■2020年,在法国的COVID-19回应期间,来自医院和协会的医疗保健专业人员在马赛的脆弱社区发起了健康调解干预措施,由地区卫生当局资助。这项混合方法研究评估了持续到2022年6月的CORHESAN计划。
■我们检查了CORHESAN文件和报告,进行访谈,并分析了活动数据,将其与每周在邻里一级确定的COVID-19热点进行比较,使用广义线性混合模型(GLMM)。
■CORHESN由多达9名健康调解员组成的团队实施,临时聘用了六名私人护士,由一名总协调员和两名兼职医疗和护理协调员监督。与庇护所建立了多种伙伴关系,协会,社会住房房东和当地机构。该团队陪同6,253名受COVID-19或接触者影响的人实际实施隔离和接触者追踪。在用于RT-PCR的5,180个鼻咽样本和用于抗原检测的1,875个样本中:12%在家中,27%在目标社区的伙伴设施中;32%取自有症状的患者,30%取自接触者追踪;40%为阳性。在街头举行了多次关于预防方法和分发个人防护包和自我诊断测试的提高认识会议,在避难所,在协会或在家里。在一个步入式疫苗接种中心共接种了5929剂COVID-19疫苗,在临时街道疫苗接种站,在合作伙伴设施的运营期间,或在对自主性有限的患者进行家访期间。GLMMs显示,干预措施显着针对具有社会经济劣势和/或过去测试不足的社区的测试干预措施(调整后的优势比(aOR),2.75[1.50-5.00])和具有高热点水平的那些(3级与0级的AOR,1.83[1.24-2.71])。
■大流行强调了健康调解干预措施在解决健康差异方面的潜力。在这个基础上,2022年7月开始了一项新计划,旨在加强马赛贫困地区的癌症筛查和疫苗接种。正在进行评估,以评估其活动和影响,并为未来的实施举措提供证据。
UNASSIGNED: In 2020, during France\'s COVID-19 response, healthcare professionals from a hospital and an association initiated health mediation interventions in Marseille\'s vulnerable neighbourhoods, funded by the regional health authorities. This mixed method research evaluates the CORHESAN program that lasted until June 2022.
UNASSIGNED: We examined CORHESAN documents and reports, conducted interviews, and analysed activity data, comparing it to the COVID-19 hotspots identified on a weekly basis at the neighbourhood level, using generalised linear mixed models (GLMMs).
UNASSIGNED: CORHESAN was implemented by a team of up to nine health mediators, six private nurses hired on an ad hoc basis, supervised by a general coordinator and two part-time medical and nursing coordinators. Multiple partnerships were established with shelters, associations, social-housing landlords and local institutions. The team accompanied 6,253 people affected by COVID-19 or contact in the practical implementation of their isolation and contact tracing. Of the 5,180 nasopharyngeal samples for RT-PCR and 1,875 for antigenic
testing: 12% were taken at home and 27% in partner facilities in the targeted neighbourhoods; 32% were taken from symptomatic patients and 30% in the context of contact tracing; and 40% were positive. Multiple awareness sessions on prevention methods and distributions of personal protection kits and self-diagnostic tests were conducted in the streets, in shelters, in associations or at home. A total of 5,929 doses of COVID-19 vaccine were administered in a walk-in vaccination centre, at temporary street vaccination posts, during operations at partner facilities, or during home-visits to patients with limited autonomy. GLMMs showed that the intervention significantly targeted its
testing interventions in neighbourhoods with socioeconomic disadvantage and/or past under-
testing (adjusted odds ratio (aOR), 2.75 [1.50-5.00]) and those with high hotspot level (aOR for level-3 versus level-0, 1.83 [1.24-2.71]).
UNASSIGNED: The pandemic emphasised the potential of health mediation interventions to address health disparities. Building on this, a new program began in July 2022, aiming at enhancing cancer screening and vaccinations in deprived areas of Marseille. Evaluations are ongoing to assess its activities and impact, and provide evidence to future implementation initiatives.