaway: CHWs were trained to recruit participants and deliver the one-session lung cancer education intervention. Post intervention changes in lung cancer screening knowledge (p = < .0001), attitudes regarding lung cancer screening benefit (p = .034) and lung cancer stigma. (p = .024)

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3. Severe acute malnutrition treatment delivered by low-literate community health workers in South Sudan: A prospective cohort study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295452/)

* Comments: Cohort results from this study (http://Test of a simplified SAM treatment protocol and a set of low‐literacy‐adapted tools developed by IRC) of a simplified SAM treatment protocol and a set of low‐literacy‐adapted tools developed by IRC featured in RR 006.

* Methods: Prospective cohort study

* Takeaway: The recovery rate for SAM children enrolled in acute malnutrition treatment by low-literate CHWs shows promise that deploying CHWs to treat SAM in areas with high prevalence and low treatment access may lead to higher recovery, better continuity of care in the transition between SAM and MAM, and shorter treatment time. The recovery rate from the severe to the moderate acute malnutrition (MAM) cut-off of MUAC 115 mm was 91% (95% confidence interval (CI) = 88%-95%). The median length of treatment was five weeks. The recovery rate of children from SAM to full recovery was 75% (95% CI = 69%-81%). The median time to full recovery was eight weeks. When the data were compared against routine monitoring and evaluation data from nearby static clinics, children treated by CHWs appeared to have improved continuity of care and shorter time to recovery.

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4. Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes (https://europepmc.org/article/med/32011591)

* Comments: Of interest to colleagues in the US: how CHWs have been integrated into the relatively novel Medicaid Health Home (MHH) virtual health care network system.

* Methods: Semistructured qualitative interviews

* Takeaway: CHWs were compatible with MHHs by enrolling patients, helping coordinate patient care, and providing social support. The complexities of CHW integration into MHHs included barriers to CHW integration, no direct reimbursement for their services, lack of clarity for CHW roles and responsibilities, and no explicit external policy for their use in MHHs.

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5. From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center (https://journals.sagepub.com/doi/full/10.1177/2150132719899207)

* Comments: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using CHWs as part of routine primary care visits.

* Methods: Mixed: Iterative process to define key components, measures adapted based on RE-AIM

* Takeaway: Social needs screens were conducted at 65% of eligible well-child visits over one year; 19.7% of screens had one or more positive responses. Screening for social needs at well-child visits is feasible as part of routine primary care. Authors attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.

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