New York City (NYC) is a global epicenter of the SARS-CoV2/COVID-19 pandemic, with 223,000 cases
and more than 25,000 deaths. Neighborhood-level disparities in cases and deaths in NYC can be explained by
socioeconomic and racial/ethnic characteristics, where Latinx and Black New Yorkers and those living in high
poverty neighborhoods are 1.5 times more likely to test positive and more than twice as likely to die as a result
of COVID-19. The community of Mott Haven is located in the South Bronx – one of the poorest congressional
districts within the continental United States. Mott Haven is highly diverse (73% are Latinx and 24% are Black),
and the COVID-19 mortality rate is higher than NYC as a whole – an epicenter within an epicenter. Yet,
although Mott Haven is clearly a priority community for COVID-related prevention, detection, vaccination, and
treatment initiatives, so far fewer than 2% of residents have been tested.
COVID-19 secondary attack rates are highest in households, varying between 12 – 38%. This led us to
propose a COVID-19 testing and mitigation intervention in public housing households in Mott Haven, which are
characterized by crowding, intergenerational co-residence, and a high proportion of low wage “essential
workers” who leave the home for work even during lockdown periods. We will evaluate the effectiveness of an
innovative Nurse-Community Health Worker (CHW)-Family Partnership intervention designed to promote
COVID-19 testing uptake, adoption of COVID-19 control measures, and mutual aid capacity at the household
level. Our intervention is adapted from the Nurse-Family Partnership model, which has been shown to be
effective and cost-effective in improving maternal and child health outcomes in high-poverty, racially- and
ethnically-diverse communities. CHWs will provide culturally-appropriate support to families, addressing
stigma, medical mistrust, and other common barriers to engagement in healthcare.
We propose a 2-arm randomized controlled trial, in which 270 households (810 individuals) will be
randomly assigned (2:1) to either the experimental group of families who will receive the Nurse-CHW-Family
Partnership intervention and the offer of in-home testing and influenza vaccination, or the treatment-as-usual
control group referred to free testing and flu vaccination located within walking distance. Participants in both
arms will be assessed at baseline and monthly for 12 months.
Findings from this study will provide an evidence-base to inform current and future public health initiatives
related to COVID-19 mitigation in other high-risk settings. Sustainability will be addressed by building local
capacity and expertise among participants, CHWs and CAB members, and partnering with them to develop the
community’s best practices for COVID-19. Should it prove to be effective, our intervention can be tailored to
increase testing and other COVID-19 control measures in other settings of vulnerability and disadvantage.