DOI: 10.60773/q2xk-0f98
title: Community-Engaged Research to Improve the COVID-19 Testing Cascade Among Underserved Populations in the US Caribbean Territories

description: SARS-CoV-2, the virus that causes COVID-19, has ravaged underserved and vulnerable populations in the US, including in the US territories of Puerto Rico (PR) and the US Virgin Islands (USVI). Pre-pandemicdata from our Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) (NIH/NIMHD U24MD006938; Pl: Nunez-Smith) indicate nearly 61 % of our population-based representativesample (n=3000) has at least one chronic condition making them high risk far severe complications from COVID-19.4 Nearly 30% of ECS participants report food insecurity.These ECS data were recenllyrequested by the Congressional Ways and Means Committee to scope the threat of the COV1D-19 pandemic to the Caribbean US territories. This competitive revision leverages the Yale TransdisciplinaryCollaborative Center for Haallh Disparities Research focused on Precision Medicine (Yale-TCC; NIH/NIMHD U54MD010711; MPI: Nunez-Smith), which supports broader scientific engagement across ECHORNmembers. ECHORN was founded in 2011 as a consortium of researchers and non-academic stakeholder partners, using a participatory action research approach, to address the epidemic of non-communicablediseases in the region. The Yale-TCC is a community-engaged and stakeholder-driven network with a consortium comprised of 60 individuals representing 35 organizations, spanning academia, research, healthpolicy, faith-based organizations, community-based organizations, and civic societies. The Yale-TCC Governing Board guides prjoritization.The goal of the proposed community-engaged research is to, in concert with the RADx-UP consortium. understand factors that have led to the disproportionate disease burden and deploy interventions thatimprove the reach, access, uptake and impact of COVID-19 testing technologies and strategies across FQHCs, local CBOs, and clinical laboratories in the USVl and PR. We use rigorous quasi-experimentaldesigns to evaluate the proposed testing inten/ention projects. This will be achieved through the following specific aims:Aim 1: Enhance testing implementation strategies in the USVI and PR utilizing community-based assets and cultural responsiveness to address barriers to full participation in the testing continuum from diagnosisthrough to seif-isolation. We propose an initial partnership with 3 FQHCs (two in USVI and one in PR) and 2 CBOs (one in USVI and one in PR) to refine and implement a multi-component Jnten/ention to increasetesting, contact tracing, and safe and effective quarantine and isolation, with a focus on the most vulnerable populations. We use an interrupted time series study design to analyze the effect of our intervention onthe primary implementation outcome of reach. We assess secondary Implementation outcomes of adoption, fidelity, acceptability, and sustainability. We also assess the secondary effectiveness outaome of ERutilization. We engage our community partners throughout the inten/ention refinement, implementation, and evaluation process.Aim 2: Assess the diffusion and uptake of FDA authorized and approved testing technologies across existing and emerging testing models. Through stakeholder and community engagement meetings, we willdetermine inten/ention components that provide the necessary education/health promotion information, training, and resources that are needed to address barriers at the FQHC, CBO, and community-levei toadopt, implement, and disseminate new testing technologies. Sustalnability of this model for integralion of future technologies or vaccines will be addressed and assessed.