COVID-19 had a significant impact on AIAN communities, worsening pre-existing health inequities, such as decreasing life expectancy. Long COVID is likely to further affect AIAN individuals, yet research on its prevalence and effects in these communities remains limited.

Objectives

We assessed the prevalence of reported Long COVID symptoms and functional limitations in a Tribal community. We demonstrated the need for inclusion of AIAN individuals in future research and suggested policy implications.

Methods

We conducted a retrospective cohort study using a phone-based survey of all adult COVID-19 cases diagnosed at an Indian health center between July 2020 and April 2023. We completed 76 interviews during which participants shared if they had symptoms at 30 and 90 days after diagnosis, types of symptoms experienced, and functional limitations before and after infection.

Results

We estimated that 20% of adults who had COVID-19 experienced Long COVID symptoms at 90 days after infection. Additionally, 37% of respondents reported increased functional limitations following their positive COVID-19 test.

Conclusion

This Tribal community had a higher prevalence of Long COVID than others in the United States, yet inconsistent definitions and other factors complicate comparisons. Further research is needed to understand the implications, guide clinical care, and inform policy development. Involving TPHDs and TECs will ensure community priorities are addressed given adequate funding. Policies should consider a standalone Long COVID program or integration into broader health initiatives to mitigate existing health inequities.

Native American communities in the United States face health disparities, with AIAN populations experiencing the lowest average life expectancy among all racial groups in the U.S. as of 2021. They also face high mortality rates from preventable diseases. Conducting a community health assessment (CHA) helps understand the disease burden, identify unmet health needs, and inform resource allocation to improve health outcomes.

Objectives

This study aims to provide data-driven insights to guide culturally responsive plans, helping reduce disparities and improve health outcomes for AIAN communities.

Methods

A mixed-methods approach was used to assess the health status of a small Tribal community in California through surveys (N=36) and key informant interviews (N=8), following IRB approval. The assessment explored health needs and barriers to care. Small Tribal communities often face challenges of underrepresentation in data, which this study aimed to address.

Results

The community's primary concerns centered on the lack of emergency services, limited transportation, and access to fresh food. Key health priorities included diabetes (20%), hypertension (14%), mental health (28%), and low vaccine uptake, with respondents not receiving flu (78%), pneumonia (70%), or RSV vaccines (72%). Notable, community strengths included the presence of a regular medical provider at the clinic and a community health representative conducting home visits.

Conclusion

The CHA revealed health challenges in the Tribal community, highlighting the need for better mental health support, transportation, food access, and vaccine uptake. These findings will inform of a targeted health improvement plan to guide resource allocation.

In response to a syphilis outbreak at a Tribal Nation, a CDC-developed assessment tool was adapted into a HIV syndemic facility assessment tool to evaluate and strengthen health systems addressing interconnected conditions—syphilis, HIV, HCV, gonorrhea, chlamydia, and substance use disorder (SUD)—in Tribal, Urban Indian, and Indian Health Service (IHS) clinical settings across the U.S.

Objectives

The objective was to assess and enhance capacity, preparedness, workforce development, and best practices for HIV syndemic-related care through a culturally responsive and systems-level lens.

Methods

Using a mixed-methods approach, the tool was implemented in multiple settings through structured interviews, facility reviews, and stakeholder consultations. It facilitated a comprehensive evaluation of diagnostic, treatment, prevention, and referral systems while surfacing strengths, gaps, and opportunities for growth.

Results

Results demonstrated that the tool strengthened intergovernmental partnerships between Tribal Nations and state/local health jurisdictions; enhanced workforce training and readiness; and supported the adoption of best practices. Key system-level findings included the need for increased investment in Tribal-based disease investigators and contact tracers, and the importance of formal, sovereignty-affirming collaborations between Tribes and states to improve data sharing and care coordination.

Conclusion

This tool demonstrates the critical value of assessment tools as quality improvement strategies in Tribal health settings. Continued development and implementation of culturally grounded, systems-informed assessments are essential to improving syndemic response and advancing health equity in Indian Country.

Twenty CHR/CHR Supervisors were recruited from 10 Tribal clinic sites in California (CA) between 7/2023-2/2024. Fourteen participants completed a recorded interview session of 45-60 minutes using a semi-structured interview guide containing questions in seven domains: 1) background, 2) setting, 3) scope of services, 4) services during COVID-19, 5) influence of AIAN culture on care, 6) drivers/barriers to providing optimal elder care, and 7) organizational support.

Objectives

Assess the supply and sufficiency of CHR with access to training and resources in Tribal and urban clinic settings with; identify barriers/ facilitators to optimally meet AIAN patient healthcare needs.

Methods

Qualitative methods were used. A convenience sample of key informants was drawn from the CA Area IHS system utilizing investigator team contacts and snowball sampling. Two investigators coded key informant interviews using Dedoose™ software, three coding passes were conducted and inter-rater reliability was checked. A thematic analysis was completed and key themes derived.

Results

Nine key themes were identified related to the CHR role in Tribal settings. Among these the vulnerability to budget cuts and constrained funding was described. The impact of highly rural environments on CHR services and the need for culturally appropriate training, specifically in historical trauma for all levels of organization staff was described and emphasized. Barriers to CHR training and resources were described as impeding optimal care.

Conclusion

Consideration of systems and environmental conditions of Tribal CHR/frontline workforce is needed to appropriately support and retain this core part of the health care team.