The Clinical and Translational Science Institute (CTSI) wished for University of Pittsburgh investigators to identify potential disparities and to develop solutions to reduce any disparities in delivery of COVID-19 vaccines and/or therapeutics. To help this effort, CTSI awarded a small number of grants for up to $25,000 in funding to reduce disparities in COVID-19 vaccination and/or therapeutics.
Disparities in COVID-19 Therapeutics and Vaccinations Pilot Grant Program Awardees
COVID-19 Vaccine Accessibility, Perceptions, and Attitudes in the LGBTQ+ Community
Tyler Traister, DNP, RN (PI); Ken Ho, MD, MPH; Dianxu Ren, PhD; Paula Sherwood, PhD, RN, CNRN, FAAN; Connor Berndt, BSN, RN
Lesbian, gay, bisexual, transgender, queer, and other gender minorities (LGBTQ+) face unique challenges and barriers to accessing healthcare which can ultimately result in poor health outcomes. Recent research has highlighted differences in attitudes and vaccination rates for COVID-19 in this vulnerable community suggesting that the LGBTQ+ community is more hesitant than the general population to receive the COVID— 19 vaccine. The majority of research surrounding vaccine acceptance has predominantly focused on cisgender heteronormative populations, which limits generalizability to LGBTQ+ populations. This critical gap in the literature needs to be addressed in order to understand how best to vaccinate this vulnerable community.
We propose a multidisciplinary, community-focused mixed-methods study initiated by a new investigator. Our aims are to examine perceptions and attitudes regarding the acceptability, accessibility and efficacy of the COVID-19 vaccine among persons who self-identify as LGBTQ+. We selected a mixed-methods sequential explanatory design that involves collecting and analyzing quantitative and then qualitative data in two consecutive phases of the same study for the purpose of complementarity. The study will be conducted online throughout the United States through various LGBTQ+ community centers in Illinois, California, Pennsylvania, Delaware, Hawaii, and Texas.
The proposed study will help to end the erasure of LGBTQ+ communities in health research by ensuring that they are included. Our results will help to the increase the rates of COVID-19 vaccine uptake within LGBTQ+ communities. This will be accomplished by directly disseminating data to community organizations so that responsive and tailored interventions can be executed.
Racial Inequalities in COVID Vaccine Uptake & Access
There is a long history of racial inequities in health that has presented in COVID-19 cases, hospitalizations, deaths, testing and vaccination. As a result, a group of concerned citizens in the Allegheny County region came together to work collectively to address COVID-19 inequities but also inequities in health broadly, housing, economic development and other sectors that were exacerbated as a result of COVID. Key aspects of this work has included community interventions to address access to testing and vaccines for COVID-19. Community and data-to-action approaches that center the communities that carry the disproportionate burden of COVID inequities is critical to eliminating the pandemic, including approaches to best understand vaccine distribution across the region. As a result, this study will identify factors related to vaccine uptake and hesitancy, assess experiences of COVID-19 testing and vaccination among Black residents and estimate COVID-19 testing and vaccination rates across Allegheny County and by race/ethnicity and over time. The results will provide timely data for local decision-making and prevent and redress poor COVID-19 outcomes among historically oppressed populations.
SARS-CoV2 Vaccination in Pregnant and Lactating Women
Anne-Marie Rick, MD, MPH (PI); Judith Martin, MD; John Williams, MD; Richard Beigi, MD, MSc; Hyagriv Simhan, MD, MSc; Anita McElroy, PhD; Christina Megli, MD, PhD; Jill Demirci, RN, PhD, IBCLC
Pregnant and lactating women have been remarkably underrepresented in SARS-CoV2 vaccine trials, which has led to contradictory and unclear vaccine advice and disparities in vaccine uptake in this population. Using two complementary prospective cohorts of pregnant (Cohort 1=100) and lactating (Cohort 2=100) people, we will study their vaccine attitudes toward SARS-CoV2 vaccines, as well as address fundamental gaps in knowledge that drive vaccine disparities for these groups including immunogenicity of SARS-CoV2 vaccines. A critical piece of missing data and information to be shared includes the capacity of vaccination to promote passive immunity in infants. We aim to use these data to promote SARS-CoV2 vaccine equity among pregnant and lactating people. Aim 1, we will assess barriers to vaccination and factors promoting vaccine hesitance and acceptance in pregnant and lactating women through longitudinal surveys and qualitative interviews (Cohort 1 & 2). Aim 2 will focus on maternal immunity by measuring virus-specific antibody for each vaccine type (mRNA vaccine versus adenovirus-vectored vaccine) in blood of pregnant people and compare by trimester of immunization (Cohort 1). Aim 3 will evaluate efficiency of passive transplacental transfer of IgG by trimester of immunization from vaccinated mothers to their infants in utero (Cohort 1). In Aim 4, we will characterize the robustness and duration of antibody responses in human milk following vaccination with different SARS-CoV2 vaccines (Cohort 2). Our team of assembled experts in clinical and translational research ensures the rigor of this research, for which there is a critical and immediate need to inform vaccination of pregnant and lactating women during this pandemic.
Vaccine Equity for Immigrants of Color
Immigrant and refugee communities of color, particularly those with limited English proficiency (IRC-LEP), have been disproportionately affected by the COVID-19 pandemic. However, COVID-19 vaccine prioritization in these communities is threatened by inequitable access and mistrust, much of which is due to technology, immigration status, and language barriers as well as historical and present-day racism and xenophobia in healthcare. An initial step toward addressing these barriers is through community-academic partnerships in which the lived experiences of IRC-LEP individuals can inform best practices for healthcare providers and health systems. This pilot grant seeks to leverage the partnerships in place through the Pittsburgh Community Vaccine Collaborative—which is currently working to promote vaccine equity among communities of color—to focus on the unique needs of IRC-LEP communities. Utilizing a conceptual framework focused on intersectionality, health equity, and human-centered design, the community-academic research team will first conduct a series of focus groups with individuals from the largest Allegheny county IRC-LEP communities (Aim 1). These focus groups will inform the development of a stakeholder-designed toolkit for healthcare providers and health systems to promote COVID-19 vaccine access and equity for IRC-LEP communities (Aim 2). This pilot study will allow for future funding applications through federal and foundation mechanisms by development of a vaccine equity toolkit for healthcare providers and health systems that can be tested, implemented, and adapted for different IRC-LEP communities. Our pilot work will also inform external proposals focused on engaging with community partners to improve healthcare access and quality for IRC-LEP communities.